Diabetes-related Complications

Jim Shannon Excerpts

Tuesday 7th June 2016 Westminster Hall

[Paula Sherriff]

I thank hon. Members for their contributions, and I will now try to make a little progress.

Earlier this year, the Public Accounts Committee said that

“the costs of diabetes to the NHS will continue to rise. In order to control these costs, the Department and NHS must take significant action to improve prevention and treatment for diabetes patients in the next couple of years.”

The wider impact on people’s health is significant. One in five hospital admissions for heart failure, heart attack and stroke are among people with diabetes. The condition is responsible for more than 135 amputations per week. It is the leading cause of preventable sight loss in people of working age and the single most common cause of kidney failure.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing the debate. I declare an interest as a type 2 diabetic. I lost almost 4 stone and I am still a type 2 diabetic. I still need tablets to keep me right, and many type 2 diabetics are the same. Experts at Queen’s University Belfast are spearheading a new major research project aimed at ascertaining why thousands of diabetics around the world suffer kidney failure, which she referred to. They have examined DNA samples from 20,000 diabetics to help identify the genetic factors in diabetic kidney disease. The project could enable personalised procedures for those at risk. Does she agree that such research is the key to unlocking life-changing advances for diabetics?

[Paula Sherriff]

I absolutely agree, and it is encouraging to learn that such research and development is being carried out. I will later share details of a visit that my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and I undertook recently, which proved very interesting.

HPV Vaccinations for MSM

Jim Shannon Excerpts

Tuesday 7th June 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Hollobone, and it is a pleasure to be able to speak in the debate.

I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing a debate on such an important issue. He has been a stalwart speaker on the issue in this Parliament and the previous one. He never lets his subject matter fall, and I thank him for his commitment and his energy.

It is good to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place again. It is also especially nice to see the Minister in her place again—she is spending a great deal of her afternoon in Westminster Hall, but it is always a pleasure to have her here. I look forward to her response to this debate.

For years, often due to stigma and attitudes, the issue was ignored, so it is welcome that we can now give it the attention that it deserves, not only in Parliament, as today and in the past, but in all walks of life, because it is now part of national conversations on advancing healthcare. As the Democratic Unionist party health spokesperson at Westminster, I am pleased to participate in the debate, to encourage and support the hon. Member for Finchley and Golders Green in what he is talking about today, and to comment on what we have done in Northern Ireland, as I always do in such debates, hopefully adding to our general knowledge of the subject.

Genital warts are the most common viral sexually transmitted infection and are caused by the human papilloma virus. In September 2008, Northern Ireland introduced an HPV vaccination programme targeting 12 and 13-year-old girls in schools. It primarily vaccinated against HPV 16 and 18, which are associated with more than 70% of cervical cancers. From September 2012, 12 and 13-year-old girls were offered the quadrivalent vaccine, which protects against not only types 16 and 18, but types 6 and 11, which are mainly associated with the majority of genital wart viruses. It is expected that rates of first episodes of genital warts will be positively impacted by the introduction of the HPV vaccination programme.

In men, there is no reliable test for HPV infection. As the hon. Gentleman said, it is often difficult to diagnose, and there are no symptoms for high-risk HPV. People who are known to be at a high risk of having anal HPV and of developing anal cancer may be offered an anal smear, but nothing goes beyond that. It is frustrating to have some steps in the health process, but no steps to take things to the next stage and to do what the hon. Gentleman said. That is why we are having the debate today and why it is critical for men to start receiving equality with women in terms of the protection offered against HPV by the health service. Given the higher risk of HPV infection associated with men who have sex with men, surely the provision of a vaccine is a no-brainer.

In November 2015, following a review of the evidence, the Joint Committee on Vaccination and Immunisation published a position statement recommending the introduction of a vaccination programme for men who have sex with men, are aged up to 45, and attend genitourinary and HIV clinics. Some steps forward have been taken, but larger steps are needed, with more ground being covered.

Since the JCVI recommendations, and in line with them, the Welsh and Scottish Governments have announced that they will roll out vaccination programmes. I hope that the Department of Health in Northern Ireland will follow suit—the matter is devolved, as the Minister knows—and that men throughout the United Kingdom will get the long-overdue support that they deserve. It is about fairness, and when there is clear evidence that a section of the population might be at particular risk of something, appropriate action should and must be taken.

Continued monitoring of results is also necessary to ensure that the recommendations, when implemented, have the desired results, and that any changes or extensions to the plans can be made to ensure the most full and proper protection available is afforded to all those affected. To conclude, developments are long overdue. The debate has been welcome and an opportunity to highlight the issue—I congratulate the hon. Gentleman again. The fact that a goodly number of Members are participating is an indication that we, too, want to see change. It is about seeing the plans implemented and ensuring that the proposals work well in practice.

Excess Winter Deaths

Jim Shannon Excerpts

Monday 6th June 2016 Commons Chamber

[Dan Jarvis (Barnsley Central) (Lab)]

I am grateful to have secured this opportunity to raise the important subject of excess winter deaths again in this House. I first raised the issue with the Prime Minister some four years ago. Since then, tragically, 117,000 people have died unnecessarily because of the cold—43,000 in the winter of 2014-15 alone. I think we can all agree that it is simply unacceptable that each year tens of thousands of people are dying unnecessarily. I am not going to pretend that this is an easy problem to solve or that any one Government are to blame. Tonight I intend to outline where I believe the Government’s approach can be improved and, in a constructive manner, offer suggestions of steps that I believe should be taken to address this national scandal, because while today was a very warm day, now—during the summer months—is precisely the time when we should be preparing for the winter.

The majority of those who are dying are elderly. We know that the demographic group most affected by excess winter deaths is women aged over 85, yet we also know from the evidence across Europe that more people are dying unnecessarily here than is the case elsewhere. Scandinavian countries including Norway, Denmark, Finland and Sweden all have significantly lower rates of excess winter deaths than the UK, despite all of those countries being considerably colder. One of the reasons for that is that, in policy terms, Scandinavian countries tend to be better prepared. As former director general of Age UK Michelle Mitchell put it,

“excess winter deaths are much lower because they take staying warm seriously and prepare for the cold weather.”

We know that that preparation is key, and I will outline several areas where preparation in our country could be improved.

The first is public health. The Office for National Statistics analysis of the most recent excess winter deaths figures highlights flu as an important factor in mortality levels, so I have to say to the Minister that I was concerned to be left waiting this spring for the Government’s flu plan for the upcoming winter. It was published just before recess, but that was some two months later than last year. Will the Minister say why the Government’s flu preparations are behind compared with a year ago?

Secondly, we know that cold homes are a major cause of excess winter deaths. They are also a burden on our public finances. Former chief medical officer Liam Donaldson has estimated that cold homes cost the NHS £850 million each year. Unfortunately, many elderly people live in fuel poverty—people like Lynne from Cumbria, who to keep warm in winter has to put on several layers of clothing and heat a hot water bottle, because she cannot afford to have the heating on when she needs to. For people like Lynne energy prices are a big issue. I welcome the fact that energy prices are falling, but they are not falling in line with wholesale prices, and too many energy customers find themselves on tariffs that lead to them paying more than they should. What discussions has the Minister had with her colleagues at the Department of Energy and Climate Change about alleviating fuel poverty to help to prevent excess winter deaths?

In addition, more can and should be done about home insulation. Although neither programme was perfect, I thought the green deal and energy company obligation were steps in the right direction. However, the green deal has now expired and the energy company obligation expires next year. We have been told that it will be reformed and renewed but, as yet, no timeline has been set out by the Government for doing so. May I ask the Minister what discussions she has had with fellow Ministers at the Department of Energy and Climate Change about ensuring that home insulation is increased?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing an important issue to the House in this Adjournment debate. In the period from July 2014 to August 2015, there were 870 excess winter deaths in Northern Ireland—the highest figure since 2009-10. It is unbelievable that the figure is so high in a developed nation such as ours. Does he agree that we need to do more to eradicate winter deaths, not just reduce them? In other words, it should be target zero.

[Dan Jarvis]

I am grateful to the hon. Gentleman for his intervention. He is absolutely right to draw attention to the heavy costs that his part of the world has borne. He is right to point out that in a prosperous, wealthy nation—yes, of course we have challenges—it is simply unacceptable that anyone should die as a result of the cold. The numbers that he has outlined in Northern Ireland and the national numbers that I outlined are simply unacceptable. As I said, this not the fault of any single Government—this is an issue that has challenged successive Governments. The Prime Minister recently said to me that these figures act as a standing rebuke to all Governments. The issue for us in the House tonight is what practical measures and action the Government can take to reduce the numbers and get to the point, as the hon. Gentleman suggested, where no one dies in this country as a result of the cold.

I was outlining some of those practical measures and was asking the Minister about the conversations that I hoped she would have with her colleagues at DECC on home insulation. Any measures that the Government seek to take should be targeted at those groups such as the elderly who are the most vulnerable to the cold. That brings me to a crucial point about the importance of cross-government working. Excess winter deaths are clearly an issue that requires a cross-government approach, but despite the fact that nearly 44,000 people died unnecessarily in the most recent winter for which we have figures, there is not a joined-up cross-government plan to reduce excess winter deaths.

A number of Departments, including the Department of Health, the Department of Energy and Climate Change, the Department for Work and Pensions, the Cabinet Office and the Department for Communities and Local Government, have policies which could contribute to reducing excess winter deaths. As yet, there is no overarching cross-government strategy to join up those policies and ensure that they contribute in the best possible way to reducing excess winter deaths. It is often left to local authorities to develop their own approach to reducing excess winter deaths. In Barnsley, we are fortunate that our local authority takes this issue very seriously. The council is making a concerted effort to ensure that vulnerable and elderly people live in heated homes.

--- Later in debate ---

[Jim Shannon]

The hon. Gentleman is outlining a plan of action. Does he feel that there is a role that the Salvation Army and church groups, whose congregations are normally elderly people, could play in the Government’s strategy?

[Dan Jarvis]

I absolutely do believe that there is a role for the charitable sector and for a range of organisations that make hugely significant contributions. However, the point I am trying to make concerns the means by which we draw those contributions together—the practical co-ordination measures that can be taken at a local level, led by directors of public health, to ensure that we have the most effective response and bring together all the different agencies locally, including the local authority, the clinical commissioning group, the local hospital, the GPs practices and the organisations the hon. Gentleman rightly referred to.

Before drawing to a conclusion, I want to take the opportunity to tell the House that I have started a petition today on Parliament’s petition website so that people across the country can join me in calling for a national strategy. I am pleased to say that, despite the fact that the petition launched only a few hours ago, it has already received a signature from one of the Minister’s own constituents—I hope she will welcome that contribution.

To conclude, the way in which a society cares for the most vulnerable is an important metric by which any society should seek to be judged. At the moment, given the numbers of people who are dying each year, we as a country are failing that test. Reducing excess winter deaths is an issue Members on both sides of the House can work together on. I look forward to the Minister’s response. I know she treats these matters with the concern they rightly deserve. I hope that tonight will not be the end of the discussion but the beginning and that she will go away and consult colleagues across the Government to see what more can be done so that, this winter and in winters to come, we can prevent people from dying unnecessarily.

Defending Public Services

Jim Shannon Excerpts

Monday 23rd May 2016 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to be called to speak in this debate on the Gracious Speech. There is always a theme in these debates on the Queen’s Speech—a list of goals that are not present, a list of what should have been in there that was not, and what people do not like about it and what they do like about it. What has saddened me is that the common theme from the Opposition is that they do not think that there is much in the Queen’s Speech, and yet, as we have just heard, there are 21 separate Bills. There is quite a lot in there.

It takes me back to 2010, when I first became an MP, because this Queen’s Speech is all about why I wanted to come into politics in the first place. Looking back to 2010, I see that on my website I described myself as the fresh-faced MP for Blackpool North and Cleveleys. That is no longer true—I look in the mirror now and see that the lines are slightly deeper, the eyes slightly more sunken; I am on the wrong side of 40—but one thing has not changed: my belief that I got into politics to stand up for the people who are directly under the state’s care who have no one to stand up for them. They include the patients in hospital, whom we discussed in opening today’s debate; the young people in care waiting to be fostered or adopted, who the Prison Reform Trust told us today are over-represented in the youth justice system, not just by a small amount but by an absolutely massive amount; and the prisoners in our prisons who are not being educated properly or rehabilitated, which has a direct impact on the number of victims there will be if we do not reduce reoffending. Getting that right has to be the right thing to do.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman share my concern about the radicalisation, both Islamist and neo-Nazi, that takes place in prisons? Is there not a need for the Government to tackle that? People are going into prison with some sort of innocence in terms of religious belief and coming out with a radical opinion. There has to be something done.

[Paul Maynard]

I thank the hon. Gentleman for making that point. He tempts me to indulge in a nine-minute disquisition on how we balance the presence of faith in our prison system with the need to safeguard against radicalisation. I agree with him broadly, but I do not want to go down that path, tempting though it may be. I would much rather focus on the fact that what brings all this together—standing up for those who have no one else to stand up for them—is this idea of life chances, which is the theme behind the Queen’s Speech.

The Whip should listen carefully now: although I hate the phrase “life chances”, he should not write that down in his little black book, because to my mind what we are really talking about is social justice. Like Ruth Davidson, I am proud to say I am a John Major Conservative. I believe in equality of opportunity. I do not believe in equality of outcome because it cannot be guaranteed, but I do believe that part of achieving social justice is taking ownership of the consequences of our policies. We have to have some regard for the outcomes.

That can be hard to justify when we look only at globalised national statistics. They do not give us the granular narrative detail of individual lives. Many times in this Chamber we have debated how we measure child poverty, what the best indicators are, what they mean, and how we tackle child poverty. We can disagree constructively on what those indicators are and how we utilise them, but I believe we need to go down another level. A good example is an article I urge everyone to read that appeared in The Atlantic magazine last month about the proportion of Americans who, if landed with an unexpected bill for $400, would not be able to meet it out of their earnings. Shockingly, some 47% of Americans would not be able to pay that bill for $400 without recourse to either borrowing from others or payday lending. I shudder to think what the figure is in this country. No doubt a sociology department somewhere is preparing a research funding request as we speak to find out that information. We need to burrow down so much more into the detail to get a true understanding of how to improve life chances.

Think about the connection between social isolation and ill health—the number of lonely elderly people in my constituency who probably do not speak to anyone day in, day out, and the younger people with serious health conditions who may feel socially isolated. Social isolation is the key predictor of future ill health and therefore future demand on the health service. That has to be taken into account. Think also of children. I visit many primary schools and I know that in the more deprived parts of my constituency there is a major problem with the number of children arriving at school aged four who are untoileted. Think of the burden that places on the staff in toilet training them, taking them away from the educational aspects of their job.

Another wider issue for older children perhaps, those who are eligible for free school meals, is how many of them are not fed properly during the school holidays. I know the hon. Member for Washington and Sunderland West (Mrs Hodgson) is deeply concerned about that. Although all that is difficult to measure, it gives a different dimension to the story of life chances from the national global figures for whether child poverty is going up or down in any particular set of years we all focus on. We need to be much more creative in our approach.

I had hoped that by talking for an extra five minutes, my hon. Friend the Minister for Culture and the Digital Economy would have returned to his seat to hear what I am about to say about Department for Culture, Media and Sport issues. I know he has to wind up the debate and I was hoping to help him. He published an excellent culture White Paper just before the Queen’s Speech—the first since Jenny Lee’s ground-breaking document in the 1960s. The key element of the latest White Paper is about broadening participation. I had not really thought about it in those terms, but I was invited by a constituent, James Nash, to a concert by the National Youth Orchestra at the Liverpool Philharmonic hall a few weeks ago. James plays trumpet at grade 8 —grade 8 is a requirement to play in the National Youth Orchestra. He is very proud of his participation and thoroughly enjoying the experience. He went to a local comprehensive and is very musically talented so this is a fantastic opportunity for him, yet that orchestra is a charity, supported by the Arts Council.

I had the pleasure of hearing Thornton Cleveleys Brass Band the Sunday before last. For the first time ever, it has won a regional division of its national brass band competition at the fourth tier, I gather, of brass bands. It will soon compete in Cheltenham in the national competition. That band is looking for funds and it will be going to the Arts Council, which now supports brass bands thanks, I believe, to the Minister’s intervention. That broadens participation by so many young people who enter music through the local brass band.

There are many ways in which culture is broadening horizons, but unfortunately in Lancashire there is one way in which those horizons are narrowing rapidly—through the very sad decision by Lancashire County Council to close so many of our local libraries. Almost half of Lancashire’s libraries are being shut. I am losing Cleveleys library, which has a children’s centre attached, and Thornton library, which is just over the constituency boundary but I feel I have a share in it with my hon. Friend the Member for Wyre and Preston North (Mr Wallace). We all recognise that councils have to make savings. What I find so frustrating is that when others have come up with solutions to help to keep libraries open and make the savings, Lancashire County Council will not sit down and listen.

Wyre Borough Council wants to convert all Wyre’s libraries into a community interest company, thereby forgoing many of the business rates and other associated costs that make them so expensive to run for the county council. By doing that, it can save the money the county council wants to save and keep every single library open, but shockingly the county council will not even sit down and talk about it. The hon. Member for West Ham (Lyn Brown) rightly praised councils that innovate. Please could she have a word with Lancashire to persuade the council to innovate? Many other councils of all stripes have rethought how they do library provision. Why can Lancashire not do the same? Does it want to make a cheap political point? I desperately hope not, because that would be a tragedy.

I remember back in 2008 the right hon. Member for Leigh (Andy Burnham) taking the visionary step of calling a public inquiry because Wirral Metropolitan Borough Council had chosen to close so many of its libraries. I attended that public inquiry. I know he is not here, but I very much hope that my hon. Friend the Minister for Culture and the Digital Economy will agree to meet me to discuss whether Lancashire’s plans are enough to justify another public inquiry under the terms of the Public Libraries and Museums Act 1964. The council has an obligation to provide a “comprehensive and fair” service. My concern is that what Lancashire is planning is not fair—I know that is a subjective term—and it is certainly not comprehensive.

My constituents, who have been accustomed to going to Thornton and Cleveleys libraries will now have to go further afield, to Fleetwood and Poulton, shortly after seeing all their bus connections to such areas slashed by the county council. That is doubly frustrating. I urge Ministers at least to arrange for me to have a conversation with my hon. Friend the Minister for Culture and the Digital Economy to discuss those issues.

On a wider point, whenever I come here, I desperately try to believe that all of us are here for the right reasons—we all want to make things better for the people we represent in our constituencies. Some of us hide it better than others, perhaps, by our conduct in this place. Some are more bolshie, some are ruder, some cat-call me from a sedentary position and some chunter away, but I always try to find something positive in what the other person is saying, and I urge all Members to try to do that.

Whatever we think of the phrase “life chances”, the issues that it covers are surely the reason why we came here today. I urge all Members to look for the positives in what this Government are trying to do. I know that the Opposition have to scrutinise us, but I hope they will open their hearts occasionally to find the good stuff that we are doing and help us to do it better still, rather than just criticising us for being anti-public sector, anti-everyone and anti-everything.

Junior Doctors Contract

Jim Shannon Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I absolutely agree with that wise comment, and it befits someone who is experienced in working in the Department of Health. We always get further if we sit around the table and talk about such issues. The Government are determined to improve the quality and safety of care for patients, and it is important to recognise that if the Government are successful, it will be better for the morale of doctors. The happiest, most motivated doctors work in the hospitals that are giving the best care to patients. That is why it is a win-win.

I say to Labour Members that it was the refusal of the BMA for many years to talk about the issue that my right hon. Friend referred to that meant we reached a deadlock. The fact that the Government were willing to proceed with important reforms on our own if we had to meant that, in the end, everyone came together and had a sensible negotiation. We got to the right place. I am sure everyone wishes that we had not had to go on the journey we went on to get there, but now that we have got there, I think it is the time for being constructive on all sides.

[Jim Shannon (Strangford) (DUP)]

I also thank the Minister and the BMA for coming to an agreement. The Minister said that it was a win-win for everyone, and so it is. It is always good to talk, and dialogue brings results. That happened in Northern Ireland, and it has happened with the conclusion of this process as well. A good deal has been reached, and some 45,000 junior doctor BMA members will now be asked to vote on it.

We have had eight days of strikes since January, and some 40,000 planned non-urgent operations and 100,000 out-patient appointments have been cancelled. May I ask the Minister what will be done to catch those up, and what discussions he has had with the Northern Ireland Assembly about the agreement?

[Mr Hunt]

I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Specialist nurses are vital for the care and support that they provide for patients and families, not just for the elderly but for the disabled. What is his Department doing to ensure that funding for specialist nurses is maintained and that we do not end up in the situation that we have in Northern Ireland with Four Seasons, which is responsible for 62 homes in Northern Ireland and 450 across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Ben Gummer]

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.

Ambulatory Care

Jim Shannon Excerpts

Wednesday 27th April 2016 Westminster Hall

[John Howell]

I thank my hon. Friend for allowing me to have a rest and to make the most of that time—as I get older, I need that. I do agree with her; she makes a very valid point. I am concentrating on older people because traditionally that is where the population who have used the hospital in Henley have come from. I think that in the past year only one was under 55. But as I said, my hon. Friend makes a very valid point.

In many cases, the decline that people experience cannot be attributed to the progression of the acute problem for which they were hospitalised in the first place. An example is pneumonia. Even if the disease is cured in a few days or, indeed, if a hip fracture repair is technically perfect and uncomplicated, the patient may never return to the same functional status as they had before they went into hospital.

According to the US study, between 30% and 60% of patients with hip fractures are discharged from the hospital to nursing homes; 20% to 30% of those persons are still residing in nursing homes one year later. Only 20% of one large group of patients returned to their pre-operative functional level after a hip fracture repair.

Many hospitalised patients have difficulty implementing their habitual strategies to avoid incontinence. The environment is unfamiliar. The path to the toilet may not be clear. The high bed may be intimidating. The bed rail becomes an absolute barrier, and the various “tethers”, such as intravenous lines, nasal oxygen lines and catheters, become restraining harnesses. About 40% to 50% of hospitalised persons over the age of 65 are incontinent within a few days of hospitalisation. A high percentage of hospitalised older persons discharged to nursing homes never return to their homes or community. In one study, 55% of persons over the age of 65 who entered nursing homes remained for more than a year. Many of the others were discharged to other hospitals or long-term care facilities, or simply died. The outcome for many hospitalised elders is loss of home and, ultimately, loss of place.

It is most important that relationships among physicians, nurses and other health professionals reflect the interdisciplinary nature of the whole of this process. In particular, I am a great enthusiast for the integration of the NHS with social care. That needs to move ahead very quickly to give the clinicians the responsibility for commissioning the social care that is required. Maintaining wellness and independence in the community prevents conditions deteriorating and therefore results in better health outcomes. Emergency hospital admissions are distressing.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this very important issue to Westminster Hall for consideration. Over the past five years in Northern Ireland, category A ambulance call-outs have increased by 30.9%. It is a devolved matter, but it does indicate a greater dependence on and need for ambulance responses. Does the hon. Gentleman have any thoughts about the best way to ensure that the ambulance service and ambulance staff can do better for elderly people?

[John Howell]

The hon. Gentleman makes a valid point. The costs need to be offset. This is a balancing exercise within the NHS. Costs that are saved by stopping people going into hospital can be spent on the treatments and services they require to get them better. That is a far better way of working.

Emergency hospital admissions are distressing. Better management that keeps people well and out of hospital should lead to a better patient experience. The King’s Fund estimates that emergency admissions for ambulatory care-sensitive conditions could be reduced by between 8% and 18% simply by tackling variations in care and spreading existing good practice. That would result in savings of between £96 million and £238 million, which, as part of the overall management of the NHS budget, could be allocated against the provision of the often quite expensive services that provide the necessary medical investigations on the spot.

A doctor in my constituency, Dr Andrew Burnett of the Sonning Common practice, said:

“Very few of my patients want to be admitted to hospital.”

Most people, if they need to be treated or, indeed, if they are nearing the end of their life, would like that experience to be located at home. I think that probably applies to us all.

There is a particular problem in relation to dementia. I spoke to the Alzheimer’s Society, which said that people are often admitted with an acute physical illness on top of their dementia, and the combination of the two can cause their confusion to become worse. They are then taken out of familiar surroundings and placed on a hospital ward with lots of strange people, noises and smells. That can be terrifying for them and they rapidly deteriorate. The advice from the Alzheimer’s Society is to try to keep people out of hospital for as long as possible. That is why we, and the Oxfordshire medical facilities, are striving hard to develop systems to enable people with physical illnesses to be managed out of hospital.

That is one of the rationales for the new Townlands hospital in Henley, where the clinical commissioning group, along with Oxford University hospitals, Oxford Health and, indeed, the county council, are members of the ambulatory emergency care network, through which organisations can learn from one another to develop robust pathways. Some good case studies are involved in that, but time prevents me from going through them at the moment. I draw the Minister’s attention to those if he needs some examples of how ambulatory care actually works.

Another clinician, Pete McGrane of the CCG, has said:

“Patients who were recently hospitalized are not only recovering from their acute illness; they also experience a period of generalized risk for a range of adverse health events.”

There have been cases in my constituency where the health of elderly people has deteriorated following discharge, or even in hospital, due to other conditions. The relatives have sought to blame the health service for poor care. After following up on those cases, the complaints investigation has shown that it is not poor care that has exacerbated the patients’ distress and symptoms; it is a direct consequence of hospitalisation.

I went to see a hospital in Welwyn Garden City, which has no beds inside. Instead, it has beds in an adjoining care home at the side of the hospital. The place was absolutely heaving with people. I met a gentleman there called Dave. I do not have his surname, nor have I asked his permission to use his name, so we will just keep it as Dave. He could not speak highly enough of the treatment he got. He called in every day for treatment and then got on with his life at home. It revolutionised the treatment he received, which, doctors had confirmed, would otherwise have required a debilitating 56 days of medication, staying in hospital. His experience of hospital stays had shown up their disadvantages, and he pointed out that people were so much more likely to improve, as he had, and to feel better, as he did, if they could stay at home. He was clearly a great enthusiast for this type of service.

In Henley, there is one issue, above all, which I have already touched on and want to emphasise. It was helped by some papers that were forwarded to me by the Health Foundation, which said that it is undertaking

“a joint research programme…monitoring how the quality of health and social care is changing over time.”

I have been very concerned by the way in which we move forward with the integration of social care and health in the county to ensure that it delivers the sort of services that are required in the full context of the patient.

I am pleased and proud that I have helped to deliver a 21st century medical facility for the people not just of Henley, but of the whole of southern Oxfordshire, and that that incorporates ambulatory care. It is clearly the way forward and it is a way forward that I am sure will work.

Lewy Body Dementia

Jim Shannon Excerpts

Tuesday 26th April 2016 Westminster Hall

[Conor McGinn (St Helens North) (Lab)]

I beg to move,

That this House has considered awareness and recognition of dementia with Lewy bodies.

It is a pleasure to have secured this debate, under your chairmanship, Sir Alan, on dementia with Lewy bodies, or DLB as it is known, and as I will refer to it henceforth. May I start by congratulating the Minister on his very significant achievement on Sunday in completing the London marathon? Well done to him for the moneys that he raised for his charities. In the same vein, it is with some pride that I declare that I was recently appointed an ambassador for the Lewy Body Society, a charity whose mission is to raise awareness of DLB among the general public and educate those in the medical profession and decision-making positions about all aspects of the disease, as well as to support and fund research into it. For 10 years, the LBS has raised awareness, provided support and information, and funded research into DLB, which is the second most frequent cause of age-related neurodegenerative dementia. I am delighted that some of those involved in the campaign are in Parliament today.

It might be helpful if I say a little about DLB. Lewy bodies are abnormal aggregates of protein that develop inside nerve cells in Parkinson’s disease, DLB and some other disorders. They were first discovered by Dr Frederick Lewy as far back as 1912, but incredibly, despite that, DLB was virtually unknown until the late 1980s, when advances in techniques made it possible to identify Lewy bodies under a microscope.

Every case of DLB is as individual as the person living with it. Different people show different combinations of symptoms. At present, a diagnosis of DLB can be confirmed only by autopsy, but a careful clinical evaluation of the patient and their symptoms can in many cases form the basis for making a reasonably confident lifetime diagnosis. There are also technological advances in imaging and research into biomarkers that it is hoped will result in earlier and more accurate diagnoses.

The central symptom of DLB is dementia, which is defined as progressive mental decline that is serious enough to interfere with normal daily activities such as eating, washing, dressing, cooking, shopping and managing finances. Significant memory loss may not develop until later. There may also be problems with executive function in respect of attention, problem solving and spatial awareness. This can easily be mistaken for Alzheimer’s disease.

Additional symptoms that may lead to a diagnosis of probable DLB are, first, disturbances in REM—rapid eye movement—sleep. The impact of that on a family carer is terrible. The carer is unable to sleep themselves and therefore becomes unable to support the person with DLB. REM sleep is the deep sleep in which people dream. A certain amount of good, REM sleep is necessary for people to function efficiently. DLB sufferers may talk in their sleep or act out their dreams. Sometimes that is so marked that the sufferer falls off the bed.

Secondly, there is severe sensitivity to neuroleptic drugs. Sometimes people with DLB are prescribed neuroleptic—antipsychotic—drugs to help with their symptoms. That should be done only by someone experienced in the illness, as many of those drugs can be extremely harmful or even fatal to people with DLB. That problem has been recorded.

Despite the importance of correct diagnosis and treatment of DLB, the disease is often not recognised, identified or diagnosed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing a very important issue to the House. The week before last, I had a debate in this Chamber on dementia and Alzheimer’s disease, which a number of hon. Members attended. Dementia has the potential to be the defining condition of this age. Does he think that there should be more research and more partnerships between parts of Government, between universities and between businesses to find a cure for this disease? By finding a cure, we will help to ensure that diagnosis happens earlier, as it should.

[Conor McGinn]

The hon. Gentleman, whom I would feel comfortable referring to as my hon. Friend, makes the point with his usual eloquence, and I could not agree more. I will say a little more later about some of the research being done.

Dementia is not just about memory. The supportive symptoms of DLB are fainting, falls, problems with swallowing and continence, delusions, depression and hallucinations, including hearing, smelling or feeling things. Some people have benign or pleasant hallucinations of, for example, children or animals. A sense of the presence of someone who is not there is common in many patients. Other sufferers see frightening and disturbing things and may react to them by displaying challenging behaviours that prove very difficult for the family to manage.

More than 700,000 people in the UK have dementia. That number is projected to rise to 1 million by 2021 unless significant advances are made; indeed, the figure is expected to double in the next 20 years. As the hon. Gentleman said, the issue now touches the lives of virtually every family in the United Kingdom. It is a big issue for the NHS, but also for all local authorities and, indeed, all public services. In the UK, approximately 100,000 people are thought to suffer from DLB. At least 5% of people aged 85 or older are thought to suffer from this little known, but not uncommon, and devastating disease.

It is important to note that diagnosis rates of dementia across the country are low and incredibly varied. In the UK, less than half of people living with dementia are diagnosed, let alone differentiations being made between the types of dementia.

Antibiotics: Research and Development

Jim Shannon Excerpts

Tuesday 26th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to be called to speak to speak in this debate, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an increasingly important issue that we are more aware of today than ever before. He set out a comprehensive scene, which has been most helpful. He covered many of the issues involved, which will probably take away from other contributions, but he added to the debate, and that is the important thing.

The discovery of antibiotics revolutionised healthcare, allowing for the effective treatment of illnesses, including TB, that had previously been commonplace and frequently deadly. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) referred to the increase in TB in his constituency, which I am aware of because of events that have taken place here in Westminster. The incidence of TB in the United Kingdom has risen sharply in certain areas, and there is a tie-in between how we address TB and HIV. It is important that we look at the bigger picture.

Pathogens have evolved to resist new drugs. Resistance has increasingly become a problem as the pace at which new antibiotics are discovered has slowed and antibiotic use, including misuse and overuse, has risen. Antimicrobial resistance presents arguably the most serious threat to global health security and is threatening to undo major gains in the control of infectious diseases. If it is left unaddressed, 300 million people will die prematurely because of AMR by 2050 and the world’s GDP will be 2% to 3.5% lower. This year, the World Health Organisation and the G20 are considering AMR, providing the UK Government with an opportunity to build on the leadership they have shown to date. The UK Government prioritised tackling drug resistance in their aid strategy published last November. They also created the related Ross fund, which they are to be congratulated on. In addition, they brought the issue to the attention of the international community by commissioning the independent review on AMR in 2014.

The Ross fund is a commitment to spend £1 billion over the next five years on research and development on infectious disease, including £315 million to fight AMR. It is jointly administered by the Department of Health and the Department for International Development. Will the Minister give us some indication of how those Departments are working together to achieve the goals set? Commitments under the Ross fund are yet to be detailed. The all-party group played an instrumental role in securing the Conservative party’s manifesto pledge to create the fund. Given the urgency of tackling the TB epidemic, it is important that TB is prioritised within the Ross fund. Will the Minister tell us— I am sure he will—how that will happen? Although the Government’s steps are welcome, we must ask when the funding provided through the Ross fund will be allocated, because many of us are keen to see that happen. The hon. Member for York Outer also asked that question. Investment in TB diagnostics, drugs and vaccines through the fund is critical, and we need to see where the money is being spent and what the feedback is.

TB is the world’s leading infectious killer, killing some 1.5 million people every year, or 4,000 every day. TB is the biggest killer of people with HIV, as I mentioned earlier with reference to London. As the only drug-resistant infections spread through the air, multi-drug-resistant and extensively drug-resistant TB pose a serious threat to global health security. When we think about what is happening in London with TB and HIV, we should also think about what is happening in other parts of the world, where greater numbers are affected and there could be even more deaths.

Multi-drug-resistant TB—MDR-TB—is resistant to certain drugs. It can take more than 4,000 pills over a period of six months to cure someone with TB, and the drugs are often associated with severe side effects that can make treatment unbearable. As a result, patients often do not finish treatment, which increases the likelihood of drug resistance. I do not know whether any research is happening into how to make the drugs more palatable, if that is possible.

As well as treatment failure, inferior treatment and infection with resistant strains are drivers of MDR-TB. The number of cases of drug-resistant TB is increasing. There were nearly half a million new cases of MDR-TB last year and almost 200,000 deaths. One quarter of MDR-TB cases are in the WHO European region. MDR-TB requires patients to take a course of drugs over an 18 to 24-month period, including eight months of daily intravenous injections. That would be quite hard for anybody. Fewer than half of people who start treatment successfully complete the course due to the unbearable side effects, which can include permanent deafness. We have to be aware of not only what is done to treat people medically but the side effects.

The treatment of MDR-TB can cost 450 times the amount usually required to treat TB. In the UK, treatment of MDR-TB costs about £70,000, which is quite a lot of money, but if it addresses the issue, it has to be done. Due to stigma, lack of access to services and poor understanding, 3 million people—more than a third of those who fall ill with TB each year—fail to be diagnosed. MDR-TB already accounts for one third of the 700,000 annual deaths from AMR, and if it is left unaddressed, an additional 2.59 million people will die each year from the disease by 2050. It is imperative that TB is included in the AMR review’s recommendations to be published this year and considered in any international negotiations that follow. The G20 and the WHO will consider AMR this year.

I will finish with one more point—I am conscious of the suggested time for speeches, Mr Evans, but it is important that Members hear this. Although there may be a natural inclination to focus on the impact of increasing resistance to antibiotics on people, there is great work happening within the livestock industry, and particularly the poultry industry. The British Poultry Council has managed to achieve some encouraging results with its antibiotic stewardship scheme. It is the first UK livestock industry to pioneer a data collection mechanism to record antibiotic usage, which covers 90% of production across the chicken, turkey and duck sectors. It is important to record that since the scheme began monitoring overall use, it has demonstrated an encouraging downward trend. Between 2012 and 2015 production increased by 5%, with UK poultry meat accounting for 44% of total UK meat production. The total quantity of antibiotics used by scheme members in the same period decreased by 44%. In 2012, the scheme introduced a voluntary ban on the use of third and fourth-generation cephalosporins and a commitment to reduce the use of fluoroquinolone antibiotics. In 2016, the scheme made a further commitment not to use colistin.

Those encouraging results within the poultry industry should be recognised and encouraged, but as we have seen, when it comes to antibiotics for people, we need to wake up to the issue sooner rather than later. We need the Government to commit to delivering on the Ross fund and to continuing to look for further ways in which they can help address this issue.

--- Later in debate ---

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

It is a great pleasure to serve under your chairmanship, Mr Evans. I believe we are expecting a vote, so my speech may be interrupted. I shall crack on, awaiting the bell.

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing the debate and on the tenacity with which he has raised this issue in the House in recent years. It is a great opportunity to have this debate today, when so much is going on this week in London on international health leadership. My hon. Friend’s speech and the informed and constructive comments that he and others have made highlight how seriously this issue is taken throughout the House. Last Monday we had more than 60 Members of Parliament in this Chamber. The fact that we have a dozen today does not suggest that there is any less interest; many Members are tied up in other debates. I know that Members from all parties are concerned about this issue.

The debate is timely, because it coincides with a two-day international summit on antimicrobial resistance convened by the Wellcome Trust in London, which brings together a global gathering of scientists and policy makers to explore key areas for action. I thank the Wellcome Trust and pay tribute to it for its leadership. In so many areas of public policy, it has put its money and expertise to work for us. I also pay tribute to Jim O’Neill and his team, as others have done, for their work on the issue.

I will set out the context of the debate, as a number of other hon. Members have done. Antibiotics play a crucial role not just in human health but in animal health and welfare—my hon. Friend is a doughty campaigner for agricultural causes—and so are of great strategic interest in the wider field of biosecurity. We have seen the impact of diseases in domestic and agricultural poultry and in some of our tree species, and we are trying to view this issue in the wider global context of biosecurity from infectious diseases.

[Jim Shannon]

There have been some marvellous steps forward in addressing the use of antibiotics on poultry, as I indicated in my speech. Many people are trying to move that forward. If we take steps forward with poultry and other animals, we can transfer that work to humans too.

[George Freeman]

The hon. Gentleman makes an excellent point. As ever, Belfast University and the Northern Ireland life sciences cluster are doing good work in agriculture and in the medical space.

For the reasons that I outlined, the growth of resistance presents a genuine strategic global threat, which, as hon. Members from throughout the House have gratifyingly acknowledged, the Government have taken a strategic grip of. Globally, some 700,000 people will die this year because of antimicrobial resistance. In Europe, the healthcare and societal costs of resistance are estimated to be of the order of €1.5 billion per annum. That translates into a verifiable and measurable cost to the NHS of £180 million, but it may well be an awful lot more. Meanwhile, we face an antibiotic discovery void. The golden age of discovery ended in the 1980s. We have had very few new antibiotics since then and no new class since 1987.

I had a 15-year career in the sector and spent one chunk of it starting, financing and managing a small anti-infectives company that was spun out of Hammersmith and Imperial College and used some phenomenally powerful technology to look at the genetics of how microbes reproduce. We spent a lot of money on some elegant science, but we did not produce a new anti-infective. The truth is that these bugs are very difficult targets in biomedicine. It is difficult to go after the cell wall of Gram-positive and Gram-negative bacteria. Their ability to reproduce and develop resistance to drugs—they are moving targets, as it were—makes it particularly difficult to design effective drugs for them.

The good news—if I may put it that way—is that we can do things that will make and are making a real difference. The chief medical officer outlined the scale of the issue and its implications for public health in her 2013 annual report. She called for urgent action at a national and international level. The UK responded by publishing our five-year antimicrobial resistance strategy, the core aims of which were to improve understanding of resistance, to ensure that existing medicines remain effective and to stimulate the development of new antibiotics, diagnostics and therapies. Three years on, we have made considerable progress. We have put the building blocks for success in place, including better data, guidance and a strengthened framework—

Brain Tumours

Jim Shannon Excerpts

Monday 18th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Warrington North (Helen Jones) on her detailed and concise presentation. I am here because my constituents have contacted me. I suspect that is why we are all here: we have poignant personal stories to share.

Brain tumours kill more children and young adults than any other form of cancer. Every day, 10 children and young people in the United Kingdom learn that they have cancer. More than 16,000 people are newly diagnosed with this form of cancer each year in the United Kingdom, yet just 1% of the national spending on cancer research is allocated to this horrendous disease. I am glad to see the Minister in his place; I always look forward to his responses. I am sure that he will respond in a positive fashion and give us the hope for which everyone in this Chamber wishes, along with our constituents.

The allocation of funding is even more alarming when we consider the survival rates for brain tumour patients. Breast and prostate cancer patients, to give two examples, have an 80% five-year survival rate, compared with that of brain tumour patients, which is less than 20%. Clearly, more needs to be done on investment in brain tumour research. Can the Minister indicate what partnerships he is encouraging between universities, Departments and big business to ensure that we can move forward?

[Gavin Robinson (Belfast East) (DUP)]

Our colleague the hon. Member for North Down (Lady Hermon) could not be with us today, but she lost her sister, who was completely asymptomatic, at the age of 37. That reinforces the point that discovery often occurs too late, which is why research and awareness are crucial.

[Jim Shannon]

As always, I thank my hon. Friend for his intervention.

Secondary or metastatic brain tumours are particularly important to consider. Up to 40% of cancers in other parts of the body will eventually spread to the brain. Let us focus on the key issues, such as the blood-brain barrier.

The National Cancer Intelligence Network found that 61% of brain tumour patients were diagnosed in accident and emergency, including 53% of children up to 14 years old, 25% of those aged 15 to 24 and 20% of older adults. Although there are many charities, I will put in a quick plug for CLIC Sargent and its work. Its paper, “The Best Chance from the Start”, found that the rarity of cancer in children and younger people, added to the fact that symptoms can be non-specific, can make it challenging for GPs to recognise the symptoms.

Many constituents have written to me, but I will conclude by quoting two. One is my constituent Mary Patterson, a survivor. She was diagnosed, she had surgery and she is alive today, although her life is restricted. Another story involves a lady in my constituency called Heather, who writes about her late husband George:

“My own interest in this petition and upcoming debate came about because my husband, George Ramsey, died 1 July 2011 from a brain tumour, only nine weeks after diagnosis. He was just 50 years old, and had just retired from the fire service after 32 years of service. Unfortunately my husband received poor management from the neurosurgery department, and his treatment was delayed after the team ran out of time to discuss his case on two separate occasions.”

An ombudsman investigated and reported to the Assembly. I conclude with this comment of hers:

“In his last five years in the fire service, he was the community liaison and youth engagement officer for the Belfast area. The chairman of the Belfast City Council stated that George’s work had ‘made Belfast a safer place’.”

That is a touching and personal testimony. The sad thing is that it is happening to families up and down the country at this moment. Although we have the opportunity to get back on track, it is sad that it took a petition to bring us here.

--- Later in debate ---

[George Freeman]

The hon. Lady, with whom I work closely on a number of issues, makes an excellent point. There are a number of criteria that drive how funding is allocated, and that is one of the things we ought to look at. If I can get to the end of my speech, I will make some recommendations about how we might pick that up and look at it.

I want to announce today that the Government accept that we need to do more in this space, committing to a number of specific actions that reflect the concerns that have been raised, both here and in the Petitions Committee and the all-party group report. I suggest that I should convene in the Department of Health a task and finish group to examine a number of the issues that have been raised here today, and to ask a question. I do not believe that as a Government we are not doing enough. We have put £0.7 billion a year into the Medical Research Council, to do the deep science on the medical frontier. We have put £1 billion a year—ring-fenced—into the National Institute for Health Research’s clinical infrastructure. We are funding the genomics programme and putting £4 billion into digital health and the informatics that go around it. The question we should ask is: surely there is more we can do to help to make that resource and that infrastructure support this particular disease area? I will say a little more about why I think that case has been made and what we might do about it.

I will not repeat all the numbers—hon. Members have heard them—but about 4,000 brain cancer cases are diagnosed each year in this country, resulting in about 3,500 deaths a year. We all know that brain tumours are very complicated—there are about 130 different types of them—and the truth is that we do not know what causes most of these cancers. Old age is a risk factor, but as many hon. Members have said with great passion today, it is those children who are diagnosed who drive us. Four-hundred children a year are diagnosed, and we just do not understand or know exactly what is driving it. There are various hypotheses around genetic conditions and some exposures.

Unlike for most other cancers, brain cancer mortality rates have increased. According to figures from the Office for National Statistics, in the last 30 years the mortality rate for brain cancer has increased by 15% for men and almost 10% for women. Improvements in diagnostics and treatments have helped to improve short-term survival in adults, with around 49% of people diagnosed with brain cancer now surviving for at least a year, compared with around 25% 30 years ago. Long-term survival has also improved, with around 20% of people now surviving for five years or more, compared with around 10% 30 years ago. We have also recently seen an increase of more than 25% in GP referrals for magnetic resonance imaging for potential brain tumours, from about 30,000 to 50,000. Veterans of these issues will know that those are relatively small numbers over quite a long period, compared with the explosive pace of progress in a number of the other disease areas that we often discuss.

A number of Members have talked about early diagnosis, which is clearly absolutely key with this cancer, as with all cancers. Last year, a report by the independent cancer taskforce set out 96 recommendations, broadly covering six strategic priorities, including early diagnosis, and NHS England is working with partners to establish a new cancer programme to implement those recommendations. By the end of this Parliament, everyone referred with a suspected cancer will receive a definitive diagnosis or the all-clear within four weeks.

[Jim Shannon]

rose—

[George Freeman]

I will give way to the hon. Gentleman, because he is a doughty pursuer of mine.

[Jim Shannon]

I thank the Minister for his response. Will he set out the funding or help that he can give to universities? He knows I am very keen on that issue. Universities have put forward some very good medical initiatives and some new medications and medicines as well, and Queen’s University Belfast is one of those universities. Can we do more with universities, business and Government? If we can, we can find the cure, which would be a big step forward.

[George Freeman]

I think we can do more and I welcome this opportunity to praise the role of Queen’s University Belfast in this field; it is a centre of real excellence in cancer science.

The standard treatment by the end of this Parliament will be underpinned by a commitment of an extra £300 million from Government in diagnostics. Last June, the National Institute for Health and Care Excellence published updated guidance on cancer referrals, which will make it easier for GPs to think about the possibility of cancer much sooner and to refer people for tests more quickly. This guidance includes new recommendations about brain cancer in adults, children and young people.

We are investing substantially in research. That is not to say we are doing enough—I will come to that in a moment—but we are investing £1.7 billion every year in health research. I am delighted that in the last autumn statement my right hon. Friend the Chancellor ring-fenced our investment, despite some difficult public spending pressures. We spend £0.7 billion a year on the MRC and £1 billion a year on the NIHR’s clinical infrastructure across the NHS. Cancer research spend by the NIHR rose by over a third during the last Parliament to around £135 million a year. Most of that investment—around £115 million—is on infrastructure. The model is that industry and charity can then run research projects through that infrastructure—I will come back to that point in a moment. That investment supports translating scientific breakthroughs into benefits for patients.

Spend specifically on brain tumour research cannot currently be separated out from total spend data for the cancer research infrastructure. I can, reassuringly, share with colleagues the information that six of our 11 NIHR biomedical research centres are conducting brain tumour research, and that the NIHR clinical research network had 30 brain tumour research studies that were recruiting patients in 2015-16. The NIHR is also funding research programmes and fellowships. For example, the health technology assessment programme is funding a £1.4 million trial involving patients who have received surgery for atypical meningioma.

The other main Government fund for health is the MRC. Over the five years to 2014-15, the MRC spent £10.9 million on research into brain and pituitary tumours, which spans basic discovery science, translational projects and early clinical trials. Both the NIHR and MRC also fund the Clinical Practice Research Datalink—the CPRD —which shares data for research. Four brain tumour studies have been published using CPRD data.

I want to mention the important role of charities. Those that follow my work will know that I have recently opened the door and made what has been described as a bold, generous and comprehensive offer to the Association of Medical Research Charities to come to the top table in the new landscape of life science research co-ordination that I am putting place. Medical research charities in this country raise £1.4 billion every year for research, from the smallest charities on the high street to CRUK, which has now become a major strategic funder and shaper of cancer policy.

I welcome the work that the 18 major charitable and public funders of cancer research are doing in the UK through the National Cancer Research Institute. Through that work and the work that the NIHR is doing with research councils, increased brain tumour research investment by charities drives increased support by the NIHR. Here is the challenge: our system works on the basis of bids and of accelerated funding. Once funding starts to drive clinical and academic results, that generates more funding, which drives more research. The danger in that model is that, unless that initial critical mass can be achieved, things can get squeezed out.

We have invited a number of applications for experimental cancer medicine centre status over this funding period, which are funded by the NIHR and Cancer Research UK. I am delighted to be able to announce that, on behalf of the arm’s-length bodies, NHS England will next month publish an implementation plan for the cancer taskforce strategy, “Achieving world-class cancer outcomes”. As part of one of the specific recommendations in that strategy, Public Health England is investigating how we can use new and existing data sources to identify secondary cancers and cancer progression more generally, including for brain tumours.

I hope I have demonstrated that some progress is being made, but as I have said, I do not think that progress being made is a reason not to do more; I think hon. Members have made a powerful case that we should. We formally accept that more needs to be done. The case has been made that we need to look carefully at what we can do. As the report recommends, I will be asking the NIHR to look at publishing a national register that considers how we spend public funds across research of different disease areas and different organs by therapeutic area, not least because it is a powerful way of helping to draw in co-investment from industry and charities. I shall be raising those issues with the MRC and, having recently convened the NIHR Parliament day, suggesting that at next year’s NIHR Parliament day we come back with that register and that breakdown of information.

We should look at issues around earlier diagnosis. I am prepared to announce today that we should specifically include brain cancer in the Genomics England programme, which is dealing with rare diseases and cancers, to make sure that it is properly picked up, and to talk to NICE about the point made about its guidance procedures. To pull all this together, I want to suggest that I should convene a task and finish working group in the Department of Health to touch on other issues that have been raised, including data collection, trials, off-label drugs, research barriers and skills.

I am conscious that I need to leave the sponsor of the debate a few seconds to close, but I hope that colleagues will see in my response that I have tried both to give patients some hope that we are listening and to strike a blow for good democracy, as well as good medical research.