Children with Life-limiting Conditions

Jim Shannon Excerpts

Tuesday 29th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered support for children with life-limiting and life-threatening conditions and their families.

I am conscious that other people want to speak, so I will limit my time and give them a chance to contribute, Ms Dorries. I am pleased to see the Minister in her place. I spoke to her last week and before today’s debate. I thank the Backbench Business Committee for selecting this important debate and the Minister for her attendance. I also thank everyone who is here to speak on behalf of their constituents. This matter is not for my constituency alone; it needs to be addressed UK-wide in a co-ordinated manner. As for the magnitude of the issue, 49,000 babies, children and young people live in the UK with health conditions that are life-limiting or life-threatening, and the number is rising. There are 40,000 in England alone.

I have three wonderful children and three perfect grandchildren. They are the best in the world, but every grandparent probably thinks that about their grandchildren. Hearing the news that one’s child has a life-limiting condition and is likely to die young is devastating. My heart always goes out to those who hear such dreadful news. The children have complex and unpredictable conditions and often need round-the-clock care seven days a week. Families have to cope with the knowledge that their child will die before them, and daily life for the whole family can become extremely challenging.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I thank the hon. Gentleman for giving way and congratulate him on securing this debate. Will he join me in praising the children’s hospice movement, including Tŷ Hafan, which serves my constituency in south Wales, for their excellent work in providing care not only for the children but for the families who need support?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. He is absolutely right. By the way, several of today’s speakers applied for this debate along with me and I thank them also. Hospice care is important and I thank the hon. Gentleman for his contribution. Every one of us knows the role that hospices play in the lives of those who need help at a very difficult time. Although there are many excellent services, many families still have difficulty accessing the care and support that they need, which is why hospices are important.

Children with life-threatening conditions need palliative care from when their condition is diagnosed or recognised until the end of their lives. Families also need care and support throughout the trajectory of their child’s illness, including bereavement care after they have passed away. Palliative care for children includes, but is not limited to end-of-life care, and the two terms should not be used interchangeably.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. Gentleman recognise, as highlighted by CLIC Sargent, the financial cost? It might be the last thing that people think about when everything else is going on, but there is a huge financial cost. The costs associated with cancer treatment are estimated to be around £600 a month extra, and the travel costs are on average £180 per family. For some people that is a huge amount of money.

[Jim Shannon]

I thank the right hon. Gentleman for his intervention and reiterate the point he has made. The financial implications, restrictions and pressures are important. I know CLIC Sargent well. It does massive fundraising in my constituency and elsewhere. I appreciate its work immensely.

Children’s palliative care providers offer a range of services, including supporting families to manage their children’s pain and distressing symptoms; providing children and their families with lifeline short breaks; and offering bereavement support both before and after the child has passed away. Families want to be able to choose where they receive the lifeline children’s palliative care services that they rely on when they need and want them. They also want to choose who cares for their child and which treatments they receive.

Along with others, I am a vice-chair of the all-party group for children who need palliative care. We seek to educate, inform and motivate parliamentarians to take action to help transform the lives of children and young people with life-limiting and life-threatening conditions across the United Kingdom of Great Britain and Northern Ireland. We are supported to do so by our secretariat, Together for Short Lives, the UK’s leading charity for the 49,000 children living with life-limiting conditions and their families. In November 2017, the all-party group began a Select Committee-style inquiry into the extent to which the Government are meeting their choice in end-of-life care commitment for babies, children and young people. The Government are clear that that commitment applies to people of all ages who need palliative care. The commitment explicitly states:

“To support high quality personalised care for children and young people, commissioners and providers of services must prioritise children’s palliative care in their strategic planning”.

Prioritising children’s palliative care in strategic planning is so important.

In a report last October, the all-party group published what we found and what action we recommend as a result of our inquiry. Despite the end-of-life care commitment, the APPG has heard evidence from young people, families, services and professionals that the quality of palliative care that children and families can access is patchy—the reason for today’s debate—and depends on what part of England they live in. MPs and peers have stated that that is unfair and represents a wholly unjustified health inequality.

The APPG highlighted five areas of particular concern where many children and their families have limited access. The first is children’s palliative care out of hours and at weekends. They also need short breaks and respite. As MPs we know these things, but the respite that is needed is so important to give parents a break. Age-appropriate palliative care and smooth transitions to adult services must be smoother, simpler and less stressful. Specialist children’s palliative care teams led by level 4 consultants are needed, and we need advance care planning. Those five barriers explain why the Government's choice commitment is at serious risk of not being met, which is why we are having this debate.

I am very pleased to see the Minister and the shadow Minister in their places. I know they both understand the issues. That certainly came out in my discussions with the Minister last week. Today we hope to hear the responses that we need to satisfy our concerns.

The first area of concern is leadership and accountability. Almost half—46%—of clinical commissioning groups are failing to implement the Government’s choice in end-of-life care commitment and have no plans to do so, which is disappointing, but there are reasons for it. Only a third of CCGs responded that they are implementing the guidance, and a further 19% stated that their plans to do so are in development. Consequently, will the Government and NHS England consider appropriate mechanisms to bridge the children’s palliative care accountability gap? Furthermore, will the Government develop a system to monitor how sustainability and transformation partnerships, integrated care systems, CCGs and local authorities are supporting children’s palliative care in accordance with their legal duties? That is very important. Will the Government develop outcome indicators that measure the extent to which children with life-limiting conditions and their families can make choices about the palliative care that they receive? If so, will they reflect the outcomes set out in the National Institute for Health and Care Excellence quality standard for end-of-life care for infants, children and young people?

The second area concerns clarity. Will the Minister work with her colleagues at the Department for Education and NHS England to write to STPs, ICSs, CCGs and local authorities to clarify which parts of the health and care system in England are responsible for commissioning palliative care for children and young people aged 0 to 25? We always go on about data, but data is important to get a strategy that works. It is vital to make it clear who is responsible for commissioning short breaks and specialised children’s palliative care, as described by NHS England.

The third area is funding. Unfortunately, there has been a downward spiral in the trajectory of funding: 22% in 2016-17 and 2015-16 compared with 23% in 2014-15 and 27% in 2013-14. That downward trend worries us greatly. There was a wide range in the state’s contributions to voluntary care sector children’s palliative care providers’ charitable costs in 2015-16. The maximum contribution received by a charity in 2015-16 was more than half and the lowest was 2%. Like other members of the APPG, I was therefore pleased to welcome NHS England’s recent decision to commit to funding children’s palliative care in the long-term plan. However, I want to highlight the mismatch in the two announcements that NHS England made.

On 27 December, NHS England announced that up to £18 million would be available to children’s hospices through the long-term plan, of which £7 million would depend upon CCGs contributing another £7 million through match funding, which is fair enough, taking the total to £25 million. Yet in paragraph 3.41 of the plan, published on 7 January, NHS England said that the £25 million would be for local children’s palliative and end-of-life care services, including children’s hospices. Does the Minister recognise that the two NHS England announcements were confusing, and can she clarify whether the £25 million will be for children’s hospices only, or a wider group of services? We need answers to those points. I gave the Minister advance notice of all my questions. It was almost the highest number of questions I have ever asked a Minister at one time, even though I ask a lot of questions.

Can the Minister guarantee that the £11 million children’s hospice grant will be protected and increased as a result of the long-term plan, to reflect the growing demand and the complexity of care provided by those lifeline services, and will she guarantee that total NHS funding for children’s palliative care will not fall as a result of the long-term plan? Will she also monitor the amount of money that NHS England, clinical commissioning groups and local authorities are contributing to children and adult hospice and palliative care charities? If so, will she ensure that they bring about parity in the state’s percentage contribution to their charitable costs?

I often refer to the Scottish Government—in the best of terms, as well. I note that they have committed to bringing about parity and funding 50% of the agreed charitable costs of children’s hospices across Scotland. They often set the bar, and set an example for the rest of us to try to achieve. I know that my hon. Friends from the Scottish National party will speak to that, and I look forward to their contributions.

The funding challenges are being exacerbated by the Government’s decision not to provide voluntary sector providers that do not apply “Agenda for Change” pay and conditions with financial support in order to mitigate the recent pay rise for non-clinical NHS staff. Will the Minister provide financial support to help voluntary sector children’s palliative care providers, including children’s hospices that do not apply “Agenda for Change” pay and conditions, to mitigate that recent pay rise?

We have to mention the Government’s proposal to increase the proportion that employers need to contribute to the NHS pension scheme from 14.9% to 20.9%. That will also lead to children’s hospices incurring significant costs. I say very gently that there is an imbalance in what is happening. Although the cost of the increases for NHS organisations will be met by the Government through additional funding, the potential additional costs for charitable hospices will not be.

Children’s hospices are faced with the puzzling situation where NHS England is giving them more money with one hand while, through the pension scheme changes, the Government are taking it away with the other. We all have concerns about that. Will the Minister meet the significant costs that children’s hospices will incur as a result of the Government’s proposal to increase the employers’ contribution to the NHS pension scheme?

The APPG believes that the Government and NHS England should go further to ensure that children’s palliative care provided by the statutory sector, in hospitals and in the community, is funded equitably and sustainably in England. The National Institute for Health and Care Excellence calculates that by investing £12.7 million in implementing its guideline on children’s palliative care, non-cash savings worth £34.7 million would be released back into the NHS. Mathematics is not one of my stronger points, but it seems logical to do that. Will the Minister undertake a review of the palliative care available to children with life-limiting conditions in England as a matter of urgency, and will she develop a funded, cross-departmental children’s palliative care strategy for achieving better outcomes for children and families across the statutory and voluntary sectors?

There are too few professionals with the skills, knowledge and experience to provide children’s palliative care in hospitals, children’s hospices and the community. Those who are skilled, and have the ability and opportunity, do wonderful work. Will the Minister set out the steps that she is taking to develop and advance care plans with families? Shortages in children’s nurses, and generally in children’s palliative care, are particularly acute.

The final area is integration. Single, joined-up education, health and care assessments, plans and personal budgets for children and young people up to the age of 25 are available only to those who have a special educational need. The APPG is also unclear on how the Government’s approach to personalising palliative care for children and young people, which is underpinned by joint plans and budgets, correlates with the special educational needs and disabilities system. That is tremendously important to us all. I should be grateful if the Minister would tell us whether she plans to ensure that all 40,000 babies, children and young people in England with life-limiting or life-threatening conditions have the right to an integrated assessment, plan and personal budget.

Will the Minister commission a review of health and social care law, to strengthen and clarify rights and entitlements for disabled children and their families, including children with life-limiting conditions? That would help to bring about more integrated assessments and plans. Will she invest in supporting work to develop children’s palliative care managed clinical networks across England?

[Mark Tami]

The hon. Gentleman makes an important point. Does he agree that the Government need to speed up, and that they cannot apply the general criteria that they apply to everyone else? Those parents, those families, and those children need support straightaway, not after waiting for weeks—sometimes months.

[Jim Shannon]

I thank the right hon. Gentleman for his intervention and his wise words. I absolutely agree that we need to implement right away the response that families need. He is right: one size does not fit all. Every person’s case and circumstances are unique, so we need to respond with something that fits, quickly.

If not quickly met by the Government, those challenges will threaten Ministers’ ability to meet their end-of-life care choice commitment for children by 2020. We have to work to that timescale. We need that response to do away with the patchiness; there are parts where the Government are doing well and families get help, and other parts where they do not. I know that the Minister is committed to that, and hopefully her response will be helpful to all of us who are asking these questions.

We urge the Government to work with the APPG, and interested bodies and charitable groups, to implement the APPG’s recommendations. There has already been progress in the past few weeks. That is good news, and we are pleased about that. NHS England has decided to recognise children’s palliative care as an important priority in the NHS long-term plan.

I commend the Government, I commend the Minister for her commitment to the strategy, and I commend Health Ministers for the Department’s commitment to addressing health, and spending money on it. That is good news. Nobody in this House would not welcome that. I very much welcome it. Will the Minister assess the extent to which the NHS treats children’s palliative care as a priority, as it commits to in the long-term plan, and if so, how? Will she tell us a wee bit about how that long-term strategy and plan will work?

I think it is the hon. Member for Vauxhall (Kate Hoey) who says, “Jim Shannon gets more words into a minute than any other MP.” I am not sure that I have given my four-minute speech in one minute, but I have tried to compress what I wanted to say, and I gave the Minister my questions beforehand. There are hon. Members present who have a real knowledge of the subject matter. It is so important that we hear all their opinions as well.

I ask the Minister to update us on the progress that the Government are making in responding to all the APPG’s recommendations. I very much look forward to hearing her response. These children need help. The report is clear, and now we need to be clear on how the Government can and will make changes to ensure that these short lives, and the lives of loved family members, can be better. Sometimes we see only the child; we also have to see the families. I think the right hon. Member for Alyn and Deeside (Mark Tami) referred to that in his intervention. It is so important that we reach out and help. Our job as MPs is to do just that. We look to the Minister for the response that we all want.

[Several hon. Members rose—]

--- Later in debate ---

[Jim Shannon]

I thank you, Ms Dorries, for enabling all Members to speak today, and I thank the 17 right hon. and hon. Members who have spoken for their personal and incredible contributions, which came from every region of Great Britain and Northern Ireland. Their constituents should be proud of their elected representatives who made such significant contributions to the debate. I thank the Minister for her compassionate and understanding response, and for her obvious interest in and commitment to improving the situation. The meetings that she will hold will be an indication of how that goes. Today this House shone a light on an issue that has united us. Is it too much to hope that before the day is out, we may unite on other things as well?

Question put and agreed to.

Resolved,

That this House has considered support for children with life-limiting and life-threatening conditions and their families.

Cervical Cancer Smear Tests

Jim Shannon Excerpts

Monday 28th January 2019 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 225767 relating to lowering the age for smear tests for cervical cancer from 25 to 18.

It is a great pleasure to serve under your chairmanship, Sir Roger. Before I move to the substance of the debate, I want to say a little about the woman who started the petition, Natasha Sale. She died on 28 December last year. She was 31 and left four children. I have spoken to her friends this afternoon, and I think Natasha must have been a remarkable person, because it takes a remarkable person to decide, when they have a terminal diagnosis, that they will use their time to help others rather than to bemoan their fate. That is what Natasha did. In her petition, she said that

“it’s too late for me but it’s not too late for the next generation”.

I thank her family and friends, who encouraged people to sign the petition to get the debate today. I particularly thank Natasha’s family, who have kindly said they are happy with the debate going ahead. That, too, takes courage, and I am grateful to them.

Cervical cancer is something that all women fear. Like breast cancer, it strikes at the heart of how we see ourselves and how we define ourselves as women. Because of that, screening programmes have been introduced in this country. In fact, screening is changing so that women will be tested for the human papillomavirus before they get cervical screening, because most but not all cervical cancers are caused by HPV. Screening is currently on offer only to women between the ages of 25 and 64. Those between 25 and 49 are called every three years and those from 50 upwards are called every five years, yet the reasoning behind that offer is perhaps not often understood. Before the age of 25, not only is such cancer very rare, but changes in the cervix are very common. A test can produce false positives and lead to unnecessary treatment and anxiety for women.

Nevertheless, there have been repeated calls to lower the age of screening, not only in this petition, but in others, including one we received previously. In response, the Government would rightly say that the UK National Screening Committee has looked at the evidence and decided that there is no real evidence to support reducing the age of screening. Their reasoning, which is valid, is that one in three tests below that age will produce a false positive; and that, when people are given unnecessary treatment, there is a risk to future pregnancies. I hope the Government will publish the evidence on the risks of getting cervical cancer at that age and the risks from screening so that women can make an informed decision. They should publish that in a way that can be understood by people who, like me, are not doctors or scientists. The evidence is often couched in scientific jargon, which conveys very little to most of us. That is the first important thing that we want to do.

Even with that evidence published, there will always be some cases, and cases in young women can be very tragic. They can lead to the loss of a young life, and often leave children without their mother. Because the disease can be so devastating, in 2008 the then Labour Government introduced a programme of vaccination against the most virulent forms of HPV for all girls from the age of 12. In fact, for that first cohort, we vaccinated up to the age of 18 to catch up. Those who were 18 at the time will now be undergoing their first screening. If as expected the rate of cervical cancer in that age group drops, it will have been well worth while.

When the programme was introduced, I well remember MPs getting a lot of letters from parents saying they did not want their daughters vaccinated—it still happens—because they somehow saw it as encouraging promiscuity. That is not what vaccination is about. It is about vaccinating girls before they become sexually active. I hope parents will think about the risk they are putting their daughters through if they do not have the vaccinations.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for presenting the case in the petition. While the vaccine has been shown to lower incidence of cervical cancer, does she agree that cervical screening should take place as a matter of urgency, initially for those who are sexually active? The average age when sexual activity begins is 15.6 years across the United Kingdom of Great Britain and Northern Ireland. Does she agree that people cannot be allowed to wait 10 years for a first cervical smear? It must be addressed immediately.

[Helen Jones]

I will answer that point in a moment, because it is important that we look at the evidence. There will always be some cases, even among women under 25. We can never eliminate the risk completely. When that happens, it is important they get the right treatment. That is why in 2010 guidelines were published for GPs to ensure that young women who presented with abnormal symptoms were offered screening and referred on to a consultant if necessary. That does not always happen—I will come on to that in a moment.

--- Later in debate ---

[Helen Jones]

Yes, and I hope those tests will be rolled out across the rest of Britain.

On the problem of women getting access to screening services, time and again they report that they ring their GP for an appointment that is then weeks ahead. Someone I met recently told me that, in her case, it is months ahead. It can be as much as 10 weeks. All are offered appointments at times they cannot attend, perhaps because they work shifts—that applies particularly to younger women who are more likely to be in insecure employment and therefore not eager to ask for time off.

I do not know why we persist in this, but very often the comments on screening give the impression that someone is saying, “These stupid women are not going for their screening.” Actually, there is a problem of access. I remember when we had mobile breast cancer screening units that came to a place of work. I got my blood pressure tested in the middle of Warrington shopping centre because the hospital had a programme to encourage people to go for testing in case they were at risk of vascular disease. Why can we not do more to take cervical screening to places where women are? Why can they not be screened in the workplace, for example, where groups of women are much more likely to say, “Come on! We will all go together”? It is not beyond the wit of man to arrange that.

[Jim Shannon]

Will the hon. Lady give way?

[Helen Jones]

I will give way one more time and then I must make some progress.

[Jim Shannon]

Constituents have expressed concerns to me on two issues: first, that it is very painful; and secondly that it is embarrassing. When it comes to giving peace of mind to ladies going for cervical cancer screening at whatever age, it is very important that the doctors and GPs are involved at an early stage to put their minds at rest. The importance of cervical cancer screening cannot be underlined enough, but the ladies need to be assured of not having the pain and embarrassment, which is a big task for the NHS.

[Helen Jones]

The hon. Gentleman is right. Women need to be assured that they will be treated sympathetically, whatever their age. All of us who have been to screening know that sometimes it is fine, but sometimes someone is a bit ham-fisted and it is not fine. It is better than getting cancer.

Another issue needs tackling: when women under 25 present with abnormal symptoms such as abnormal vaginal bleeding, they are not always treated according to the guidelines. In fact, they are frequently not treated according to guidelines. There are plenty of examples of younger women going to their GP with symptoms and being told they are too young for cervical screening, and plenty of examples of women going time and again and, as one lady told me earlier, being fobbed off. The problem is that GPs do not see a lot of cases and cervical cancer is therefore not the first thing they think of. The Government must do more to alert GPs to the possibility of cancer to get early diagnosis and ensure that people are referred to consultants where necessary.

Appropriate ME Treatment

Jim Shannon Excerpts

Thursday 24th January 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing this debate. She has been a champion for those who suffer from ME. We thank her for all her efforts, and are here to support her.

I have had the pleasure of meeting a lady in my constituency who is attempting to cope with her illness. She is also a champion for raising awareness and changing how those who suffer from ME are dealt with—I say “suffer”, because the lady I met certainly suffers. It is estimated that ME affects some 25,000 children in the UK, and it is said to be the leading cause of long-term school sickness absence in the UK. Given the stigma that people with ME face, families will continue to meet accusations of misconduct and withholding support. What is being done to help those 25,000 children?

We urgently need to update the training of GPs and medical professionals, so that they are equipped with clear guidance for a diagnosis of ME, and can give advice and guidance on appropriate management to reflect international consensus on best practice. In addition, all commissioning bodies must ensure that medical, welfare and care services are accessible to people with ME, including home visits for those severely affected.

As the hon. Member for Glasgow North West said, not much has changed. I still have constituents with ME who are turned down for the personal independence payment, even though they are unable to leave the house for 29 days in a month. People are removed from employment and support allowance and told to go to job interviews, even if they cannot manage to stand in the shower, let alone leave the house or get a job. It is time to move past the idea that if something cannot be tested it cannot be helped.

This debilitating illness takes its toll on men, women and children throughout the United Kingdom of Great Britain and Northern Ireland, and we simply must do better by them. I would appreciate a response from the Minister on whether there are any plans to do better. If such plans are not in place, when will they be introduced? The 400 sufferers of ME in my constituency request such plans—indeed, they demand them.

Mental Health First Aid in the Workplace

Jim Shannon Excerpts

Thursday 17th January 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on securing this debate, and I thank her for setting the scene so well. I thank right hon. and hon. Members from all parts of the Chamber for their valuable contributions. I echo the comments of others in the Chamber about what a joy it is to have a debate on a subject on which we can all agree. We agree on the strategy and the way forward. I am reminded of the programme I watch on a Sunday night—“Call the Midwife”. Perhaps others watch it, too. There is always a real tragedy at the beginning of the programme, but at the end, things always turn out well. I hope that Brexit turns out the same. We will see how it goes.

Most of us in the Chamber have a good understanding of the impact that mental health issues have on people’s emotional and physical state. In the short term, mental health problems alter personality traits and the behaviour of individuals. In the long term, they can lead to suicidal thoughts. In the worst-case scenario, they can eventually drive a person to commit suicide. There were 318 suicides registered in Northern Ireland in 2015, which was the highest since records began in 1970. People often have trouble coping with mental health issues, which of course will translate into their work life. Mental health cannot be compartmentalised. That is not the key to working and living with mental health problems.

[Mr Kevan Jones]

It is too tempting not to intervene on the hon. Gentleman. Is he aware—I am sure he is—that Northern Ireland has a particular issue? When I was a Minister in the Ministry of Defence, I was shocked to see that even though the violence of the troubles was 20 or 30 years ago, there is still a legacy of mental illness from those times.

[Jim Shannon]

The right hon. Gentleman has obviously had sight of my notes, because I was going to refer to that point later. He is absolutely right. The 30-year terrorist campaign has a legacy, and it affects us. I will mention that in my comments.

When I was first elected in 2010, I took in a new part of my constituency, Ballynahinch, which I very quickly found out had some serious problems in relation to suicides. They were mostly among young people, and unfortunately they seemed to be cluster suicides, if I can use that terminology. A number of young people took their lives, but the community very quickly reacted in Killyleagh and Ballynahinch. Church groups, community groups and interested individuals came together and addressed those issues. With Government Departments, they helped to reduce the level of suicides. It was particularly stressful to be confronted with that as an MP so early in his parliamentary term.

One in six workers suffer from anxiety, depression and unmanageable stress each year, causing 74% of people with a mental health problem to take more than a year out of work. In 2015, 18 million days were lost to sickness absence caused by mental health conditions. Mental health issues affect both the work and the lifestyle of countless people. Urgent action must be taken to educate employers about the difficulties that result from mental illnesses, mainly to help those who are struggling in the workplace but also to benefit those employers, for whom that may mean cost outlays. It follows that not only is a happier worker a more productive worker, but there should be a natural decrease in sickness periods. Other Members have mentioned that.

If employers are to take steps to promote and improve people’s wellbeing in their workplaces, they need to be able to identify an instance in which someone may be struggling with mental health problems, but it is not always easy to do so. I understand that, because I have talked to many people who seem to be smiley, jokey and happy, and may be the life and soul of the party, but when they go home they are very different. Sometimes we do not really know what is happening. In the workplace, there needs to be someone who can see through the façade to the real person underneath.

Some 49% of workers said that they would not be comfortable disclosing a mental health issue at work. Others in the workplace should be educated to ensure that they can recognise individuals who are dealing with such problems. They should be trained in mental health issues—and that should include mental health first aid—so that the workplace can become a positive environment.

Given that two in five employers admit that they have seen a rise in mental health problems, it is important for workplaces to foster a culture of support and openness for those needing help, making them feel reassured about seeking assistance from fellow employees. The Scottish Association for Mental Health, backed by the Scottish Government, has adopted a programme on physical activity. I can say with all honesty and sincerity that the Scottish Government, and their Health Department in particular, lead on health issues in general, including mental health issues. I know that the hon. Member for Glasgow South West (Chris Stephens) will probably mention this, but I think it important for us to recognise good practice wherever it may be, and I hope that we can replicate it in other parts of the United Kingdom of Great Britain and Northern Ireland. Better together, that is what I always say.

I believe that the Department for Work and Pensions must take the lead, and that all workplaces should be supplied with a mental health toolkit as standard practice. It should be issued not just to those who request it, but to all who are paying tax for a business. That could be modelled on the content of the current publications by Public Health England, Business in the Community and the Samaritans—what a good job they do to address these issues. Every one of us will know what really tremendous work they do in our constituencies, and I cannot praise the volunteers highly enough. To engage employers to participate in initiatives such as “Time to Change” and be educated further on the subject of mental health, there must be a move from the Department, and help must be garnered from it.

It has been suggested that as well as becoming involved with mental health organisations, companies should review their absence policies and make keeping-in-touch arrangements, as evidence suggests that 12.7% of all sickness absence days in the UK can be attributed to mental health conditions. There must be tools to enable employers to create an employee assistance programme. I have read research indicating that in the few businesses that use such a programme, 25% of employees say that their organisation encourages staff to talk openly about their mental health issues. Research shows that the more people do that, the easier it becomes to deal with their problems. We are always hearing that “it’s good to talk”, and that is so true, but many of the people we meet may not have anyone to talk to.

Such programmes not only help the individuals who are suffering with mental health problems, but benefit companies. Better mental health support in the workplace can save UK businesses up to £8 billion per year. If we do the job right we can save money, and so can the businesses, because they will have a happier and more productive workforce.

Three quarters of all mental health problems are established by the age of 24, when people are entering long-term careers. That is another factor that we should recognise at that early stage. As many as 300,000 people a year lose their jobs because companies are not sure how to provide the help and support that they need. In the past year, 74% of people have felt stressed as they have been overwhelmed or unable to cope owing to the demands of their career. Managers should be able to spot the signs of common mental health conditions, but that happens only when they receive dedicated training. Others have referred to the need for such knowledge of what is happening. Many managers are blind to, or uneducated about, the symptoms of mental illnesses, and it is all too easy in the busy working world to be consumed by a goal and not to see the elements that are in play around us. We would never send an engineer into a dangerous environment without the necessary training, so why should we assume that companies can automatically notice when an employee’s health is plummeting?

I am sure that you, Mr Deputy Speaker, are like the rest of us in this regard: we often eat at our desks. However, that does not mean that everyone else has to do it. We have to recognise that sometimes it is good to get away from our desks and go for a walk, and have our minds on other things for a time. The benefits of regular breaks and eating lunch away from desks, and creating a positive workplace state of mind, should be promoted to those who have a busy life and seek to cram things into every second at the risk of their mental health.

As we heard a moment ago from the right hon. Member for North Durham (Mr Jones), Northern Ireland in particular is struggling with the issue of mental health owing to a lack of resources. When compared with 17 other countries, Northern Ireland was shown to have the second highest rates of mental health illness, 25% higher than those in England. That is certainly largely due to 30 years of the troubles and the legacy of the terrorist campaign, but it is more than that. We must address those issues and do better in enabling people to lead high-quality lives with the tools to handle stress and daily life. A massive step in that regard would be creating mental first aid as standard in workplaces.

Workplace mental ill health costs employers about £26 billion a year, and many places are struggling to find the large amount of money that is needed to improve their awareness of mental health. A report for the NHS found that mental illness accounts for nearly half of all ill health in people younger than 65, and that only a quarter of people in need of treatment currently get it.

This is a health issue, but it is important for four Departments to come together with a strategy, because it is not just about health. It should also involve the DWP, the Department for Education and the Department for Business, Energy and Industrial Strategy. Companies need to be given more support and funds, as does the NHS to help those who are suffering in the long term, as it is currently unable to provide the materials needed. Action needs to be taken, because the number of sick days due to mental health issues is increasing rapidly owing to negative work environments: 89% of employees with mental health problems say that it affects their work lives hugely. That needs to change, for the betterment not only of business and the economy but of those who are struggling with mental health issues.

I look forward to the comments of both the Minister and the shadow Minister. I am convinced—as, I think, is everyone in the Chamber—that we shall hear a positive and helpful response from the Minister.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 15th January 2019 Commons Chamber

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

[Jim Shannon (Strangford) (DUP)]

With recent Northern Ireland figures showing that at least 25% of young people and 40% of teens are classed as overweight or obese, will the Minister outline what cross-departmental discussions have taken place on the strategies to improve the health of young people through co-ordination and interaction with parents and the provision of healthy eating schemes?

[Steve Brine]

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

Cancer Workforce and Early Diagnosis

Jim Shannon Excerpts

Tuesday 8th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate, and for giving us the opportunity to discuss this important issue. I am the Democratic Unionist party spokesperson on health, so such matters are at the top of the tree for me. I am pleased that the Minister and shadow Minister are here to respond to our concerns, and we appreciate the Backbench Business Committee kindly granting us this debate.

Cancer is a word I hate; it is a disease I hate. A respecter of no person, it indiscriminately attacks and takes from us those who we love and rely on. I truly believe that a cure must be found and found soon for this dreaded disease, but while that work is taking place, we must focus on the best use of the limited resources available. I congratulate the Government on their NHS 10-year plan and their commitment to a cancer strategy within it.

As hon. Members have said, we all have family members and friends who have been stricken by cancer. I have a good friend who will have breast cancer surgery on Friday, and my father survived cancer on three occasions due to the expertise of the surgeon, the nurse’s care and, critically, the prayer of God’s people. My hon. Friend the Member for Upper Bann (David Simpson) referred to the bowel cancer testing kit in Northern Ireland, and probably because of my father’s history, I carry out screening with that kit every year, and therefore I would know early on whether any cancer has been detected. That is what we are doing in Northern Ireland, and hopefully it is something that other parts of the United Kingdom can take on board.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that, given the almost universal acceptance of the importance of early detection, the long-term plan, like any other plan, will be judged against an increase in early detection? That is the key.

[Jim Shannon]

I agree wholeheartedly with my hon. Friend and colleague, and although many people are dying from cancer, a larger number are surviving that diagnosis.

I wish to thank the tremendous staff who work well above their paygrade and the hours they are paid to make a difference to the quality of care and support for cancer sufferers. I also thank the wonderful charities that aim to step into the breach where at all possible. We all know of such charities, and if I do not mention some of them that does not make them any less important. Many charities, including Marie Curie, do tremendous work.

Macmillan Cancer Support is an amazing charity. In 2017, it had more than 5,700 nurses supporting 658,000 people, with a further 2,000 healthcare professionals throughout the United Kingdom. In 2017, 1.6 million people received personal, high-impact support from one or more Macmillan professionals or services. While broadly welcoming the Government scheme, Macmillan has expressed serious concerns that the plan does not adequately address the immediate and longer-term pressures facing the NHS cancer workforce. Those concerns are put forward in a constructive fashion, as they should be:

“The NHS long-term plan makes clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the HEE budget has yet to be set by the Government. This is a key priority and must be urgently addressed. The plan states that there will be a separate Workforce Implementation Plan in 2019, but more detail is needed about the timeframes, and how the implementation plan relates to the long-promised phase 2 HEE plan on the cancer workforce. It is essential that we build on the ambitious foundations of the NHS long-term plan and put in place a fully-funded strategy for the workforce that will deliver truly world-class cancer care.”

That is what Macmillan Cancer Support expressed before this debate. Perhaps the Minister will respond to those points.

I agree with the sentiments expressed by Macmillan, and more detail is needed to deal with funding gaps to address the issue of speed of diagnosis in quick-moving cancers such as pancreatic cancer. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Bristol West (Thangam Debbonaire) spoke about early diagnosis, and nearly every Member who has spoken in the debate has said it is critical—and so it is. Pancreatic cancer is the quickest-killing cancer, with one in four people dying within a month, so we need a faster pathway to diagnose and treat it, as the hon. Member for Scunthorpe (Nic Dakin), who is particularly interested in it, will know. Early diagnosis is essential in the case of pancreatic cancer, as it offers the only chance for potentially curative surgery. However, fewer than 20% of people with pancreatic cancer are diagnosed at an early stage, and fewer than 10% will receive surgery. The capacity does not currently exist, and there must be an increase in the cancer workforce to ensure timely diagnosis and treatment. Every Member who has spoken in the debate has supported the point of view expressed by Macmillan, and it is critically important.

Prostate cancer has been mentioned. When men are ill we are, by our nature, the illest people in the world, but sometimes we just do not know when we are ill. I make that point in relation to prostate cancer because we do not do the checks, although we know what has to be done. Needing the toilet more frequently, a burning sensation and passing blood are some of the symptoms, and men perhaps need to look out more for them. We need to raise awareness of prostate cancer. To be fair, I think that the Government do that, but perhaps there is a need to do more.

I hope I will be forgiven for repeating some comments that have been made, but these issues are important. The hon. Member for Bristol West referred to CLIC Sargent, and I want to make some comments on children’s cancers. CLIC Sargent is a wonderful charity and has asked me to use this opportunity to stress something that shocked me when I first read it, and which underlines the point about the workforce. Children make up the highest proportion of cancer patients diagnosed through emergency admissions, and many young people and parents have a poor experience of diagnosis. The 2016 “Best Chance from the Start” research report on experiences of diagnosis found that more than half of young people and almost half of parents had visited their GP at least three times before the cancer diagnosis.

As the hon. Member for Bristol West said, there is a particular need for early diagnosis for children. Nearly half of young people felt their GP did not take their concerns seriously. I do not think that is a criticism; it is how they felt. A third of parents felt that their GP did not take into account their knowledge of their child. We should not ignore what parents know and say about their child. It is important to do something to raise GPs’ awareness in relation to children. Just over a third of young people and a quarter of parents felt that their GP did not have enough time to listen to them talk about their symptoms. I want to ask the Minister what has been done about that. I am mindful of the pressure on GPs, who have a lot of work to do. However, something needs to happen for children diagnosed with cancer and their parents. Like the hon. Member for Bristol West, I am requesting that something be done. The urgent change that is needed can be achieved only through funding to take the pressure off diagnostics, allowing GPs to refer before the third repeat visit. They must be allowed to go with their gut and send anything suspicious to be tested further, rather than playing a numbers and probability game. Cancer does not respect the numbers game—it strikes where it might be least expected.

This is my last paragraph, Mr Howarth. Time has beaten me. I heartily welcome the strategy, but we need more detail and more action, and soon, to make a difference, and so that we can make a worthwhile attack on the plague of cancer, which affects families throughout the United Kingdom. That is why the debate is so important.

Leaving the EU: Tobacco Products and Public Health

Jim Shannon Excerpts

Monday 7th January 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Happy new year, Mr Deputy Speaker.

I beg to move,

That the draft Tobacco Products and Nicotine Inhaling Products (Amendment etc.) (EU Exit) Regulations 2018, which were laid before this House on 1 November, be approved.

Smoking causes 78,000 deaths a year in England, accounting for 16% of all deaths annually. The United Kingdom is a global leader in tobacco control and the Government are committed to ensuring that we remain so after we leave the European Union. As hon. Members know, the Government have negotiated a deal with the EU and are in the process of taking it through Parliament. As has been much discussed, the deal is designed to secure a smooth and orderly exit from the EU. At the same time, it is of course the job of a responsible Government—I am pleased to say that the shadow Leader of the House is listening intently—to prepare for all possible scenarios. We are committed to ensuring that our legislation and policy function effectively in the event of no deal. It is for this scenario that these regulations have been laid. If the UK reaches a deal with the EU, the Department will revoke or amend this instrument to reflect that agreement.

This instrument will ensure that the UK domestic legislation that implements the two main pieces of EU tobacco legislation—the tobacco products directive and the tobacco advertising directive—continue to function effectively after exit day at the end of March. The instrument also amends and revokes some EU tertiary legislation that will no longer apply to the UK after our withdrawal. The amendments and revocations are being made under the European Union (Withdrawal) Act 2018 and are necessary in order to correct deficiencies in the UK and EU legislation in the event of no deal. The primary purpose of this instrument is to ensure that tobacco control legislation continues to function effectively after exit day. These proposed amendments are critical to ensure that there is minimal disruption to tobacco control if we do not reach a deal with the European Union.

This instrument introduces three main changes. First, in the event of no deal, the UK will need to develop its own domestic notification systems for companies that wish to sell tobacco products and e-cigarettes on the UK market. The notification process is essential for ensuring that companies are complying with legislation on product standards. Public Health England and the Medicines and Healthcare Products Regulatory Agency have already commenced work to ensure that domestic notification systems are in place and functional by exit day.

Secondly, in the event of no deal, the UK will not hold copyright to the EU library of picture warnings for tobacco products. Requiring the industry to continue to use these pictures would breach copyright law. Picture warnings are a key part of tobacco control, and it is therefore extremely important that we continue to require the inclusion of graphic picture warnings on tobacco products. The UK has therefore recently signed an agreement with the Australian Government to obtain their picture warnings free of cost—who knew, Madam Deputy Speaker? This agreement covers all copyright issues. I am very grateful to the Australian Government for their assistance in this matter. Action on Smoking and Health supports the proposals on notification systems and on the picture warnings as

“pragmatic and practical, minimising the amount of additional work involved if there were to be a no deal Brexit.”

Thirdly, this instrument proposes a transfer of powers. Currently, the Commission holds a range of powers under the tobacco products directive that enable it to respond to emerging threats, changing safety and quality standards, and technological advances. This instrument transfers these powers from the Commission to the Secretary of State. It should be noted that all powers in this category relate to technical, scientific and administrative adjustments that may be necessary to respond to changing circumstances in this space.

This instrument will have some impact on the tobacco and e-cigarette industry—there is no getting away from that. My Department ran a short technical consultation in October to seek feedback on the practical issues that will affect the industry in a no-deal situation. It focused on picture warnings and the notification process that I have outlined. We received 32 responses and have welcomed practical feedback on the issues highlighted in the consultation. Tobacco control stakeholders expressed support for the continued use of picture warnings as an effective way of stopping people smoking. They also showed support for the proposals to amend the notification system for e-cigarette and tobacco products as a means of harm reduction. The tobacco industry raised concerns around the timing of implementation and cost, primarily in relation to the changes to picture warnings. The Department has consulted with external experts who confirmed that the timescale for industry to implement these changes would be difficult but certainly manageable. To support industry with these changes, the Department intends to publish detailed guidance later this month.

Let me say a word on the devolved Administrations. It is important to note that the DAs have provided their consent for the elements of the instrument that are considered to be devolved. Furthermore, we have engaged positively with them throughout the development of this instrument. This ongoing engagement has been warmly welcomed. I want to place that on the record for our friends in the devolved Administrations.

In conclusion—

[Jim Shannon (Strangford) (DUP)]

Will the Minister give way?

[Steve Brine]

In conclusion, Madam Deputy Speaker, taking my lead from your look—Members will have a chance to contribute—this instrument constitutes a necessary measure to ensure that our tobacco control regulations continue to work effectively after exit day. I should, however, emphasise that, due to the instrument being made under the withdrawal Act, the scope of the amendments in the instrument is limited to achieving that objective. Therefore, at an appropriate point in the future, the Department will review where the UK’s exit from the EU offers us opportunities to reappraise current regulation to ensure that we continue to protect the nation’s health. That is timely on this day of all days, when we have published our long-term plan.

I urge Members to support the instrument, to ensure the continuation of effective tobacco control and harm reduction. I commend the regulations to the House.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I will be succinct, Madam Deputy Speaker. I just have a couple of quick questions for the Minister, but first let me say that I welcome the regulations.

Before recess, I asked the Minister a number of questions that came from the tobacco sector itself. Has he had any contact with the sector to seek its opinion on proposed legislation to ensure that what is put forward reflects its point of view?

The Minister referred to the devolved Administrations. I am ever mindful of the current situation in Northern Ireland, which I hope will change. We have a non-functioning Assembly, which means that the responsibility for the administration of legislation falls on the permanent secretary and civil servants. Will that be done through a statutory instrument, so that the permanent secretary can make a decision? Legislation passed in this place last year on the Northern Ireland Assembly gives the permanent secretary the authority to make a legislative change. I just want to be sure about how that will work in Northern Ireland.

Madam Deputy Speaker, those are my succinct comments.

NHS Long-term Plan

Jim Shannon Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Yes, it was a joy to make that visit. We found ourselves in a new medical school in a room where the students were enjoying a dissection—my goodness, after a night without sleep it was quite a thing. It was a joy to go there with my hon. Friend and I agree with both the points she made.

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the Secretary of State on the NHS 10-year long-term plan. There are between 6,000 and 8,000 rare diseases. One in 17 people, or 6% of the population, will be affected by a rare disease in their lifetime—that is 3.5 million people in the United Kingdom. Will he confirm a commitment to assisting those with rare diseases, and can the NICE process for new life-saving drugs be urgently speeded up so that more lives can be lightened and saved?

[Matt Hancock]

I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.

Mental Capacity (Amendment) Bill [Lords]

Jim Shannon Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to follow the right hon. Member for North Norfolk (Norman Lamb), who has such expertise in this area and brought such valuable content to this debate as well as a valuable tone, which was very good to hear. I want to say a few things, first, in support of the Bill. As the right hon. Gentleman said, it is very important that we take a moment to reflect on the significance of getting this right.

Depriving someone of their liberty is a very significant act. Liberty is a fundamental right and freedom. We must take it seriously, and we must get this right. It is clear that the current system is not working. The fact that between 100,000 and 200,000 people are waiting because of an applications backlog is clearly unacceptable and cannot continue, given the consequences for individuals who have been deprived of the safeguards to which they are entitled, and the impact on their families and on care homes in which they may be residing.

[Jim Shannon (Strangford) (DUP)]

Earlier today I had a chance to speak about this matter to the Minister and some of her officials. Is it the hon. Lady’s understanding that the issue of human rights has been included in legislation that has been endorsed by Age UK, the Law Commission and Simon Wessely? If that is the case, the action that the Minister and the Government are taking this year is right, because it brings everyone together and ensures that there is legislation that everyone in the House can support.

[Helen Whately]

The hon. Gentleman has made a good point about the support for the Bill. Some Opposition Members have suggested that there is not much support for it, but it is, in fact, widely supported. Yes, there are concerns, with which I shall deal shortly, but, as the hon. Gentleman has said, there is widespread support for improvements in the current system. Those improvements include simplification—less bureaucracy and fewer administrative burdens—and the critically important representation of individuals through the independent mental capacity advocates, which will give them a voice. The frequency of assessments will become more appropriate; as my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) said earlier, timings can be inappropriate and excessively burdensome. There is a better choice of language: the Bill removes the term “unsound mind”, which is very stigmatising and completely unnecessary. I am also pleased that the Government have listened to the concerns expressed by some of my constituents about, for instance, potential conflicts of interests for care home owners when a financial interest may be involved.

However, I have three outstanding concerns. First, there is the question of how the amended Act will work for people with severe mental illnesses. The Bill clearly focuses on those who lack capacity because of, for instance, dementia, learning difficulties, autism or brain injuries, but, if I understand it correctly, it could be applied to people with severe mental illnesses. Figures suggest that the current Act is applied to a significant number of people in such circumstances. We know that such illnesses—bipolar disorders, for example—are likely to fluctuate, and that as a result people’s capacity may also fluctuate. That could cause them to be detained and deprived of their liberty when, in fact, they have regained capacity. The Minister in the Lords, Lord O’ Shaughnessy, gave a commitment that that would be addressed in the code of practice, but may I press this Minister to ensure that there are sufficient safeguards in the Bill?

NHS Reorganisation

Jim Shannon Excerpts

Wednesday 12th December 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Warrington South (Faisal Rashid) for bringing the debate. It is a pleasure to follow the hon. Member for Mitcham and Morden (Siobhain McDonagh). The Minister will not be able to answer all my questions because, as everyone knows, health is devolved to Northern Ireland. However, I will illustrate the issues with NHS reorganisation with some stories from the Province. The Minister has a close parliamentary aide from Northern Ireland, so he knows a wee bit about Northern Ireland.

I thank the House of Commons Library for the help it always gives us. Sometimes its information is enormously helpful, and today is one of those days. I have listened with great interest to the contributions so far; it is clear that, no matter the make-up of the constituency—whether Strangford in Northern Ireland, Mitcham and Morden, Warrington South or constituencies in Glasgow, Cardiff or wherever—there are issues. The NHS is struggling UK-wide, and either the pressure goes or its ability to treat will go. We are caught betwixt those two.

I welcome the Government’s commitment to spending £20 billion extra on the NHS, which is a credit to them. My constituency is on the seaside, and lots of people head that way to retire; I suspect things are the same in many constituencies. Our elderly population is growing, and the future demand on healthcare will be enormous. That is why the £20 billion that the Government have set aside is so helpful—because it gives a golden opportunity to plan ahead. The hon. Member for Warrington South was clear about where that should go.

The Library briefing—I am sure that the Minister has had chance to read it; I know that other Members have—contains six simple lessons from the Nuffield Trust, which are very helpful.

“Lesson 1: Avoid the temptations of a grand plan”.

This refers to the complex and heterogeneous nature of healthcare. We all know that it is complex; that is the very nature of healthcare. There are no one-size-fits-all policies that can address the issues. There has to be more than that.

“Lesson 2: Listen to the public—and don’t pretend you will if you won’t”.

As elected representatives, we know how these things work. When constituents come to us and tell us a problem, we listen intently and respond accordingly. This debate will hopefully be an occasion when we can do just that.

“Lesson 3: Don’t treat the workforce as an afterthought”.

It is very important that the workforce are part of a focused reorganisation plan. With the input of the workforce, there is a way forward.

“Lesson 4: Make sure the funding follows the plan”.

If funding commitments are made, they should be in there.

“Lesson 5: Don’t overrate structural reorganisation”.

In other words, it will not be sufficient to add more to the system that is operating on its own without building that structure up.

“Lesson 6: You need a plan your staff can follow”.

Create a policy and strategy that staff can get behind and support. The best way of doing that is to make sure that staff are involved in the creation of the plan, with staff values reflected in targets. All those things are vastly important, and I know that the Minister, who is a compassionate man and understands the issues well, will be able to respond even to the very generic terms that I put that in.

For Hansard and for the record, I will highlight an issue that I know is important across the whole of the United Kingdom of Great Britain and Northern Ireland: GP out-of-hours services. I emphasise the importance of that service, but we have particular problems with it in my constituency of Strangford. Part of any strategy or plan for NHS reorganisation should look at that.

My local health board is the South Eastern Health and Social Care Trust—clearly, not the responsibility of the Minister—which covers my entire constituency. On selected days just last month, the GP out-of-hours service in the main town in my constituency, Newtownards, had to close because it was understaffed, and there are particular reasons for that. People could either follow the advice and go to the nearest South Eastern Trust facility in Downpatrick, some 40 minutes away from Ards—for those who dare to live in Portavogie in the Ards peninsula, not that far from me, it is an hour and 20 minutes—or they could go to the A&E department, which was standing room only. The choice puts massive undue burden on an already drowning service.

I suggest to the Minister—as I have suggested at home; I think it would be helpful—that, whenever GPs commit themselves to operating an out-of-hours service, there may need to be another method of addressing the issues of those who use the service. For instance, why not have a staff nurse to treat minor ailments, taking pressure off the GPs? There are ways of doing things. There does not always have to be a GP there. GPs are predominantly overburdened; they certainly are in my constituency, and I suspect they are everywhere else as well.

I will give the example of my parliamentary aide from just last week, which I believe, unfortunately, is the tip of the iceberg. Her daughter, who has just turned three, is treated in an asthma clinic. She had an extremely high temperature that would not come down to the normal range and which had been going on for nearly two weeks. Her little body fought so hard to control the infection that it was going through that her breathing rate was double what it should have been. The out-of-hours service was rung, and four hours later the call was returned—a long time when the mother and family are getting panicky. The child was lifted out of sleep and brought to a waiting room full of other children who were equally unwell.

Had the service not been able to sound out her lungs, she would have had to travel to the Ulster Hospital, which she ultimately had to do the following week, as her ear infection burst an ear drum. Unfortunately, she is one of many. My aide met doctors who were harassed—not because they were nasty people, but because of their workload—but doing the best they could. When she asked whether there is insufficient funding to pay for out-of-hours care she was told that there is insufficient desire. How do we inspire doctors to be part of the out-of-hours service, which can only function with GPs who want to be part of it?

The new remuneration system came into operation in Northern Ireland in 2003. Although the system was designed to give GP practices much more flexibility on how they deliver services, allowing them to choose how to organise patient care and rewarding them for the quality of that care, the introduction of the new general medical services contract also allowed GPs to opt out of providing out-of-hours services, leaving the system essentially on its knees.

The fact is that the A&E in the Ulster Hospital in Dundonald simply cannot cope without the service. The fact is that nursing homes that rely on GPs coming out to drivers into patients who are in agony and pain, or to call time of death, need the service, as do parents who need someone to sound out the chest of their asthmatic child without being subjected to a four-hour wait in a room with ill, injured and drunk people in the middle of a cold winter’s night.

The service is vital. I read a report in July this year that referred to Wales as having similar circumstances and similar difficulties with their GP service. I am interested to know whether the shadow Minister or the Minister are aware of similar circumstances across the UK mainland. I suspect any MP in touch with their constituents, as we all are, will be able to replicate the stories that I am telling.

I very much respect GPs and the hard work that they do and their right to a social life. No longer do we expect the village doctor to be on call every day and night, but we need them to be available. There are no longer enforceable contracts, and I believe that, in any new NHS reorganisation or strategy, we must find another way of operating the out-of-hours service that gives the care that our constituents want at the times that they need it, which is usually out-of-hours or whenever they are under pressure.

I spoke very recently to a recently retired GP. He had been doing the night shift four nights a week, but realised that that was too much and pulled out. Perhaps if he had been asked to do only one or two nights, he would have stayed. Too much has been asked of too few people. We need to ensure that funding and people are available.

I know he will be mortified, but I am going to name one local GP, because he is a very popular and well liked GP in my constituency. Dr Doyle has his own practice and can be found a lot more than is right, and than is probably his duty, in the out-of-hours surgery. He makes time to help his patients by writing support letters for personal independence payment and employment and support allowance applications and he genuinely cares. I am not saying that others do not care; I am picking out this man as a representative of what happens. I look at Dr Doyle and wonder how much longer he and others like him can possibly continue. We need to spread the burden through the area.

I would urge the Health and Social Care Committee here to look at what is happening with the out-of-hours service, see the good that it does and perhaps look at a different way in which the out-of-hours provision could work. The Select Committee on Northern Ireland Affairs, on which I serve as one of the members from my party, is doing inquiries into many things, and one of them is health. People from Northern Ireland with a knowledge of and interest in health are coming here to make presentations to the Committee. And one thing that crops up is the out-of-hours service.

The question is how we adjust to the demands on the health service for the future. I started my comments by saying how much I genuinely welcome the £20 billion that the Government have set aside. We will get some of that through the Barnett consequential, so we are very pleased, but I see the needs in my constituency among the elderly population. I am also very keen that there should be early diagnosis and that preventive steps should be taken in delivering a health service for the future. If we do that, we will be doing the right thing. We must not just react all the time. Let us have a strategy that looks forward and aims to prevent things happening.

I am a type 2 diabetic, and many in the House are, as it turns out. Our Prime Minister is a type 1 diabetic. We all live with our particular ailments. But how much better would it have been if I had known about my condition earlier. I suspect that I was a diabetic for perhaps a year before I was diagnosed as one. I did not know at the time what the issue was. It was only when I went for a check-up with a doctor that I suddenly realised when he told me what was wrong. That makes me wonder whether there are steps that we can take for education, awareness and prevention. That is what we should be doing.

The Northern Ireland Affairs Committee will come to a conclusion in our inquiry on the health service in Northern Ireland, but I will conclude my speech today with this point for the Minister. The problems that I have referred to are specific in some cases to Northern Ireland and to my constituency in particular, but I believe that problems exist UK-wide and therefore that the response must be UK-wide as well.

[Mike Gapes (in the Chair)]

Order. I think that there will be a vote imminently. If so, we will break for 15 minutes and get back as quickly as possible.