Breast Cancer

Jim Shannon Excerpts

Thursday 18th October 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak in any health debates—as my party’s health spokesperson, I am interested in them—but it is particularly pleasing to speak in this debate. I thank the hon. Member for Crewe and Nantwich (Laura Smith) for presenting the case so well and, through having secured the debate, giving us other MPs the opportunity to make a contribution. It is also always a pleasure to follow the hon. Member for Lincoln (Karen Lee). All of us in the Chamber today, or who were in the main Chamber when she spoke on this topic some time ago, will remember her contributions. I thank her for them.

I am pleased that we again have an opportunity to highlight breast cancer issues while we have the Minister’s attention. We all know he is deeply interested in this subject, and we look forward to his response. I also look forward to the contribution by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), because I know she has an interest in the subject, too. There may be few of us here, but I know everyone’s contribution will be significant.

Some 55,000 people in the UK are diagnosed with breast cancer every year. Breast Cancer Now’s new 55000Reasons campaign calls for investment in breast cancer to feature in the NHS’s long-term plan. That beseechment is worthy of the Minister’s attention. Some 11,500 women and 80 men in the UK still lose their lives to breast cancer every year. I know men are a smaller proportion of sufferers, but we sometimes forget that they can be susceptible to breast cancer; I was given a salient reminder of that while researching for the debate. We sometimes do not think about that, but we should be aware of it.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the hon. Gentleman recognise that although far fewer men suffer from breast cancer, because services—particularly support services—are designed for women, men often delay coming forward with concerns and find it difficult to access support? Because they still see breast cancer as a women’s issue, they are almost afraid to be open about it.

[Jim Shannon]

As always, the hon. Lady makes an intelligent contribution; I do not mean to say that nobody else does, but she always brings her knowledge of her subject to our debates. I told her beforehand that I looked forward to her contribution, because, as always, it will be full of information we can learn from.

The hon. Lady is right: as the men present will know, we hide our health problems. We do not go to the doctor as often as we should. We just grin and bear it—except in the case of man flu, when we are probably dying almost before it starts. I should not be facetious—that is not right. I am just saying we do not react in the way we should. As the hon. Lady said, when we do go to the health service, the services are not there. We need to address that.

Between 2012 and 2016, an average of 66 women a year were diagnosed with breast cancer in the Strangford constituency. On average, 20 of those women—almost 30%—lost their battle with breast cancer in each of those years. As the MP for Strangford, that puts the issue into perspective for me, but it also tells me that the survival rate is not as good as we would like. The hon. Member for Bexhill and Battle (Huw Merriman) referred to early diagnosis, which I will come to. That statistic represents 20 homes deprived of a mother, a daughter, a sister, an aunt or a friend.

Outcomes vary tremendously among clinical commissioning groups. We continue to lag behind other European countries, such as Sweden, Portugal, Malta, Germany and France, on breast cancer survival. Projections indicate that if current trends continue and we do not address the increase in the number of people diagnosed with the disease, the number of breast cancer deaths will begin to increase within four years. I know the Minister has a cancer strategy in place and is addressing these issues, but perhaps he will indicate what is happening.

Those projections are shocking when we consider how far cancer diagnostics and treatment have progressed. My colleague the hon. Member for North Down (Lady Hermon) told me this week that a good friend of hers—a 42-year-old—has just died from cancer. Again, the reality is pertinent for us all.

I said to the hon. Member for Crewe and Nantwich that these debates always seem to come at the time when we can relate to them best. A very good friend of our family was diagnosed with breast cancer and is going through all the radiotherapy treatment. She has lost all her hair, as so often happens, and wears a scarf. The treatment is quite harsh. She is a friend of my son and the wife, and she works just down the road from us. Her employers have been good with her—they have ensured that she can at least do some part-time work. It is important for people to have something to focus their mind on when things are difficult.

Breast cancer is no respecter of the person. The large number of people affected by it means that even seemingly incremental changes have a huge potential to save more lives. Before I highlight some of the Breast Cancer Now recommendations, let me thank the Library for its work on the excellent briefing for the debate, which outlines the things we need, including public awareness and screening. It states:

“On 2 May 2018 the Secretary of State for Health and Social Care reported to Parliament a serious failure in the national breast screening programme in England and announced an independent review to investigate.”

Again, perhaps the Minister will indicate where we are with that review.

I underline the need for access to breast cancer drugs for people who are going through the most difficult times. We all know it is not just the patient who suffers—their family suffer, too. The hon. Member for Lincoln referred to that in a very personal way, which we all understand. The cancer care strategy refers to earlier diagnosis. One of its priorities is:

“A shift towards faster testing and responding more quickly to patients who present with symptoms. A target that by 2020, 95% of patients referred by a GP will be definitively diagnosed and receive test results within four weeks.”

If we reach that wonderful target, we will certainly be going the right way.

I often say to the hon. Member for Central Ayrshire, (Dr Whitford) who speaks for the Scottish National party, that she genuinely—she knows I mean this—brings a wealth of knowledge to our debates. I also tell her that, in many cases, Scotland leads the way with some of its health strategies and plans. We should look at its cancer strategy, which was published in 2016 and deals with prevention, detection, diagnosis and treatment—and aftercare, too, which is so important.

People who suffer from breast cancer often worry about financial issues, because they have a mortgage to pay and a family to look after, and sometimes the lady is the breadwinner. We must have all those things in place, so I encourage the Minister to look at Scotland’s cancer strategy, which I know the hon. Lady will refer to, probably in some detail. We look forward to that.

The excellent Breast Cancer Now recommendations include: specific lifestyle interventions; optimising the screening programme through increased uptake; strengthening the workforce; introducing new technologies; developing a screening programme tailored to an individual’s risk so cancers may be detected earlier; and reducing variation by reinforcing the position and ambition of cancer alliances. We will do this better if we do it together—I often say we are better together in everything. We can certainly learn from one another.

We should provide long-term funding and look at funding specific CNS posts to support secondary breast cancer patients in trusts where there is not a dedicated secondary CNS. We should ensure access to clinically effective drugs at a price that is affordable for the NHS. Let us have a price system. The Minister knows about the issues with the price structure for some drugs, and I know he is pursuing that matter so we get good drugs at a fair price.

I will take the time to list Breast Cancer Now’s recommendations. Its first priority is to fund

“specific interventions to prevent the 23% of breast cancer cases that are attributable to lifestyle factors in England every year.”

We should address the avoidable cancers.

The second priority is:

“Prevent over 1,200 breast cancer deaths by increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units.”

It is so important to have that in place.

The third priority is:

“Urgently invest £39 million in recruitment to the breast imaging and diagnostic workforce to enable breast services to cope with increasing demand over the next ten years.”

I welcome, as we all should, the Government’s commitment to spend an extra £20 billion on health; it is a step in the right direction and it is quite a commitment.

The fourth priority is:

“Adopt new technologies, such as tomosynthesis and Artificial Intelligence, into the breast screening and symptomatic services as soon as proven effective.”

The fifth priority is:

“Transform breast screening to risk stratified screening to spearhead the prevention and earlier diagnosis of breast cancer over the next ten years based on evidence as it emerges.”

As evidence indicates the trends and how to respond to them, we should make the changes to make that happen.

The sixth priority is:

“Ensure that innovative, clinically effective cancer treatments are quickly available to NHS patients at a price that is fair and affordable, including by reviewing the NICE appraisal methodology.”

The seventh priority is:

“Introduce a Catalyst Fund worth £3 million to incentivise generic manufacturers to make it quicker and easier for patients to routinely access cheap, off-patent drugs found to be effective in new uses.”

The eighth priority is:

“Fund new Clinical Nurse Specialist posts to support secondary breast cancer patients in over 120 Hospital Trusts without a dedicated post.”

Those things can make a difference.

[Dr Whitford]

The hon. Gentleman talks about having a separate secondary breast cancer nurse as opposed to the breast cancer nurses who are involved in the initial treatment, but that is a discussion about local set-up. The hardest thing is to tell a patient, “It’s back.” To have a nurse to support her, who she knows from five or three years ago, is a big contribution. At our hospital, there was a conscious decision not to have a separate nurse—if a patient got sent to her, that would be a bad sign—but to have the nurse they already knew.

[Jim Shannon]

The hon. Lady is right and I accept that we should look at what is being done in Scotland. If there is a better of way of doing something, let us do it that way.

The ninth priority is:

“Improve the Cancer Dashboard by including more detailed data on performance across Cancer Alliance geographies to identify inequalities within and between Alliances.”

The tenth priority is:

“Provide multi-year funding for Cancer Alliances, to increase confidence and encourage long-term thinking to drive investment in innovation, including a dedicated fund to address pathway variation.”

It would be remiss of us all not to thank the charities, which work so hard. We all know them and I will mention just a few I am aware of: Cancer Focus Northern Ireland; CancerCare; and Marie Curie—I met a Marie Curie lady at the Northern Ireland Affairs Committee yesterday. I know Marie Curie’s work because some of my constituents have been referred there in the last month. Its end-of-life care is incredible, as is that of Macmillan Cancer Support.

We need a plan of action and we must have the funding for that plan of action to be put into place. I support so fervently the English reforms that the Minister will put forward, in the hope that the ethos and the funding for my constituents will follow. We are in a different place in Northern Ireland; health is a devolved matter and the responsibility falls under the Northern Ireland Assembly, but it is not functioning correctly at this moment. Men and women need to know that there is a way forward, to ensure that no one dies of breast cancer anywhere in the UK in the not-so-distant future.

Childhood Obesity

Jim Shannon Excerpts

Tuesday 16th October 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Ms Dorries]

When I have ever not given way to the hon. Gentleman—and when has he ever not intervened?

[Jim Shannon]

I congratulate the hon. Lady on securing this debate about something that is a massive issue in my constituency. I am a type 2 diabetic—it is interesting that she has referred to that—and I became a type 2 diabetic because of the horrendous food I ate and the lifestyle I had as a young person, until I became a diabetic. It is essential that we address with young people the age-old principle of all things in moderation. I supported the sugar tax and changes to the way in which nutritional information is displayed. Does the hon. Lady agree that while large steps have been taken, there is more to be done to tackle this? Funding must be allocated to allow charities and Sure Start to run programmes on nutrition to teach people cheap and efficient ways of healthy eating.

[Ms Dorries]

The hon. Gentleman nearly got a speech in there. As I said, I will go on to address funding issues.

The parents on whom this issue impacts the most, and who are most likely to be affected, are those who make the poorest nutritional choices. They do not take The Times, or spend time on the internet reading the news or visiting any other sites where information about the effects of obesity on their children is likely to be repeated. They are also the parents who live in areas of higher deprivation. The fast-food, junk-food giants place more of their outlets in such areas than in areas of affluence, which makes the temptation easier and the consequences more impactful.

What can we as a Government do? I want to praise the headteacher and staff at Shillington Lower School in my constituency. Every morning after assembly, every child joins in with 15 minutes of vigorous exercise. Some are outdoors, running around the field perimeter, while others are in the hall doing boot camp with the cyber coach. That is in addition to their normal PE lessons and physical activities. The school actively encourages walking to school, and I have to say that Shillington Lower School’s efforts are there to be seen, but that is one approach, in one school in one village.

I am doing my little bit by embarking on a tour of schools in my constituency, and I am speaking to public health officers at Central Bedfordshire Council to find out how much more we can do locally in my Mid Bedfordshire constituency. However, this piecemeal approach is part of the problem. We have local council initiatives, as well as individual schools, teachers, parents, elected Mayors, public health officers, social workers and health visitors all doing their own little bit, and while that is all incredibly worth while, no one knows what the other is doing. The approach is taken on the basis of good intentions, but it is far from being an effective plan to deliver any measurable results.

This issue should be a governmental and departmental priority, regardless of Brexit and the noises off. This crisis has nothing to do with Brexit and everything to do with the lives of our children, yet there is no plan that co-ordinates a national strategy to make dealing with this issue a priority, and there is zero leadership from the top—I am very sad to say that. A national crisis requires leadership and a holistic, co-ordinated headline plan. Tackling this problem needs to be one of the Government’s top five priorities, and that needs to include funding.

The Minister is very much doing his bit, in line with the Government’s obesity plan. That is a great achievement, but sadly it is nowhere near enough to tackle the problem. The Minister is a good, conscientious and pragmatic man, and the father of healthy and very beautiful young children. I know that he personally is as worried about this as anyone else, but he is just one Minister in one Department, although I accept that his is the Department that should be leading on this, in accordance with the Government’s aims and objectives in this area. However, if we had some high-level leadership and direction, we could have all the Departments working together towards one strategy and working together as one taskforce to establish our short, medium and long-term goals to reduce the weight of the nation and in particular of our children.

In fact, the Minister is the only person who is accountable for tackling this national crisis. As “Off the Scales” highlights, there is little or no direct accountability among Departments for the childhood obesity plan, other than the Department of Health and Social Care and a small requirement on the Department for Education. What about the Ministry of Housing, Communities and Local Government? What about the Department for Digital, Culture, Media and Sport, given that sport is one of the biggest players in the fight against obesity? What about the Department for Environment, Food and Rural Affairs, the Department for Transport and the Treasury? We know that the Treasury is the place where all good ideas go to die, regardless of which party is in power, and it is not giving this national crisis serious consideration. So many people—from the wonderful staff at Shillington Lower School all the way up to the Department of Health and Social Care—are doing their own thing, but, sadly, none of this can be monitored or measured, because it is all entirely disjointed and unconnected.

The NHS has recently enjoyed a £20 billion cash injection. At present, only 0.2% of the NHS budget is allocated to Public Health England to deal with obesity and to put in place preventive strategies with regard to childhood obesity, yet the Government’s plan places huge responsibility on Public Health England to tackle this issue.

Baby Loss Awareness Week

Jim Shannon Excerpts

Tuesday 9th October 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank Mr Speaker for granting this debate and the Backbench Business Committee for selecting the subject. I thank the hon. Member for Eddisbury (Antoinette Sandbach), who as always set the scene on a subject about which she is very passionate and knowledgeable, with her personal story. I thank all the right hon. and hon. Members who have made incredible contributions, every one of them straight from the heart. They have certainly set the scene for a very serious debate in which we acknowledge what has happened. The hon. Member for Colchester (Will Quince) put forward ideas that he thought would be helpful. Everyone did that, to be fair, but he did so especially.

I will never begin to speak in a debate of this variety without first expressing my sincere sympathies to all those who have been affected by the loss of their baby, at whatever stage. My thoughts are with those people today, and I pray that the God of peace and comfort will be their strength. Baby loss is an extremely painful topic, but it is one that is being spoken of more and more. Such debates enable some of the pain and hurt to be talked about, and that can only be a good thing. We must thank charities such as Saying Goodbye for raising the topic and saying that it is okay to speak out, remember and reflect. Whatever way a person deals with their pain is okay, as long as they know that they are not alone. Such debates allow us to express the message, “You are not alone.” The Members present who speak in these debates reflect the opinions of our constituents outside the Chamber, about whom we talk.

As I have said in previous debates, my mother suffered several miscarriages, as did my sister and a member of my staff—in fact, the member of staff who helps me to prepare my speaking notes. For me and for all of us in the Chamber, this is a matter that is very close to our hearts. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) spoke of the miscarriages that his mum had between his birth and that of his younger brother. That is probably very real to me, as well. As we spoke about my staff member’s workload for the coming week, we realised that it was Baby Loss Awareness Week. Might I suggest that if a debate ever came at the right time, this one did? We discussed how during the last two weeks of September, we had heard of six couples who live in my constituency who had suffered miscarriages. That is six children lost; six expectations never to be fulfilled; six homes filled with sadness; six women who felt empty; six partners who felt so helpless; and countless loved ones who simply had no words. Those six people were known to all of us very personally, and the fact that one in four pregnancies ends in miscarriage has never felt so real.

In the past eight months, I have known three ladies, who are also constituents of mine, who have carried their babies for the full nine months only to have them for just two hours. I can well remember my wife, Sandra, informing me that she was pregnant with our first son, Jamie. Like every parent, I had never felt such joy. I planned for our future and imagined what he would look like. I did not check whether the baby was a boy or a girl as I have always liked the element of chance. I just hoped that whatever sex the child was, they would be accepted. To be truthful, I did ask for three boys and I got three boys—I am not sure how that worked. As I held my child, I realised that the expectation could never meet the reality of having a child in my arms. I also remember very well holding my first grandchild, Katie—I know that there are other Members here who are grandparents as well. Katie is now nine years old. I remember when Del Boy, the character on TV, took Damian in his arms and he looked at him in wonder, and there was I at the Ulster Hospital in Dundonald. I said, “Next year, Katie, we will be millionaires.” Of course, we were not millionaires, but we were in a way as we had our grandchild. Such was the joy that we felt. Therefore, when I think of those families who have lost that hope for their future, my heart simply aches. Through my constituents, I have stared into the face of pure sadness and emptiness, and I would have given anything to change the outcome. That was never going to be in my power, or in the power of anybody in this Chamber, but, having spoken to many women, one theme is clear: they cannot forget their loss and they do not want others to forget it either.

I know that my parliamentary aide will not mind me saying that she lost her first baby abroad while on a church mission trip. She returned a few years later with her family—she now has two wee girls—and planted a tree with a simple plaque in remembrance of the wee child who had died. This simple act of remembrance, while not addressing her grief, helped her to move forward, as she knew that that tree would grow and be a testament to the life that began but could not flourish and grow. This is a desire that is reflected in the events that are organised to celebrate the short lives of babies. Women no longer feel that they must and should grieve in silence. The taboo that existed in my mother’s generation that kept women silent in their grief has gone now. One look on social media will reveal messages that say no more than a date, or a number of dates, and that is proof that it is good for some women to acknowledge and commemorate their loss. Balloon releases and services of remembrance indicate that those who grieve want to see their loss acknowledged.

There are, of course, other women who wish to grieve in silence and that is their right, and I absolutely respect that. Some pain can never find a voice. We may never know the people around us who have gone through baby loss—I am sure that a trawl of families of staff members in this place would show us all to be connected in some way to a loss of child—but what we must know is that there is a way in which we can remember and pay tribute to those lives, those hopes and those dreams that have been lost.

I want to take a brief moment to think about the fathers. This is something that my aide mentioned to me and that others have referred to as well. Fathers suffer emotional loss—not the physical emotional loss—and have to watch their loved one going through the physical and emotional trauma of loss and they need to be remembered as well. It is their loss as well and they have a right to grieve, and that should be said in this place, too. Others have also referred to grandparents and other family connections. There must be support available for the whole family, and I feel that this is lacking. I have heard it said that the leaflet that is handed to a mother when she miscarries does not help. It is often not read or thought about. A follow-up phone call offering help and advice may go a long way to dealing with the pain and the fear, and I am grateful to the charities that fill that breach when perhaps, with great respect, the NHS does not.

What words do I have for those who have lost babies?

[Will Quince]

I distinctly remember the intervention that the hon. Gentleman made in that speech back in November 2015 when he raised the importance of the hospital chaplain and the huge comfort that they give to families. Does he agree that the point he made then is as valid today as it was three years ago?

[Jim Shannon]

Absolutely, and I thank the hon. Gentleman for his intervention and for reminding us of that debate. Like many others in this Chamber, I am a man of faith who feels that it is important to have a chaplain available—to have someone to share one’s grief and hard times. The intervention that he mentions was right along those lines. I felt that it was so important to have that help at that time, just when one needed it the most. I thank him for his intervention and for his salient reminder.

[Richard Graham]

Chaplains play an incredibly important role, as do the volunteers who work with them. I think that we have more than 30 in Gloucester Royal Hospital, all of whom go through a significant amount of training for about a year. They are multi-faith, so we have Muslims and Sikhs as well as Christians. We also have chaplains of no particular faith, and they are very clear about not trying to differentiate so that a Baptist chaplain might only talk to a Baptist patient and all that sort of thing. Increasingly, there are secular patients who need someone who can engage with them without religion. Does the hon. Gentleman agree that it would be useful for the Minister to say a few words about the role of chaplains in hospitals and whether the encouragement that they and the volunteers who work with them get at our hospital should become best practice around the country?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. He is right: the chaplain has a responsibility for all those of faith and of no faith, because that is the time when a person needs that wee bit of succour, support and compassion—perhaps even a shoulder to cry on. Those are important things, and he is right to mention them.

I have asked a few women for the things that have been said by them or to them, and this is the message that I want to leave with the House today, “What has happened to you is not okay, but you will be okay. Give yourself time. It doesn’t matter how much time you need. One day you will realise that the smile that you have faked for so long is now a real smile. It doesn’t mean you have forgotten your baby—it means that you can remember them while you live. Weeping endures for a night, but joy comes in the morning.

Organ Donation (Deemed Consent) Bill

Jim Shannon Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 12th September 2018 Public Bill Committees

[Caroline Flint (Don Valley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Wilson, and to be part of this historic occasion. I pay tribute to my hon. Friend the Member for Coventry North West, the Minister, and the cross-party collaboration that has ensured we can today wish the Bill a successful journey towards becoming law.

It is important to say that the Bill is not about taking away choice. Even though it is significant and historic, following the good work done in Wales, the Bill will mean that people will still have a choice. Opting out will be simple and easy, and the views of family and friends will not be dismissed, but importantly—I say this as someone who has been an organ donor for most of her adult life, as well as a blood donor—we have to answer the question, “If one of us, or one of our loved ones, were in need of an organ transplant, would we want to have it available to us?” I think we would unanimously say yes. If that is the case, we have to ask how to make sure that chance is available.

I have been struck by the campaigns outside of the House, including the Daily Mirror’s “Change the Law for Life” campaign and the support of Kidney Care UK, the British Heart Foundation and the British Medical Association. All have done their bit to make this issue so important and put it in the public sphere, but for many of us, the personal stories have had the most impact. I will cite two: the first is that of Amie Knott, from Thorne in my constituency, whose brother Andrew sadly died waiting for a transplant. She has been in touch with me and other hon. Friends across South Yorkshire to get support for the legislation, but she has not stopped there. She is continually out and about in Thorne, Doncaster and beyond, trying to encourage people to sign up to the organ donor register. I pay tribute to her.

When I took part in a television programme earlier this year, one of the guests was a mum whose very young daughter had died, and who had made the very important decision to allow her daughter’s organs to be provided for transplant. It was not an easy decision, but she said, “I had to ask myself the question: if it was the other way round and I was a mother with a child in need of a transplant, would I want that to happen? At this very emotional time, trying to cope with all my feelings and my hurt and anger at losing my daughter, how could I do something positive, or allow something positive to come out of this sad situation?” That probably echoes many of the conversations we have with family, friends and constituents.

I sincerely hope that we can ensure that the Bill is on the statute book as soon as possible. However, as my hon. Friend the Member for Sunderland Central said, the talking must not stop. People can go on the register today or tomorrow, but the talking must take place within families as well. Too often, when people signed up to be on the register, that conversation did not take place, and on too many occasions families dealing with the tragedy of losing a loved one override their loved one’s wishes. Let us ensure that the conversation does not stop with proceedings today, and certainly does not stop when the Bill becomes law. I commend everyone on the Committee and beyond for the positive contribution they have made.

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Wilson. As the Democratic Unionist party’s spokesperson on health, I add my support to the hon. Member for Coventry North West, who has endeavoured courageously to push the Bill through. Every one of us is greatly impressed by him. I put my hands on his shoulders last night and said, “You’re making history tomorrow, boy.” We are all pleased that he is able to do that.

I am also pleased that the Minister responded right away in a positive fashion and ensured that the Bill would become a law, through Government support. Today, as happens often in this House—we could probably see it happen a wee bit more, if we are honest—we can all work together collectively to change lives and make things better. It is important for me. The hon. Gentleman asked me if I would be on the Committee, and I was more than happy to do so, to add my support in a small way to the legislation coming forward.

Why is this important? Every one of us has told a story, and we do that because those stories shape who we are as individuals. I met a wee nephew, Peter, who was born with only one small kidney the size of the wee thumbnail on my hand, so from an early stage he was in need of a kidney transplant. The problem for him was that getting the right donor was difficult. At one time his mother was to be the donor, but then she fell pregnant and that was not possible. As it turned out, another kidney became available in the meantime, and from being the small boy who was not physically able to do much and whose face was—if I can use these words—“custard yella” because of his kidney malfunction, his life was changed. This wee boy loved racing motorbikes and wanted to do a newspaper round but could not do that, and the donation totally changed his life for the better. I was therefore keen to be on the Committee because right away I can see the benefits that will flow from this legislation.

The other story I want to tell is one that a gentleman from my constituency came to tell me. His son was injured in an accident in which unfortunately a lady was killed. Ultimately his son’s life-support apparatus and machinery was turned off. I tell the story because he donated all his son’s organs, which then gave life and improved lives as the organs benefited a number of people.

Before I became a Member of Parliament, I was on Newtownards council, which thought it would be good to create a memorial garden in the council’s area. We therefore have a memorial garden in the main town of Newtownards, where families who have lost someone, or whose family members’ organs have been donated—whatever the case may be—can go and have a wee bit of contemplation or quiet time for remembering. The reason I want to tell these stories is because they are all part of why we need the Bill to go through, and of how important it is for the Minister and the Government to support the Bill promoted by the hon. Member for Coventry North West.

The right hon. Member for Don Valley, who spoke before me, made a compelling point; everybody made a compelling argument. The right hon. Lady made a reference that I was going to make. I am glad that was done and I will do it again. In this House we always repeat things, but that is by the way. It is important that those who feel they cannot go with this can opt out. That is what the legislation does. It does not compel anybody to do anything, but it gives an opportunity. That is the important issue that the right hon. Lady drew attention to, which I wish to endorse.

I have opted to carry an organ donor card since I started driving, and that was not yesterday, Mr Wilson. In Northern Ireland, legislation requires someone to tick a box on their driving licence application to declare themselves a donor. I have been doing that all those years. I still have the wee donor card and the wallet, which is long-time faded, as it has been there for 40-plus years. It is important that we move this forward.

In conclusion, we have a consensus and a collective opinion. We see legislation that can change lives for the better. That is the great pleasure of coming here as a Member of Parliament. It gives pleasure to be an elected representative at any time, be it on a council, Assembly or in the House. To come forward and be part of a legislative change that brings good gives a good feeling. Today is a good day for Parliament. I thank everyone for their contribution, especially the hon. Member for Coventry North West, and the Minister for supporting the measure so enthusiastically. That means something to us all.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

Mr Wilson, it is a pleasure to serve under your chairmanship. I rise to support the amendments in the names of the hon. Member for Coventry North West and the Minister.

I rise only briefly to say that I am a convert. Originally, when I was Secretary of State for Wales, I was not convinced that an opt-out system would be beneficial. I have changed my mind; when the facts change, one should, as a politician, change one’s mind. One of the things that has changed my mind is personal contact with a family where an organ will be needed to save a young man’s life. There is nothing more powerful than having that presented to one as a politician. That means that all of us must have an open mind about so many things.

The way the trend has been going, particularly in Europe, is interesting. I think now more than 24 countries in Europe have some form of opt-out system. Although we have not yet really seen the benefits in Wales of the legislation that came in in December 2015, I frankly think that we need to improve the mathematical odds. We will do so only by creating a culture in which organ donation is spoken about, not in hushed tones or with accompanying difficulty, so that it becomes part of the common parlance.

The testimonies given by other Members in Committee show that the fact that a loved one may go, but parts of that loved one can contribute to saving or enhancing the lives of others, has to be a good thing. I support the amendments and hope the Bill gets a very fair wind so that it becomes law.

--- Later in debate ---

[Mr Robinson]

So many generous words have been extended in my direction that I feel that some redressing of the balance is necessary. I was lucky, and I hope I chose my Bill well. Judging by the support we have had through all its stages, it seems as though there is a groundswell of approval, opinion and acclamation for it, but one thing must not be overlooked, and that is that the Bill would have been very difficult if not impossible but for the support of the Government, including the Prime Minister in person. Throughout this, she has stuck to what she said in Liverpool.

I must also say that there have been tight moments, awkward moments, but the presence of the Minister with responsibility for the Bill, who is with us today, has throughout been one of charm—a smoother who, with her grace, has been able to get us through those moments too. She said it had been a pleasure to work with the Health Committee and it has indeed, and it has been a great pleasure to work with the Minister.

We keep saying these things, but perhaps we should cut down on further compliments to each other until we get the Bill through the Lords. On that basis, we are all in this together and still working hard, because we are not there yet, and who knows what the Lords will throw at us—

[Jim Shannon]

It is the first half.

[Mr Robinson]

I think that a little restraint would be a good thing. Thank you very much indeed, Mr Wilson, as always, and the Clerks. I have received excellent briefings—models of clarity—and I advise hon. Members to take a set now, in case they are challenged by any questions in their constituency work or anything like that. The briefings deal clearly with a lot of the most difficult issues. Again, Mr Wilson, it is a pleasure to serve under you. Thank you.

Amendment 1 agreed to.

Amendments made: 2, in clause 1, page 1, line 19, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 3, in clause 1, page 1, line 20, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 4, in clause 1, page 2, line 10, at end insert—

“‘permitted material’ means relevant material other than relevant material of a type specified in regulations made by the Secretary of State.”

This amendment defines “permitted material”, which will be used in new subsection (6A) of section 3 of the Human Tissue Act 2004 as a result of Amendments 1 to 3. The definition has the effect that the new provision about deemed consent will not apply in relation to relevant material of a type specified in regulations made by the Secretary of State. “Relevant material” is defined in section 53 of the Human Tissue Act 2004.

Amendment 5, in clause 1, page 2, line 11, after “of” insert “the definition of ‘excepted adult’ in”.— (Mr Geoffrey Robinson.)

This amendment is consequential on Amendment 4.

Clause 1, as amended, ordered to stand part of the Bill.

Clause 2

Consequential amendments

Amendment made: 6, in clause 2, page 2, line 36, at end insert—

“( ) In section 52 (orders and regulations), in subsection (3) (statutory instruments to which negative procedure does not apply), after ‘1(11),’ insert ‘3(9),’.

( ) In section 52, in subsection (4) (statutory instruments to which affirmative procedure applies), after ‘no regulations under section’ insert ‘3(9),’.

( ) In section 52, in the list in subsection (10) (requirement to consult), after ‘section 1(11)’ insert ‘section 3(9);’”.— (Mr Geoffrey Robinson.)

This amendment is consequential on Amendment 4 and produces the result that the regulation-making power conferred by the provision inserted by that amendment will be subject to the affirmative procedure in Parliament and to a requirement to consult such persons as the Secretary of State considers appropriate before the power is exercised.

Clause 2, as amended, ordered to stand part of the Bill.

Clause 3 ordered to stand part of the Bill.

Title

Amendment made: 7, in title, line 1, leave out from beginning to end of line and insert—

“Make amendments of the Human Tissue Act 2004 concerning consent to activities done for the purpose of”. —(Mr Geoffrey Robinson.)

This amendment replaces much of the existing long title so as to introduce reference to the making of amendments of the Human Tissue Act 2004.

Bill, as amended, to be reported.

Integrated Care

Jim Shannon Excerpts

Thursday 6th September 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak on this matter. I commend the hon. Member for Totnes (Dr Wollaston) for setting the scene, and the hon. Member for Stockton South (Dr Williams) for making such a valuable contribution. I do not have the expertise of those two hon. Members—far from it—but I have a deep interest in the health service, and the treatment and service that is provided, which is why I am here. I thank the hon. Member for Totnes and all those who made a contribution to the Health and Social Care Committee’s seventh report, “Integrated care: organisations, partnerships and systems”.

We are ever-mindful of the anniversary of our own NHS. A lot of minds have looked back over the past 70 years, and we have all looked back over the years that we have been here, and we are thankful for the institution, which has been a beacon of the best of British by far. Just last weekend, I was present as my local council, Ards and North Down Borough Council, conferred the freedom of the borough on the NHS as a gesture of good will and a vote of thanks to those who work so hard in adverse conditions to provide care to those we love. As an active representative, I speak to those who work in the NHS and are recipients of NHS services every week. The hon. Member for Totnes made many telling comments, but one that I took from the very beginning of her contribution was that the purpose is to deliver a better service for patients. That really is the core of what we are about in the NHS, and at the core of the report’s recommendations.

Until recent years I had little cause to visit doctors or use the NHS but, as often happens, with age came complications, and diabetes was one of those. The doctor then said, “You need a wee tablet for your blood pressure. Well, you don’t really need one, but we’ll give you one anyway, just to keep you right.” Along with that, last year I was in hospital on three occasions for surgical operations. Not having been there for more than 40 years, suddenly finding that I was almost a regular visitor to the hospital gave me a really good idea of what our NHS is like today. I put on record my thanks to all those who made valuable contributions to those operations. I know it was down to the skills of the doctors and surgeons, but it was also down to people’s prayers.

We all know that the NHS is hanging on by a thread in many cases. It sometimes seems like that, but when I hung in the balance the NHS rose to the challenge. Sometimes we think that the NHS cannot deliver, but very often it does, and it delivers well. Any discussion about the NHS must begin with thanks to those who make it work against all the odds and who make what should be impossible possible. All of us here—myself in particular—say, “Thank you.”

I thank every person involved in the report, and I thank the Minister who is here to respond to it; I know he will do so very positively. As I began to read the report, the massive amount of work that went into it became abundantly clear. We need to bring on board the people with the vision for the NHS, as put forward in the report. I can see the vision for the NHS—I can read it on paper anyway, and then picture it. I understand the rationale behind the vision, but I also see the fear of secret privatisation, which people believe to be taking place. Some of the hon. Members who intervened referred to that.

We have all seen what happens when things move from public to private, and people fear a lack of services. That is easy to understand when talking about the loss of a rural bus link, but not when discussing whether a mother who is 72 years of age and has cancer will get treatment on the NHS. There is a fear among the general public that risk assessments will mean that we do not give such people a chance. I know that that is not the case, but we have to consider public opinion, and how people assess and see the situation. People see things quite simply at times. It is good to see things simply, because it makes it easy to follow through with the solution—those are my feelings anyway.

My feeling is that something has to change in the NHS. We all understand that bandages are not enough—it needs clinical surgery and massive intervention, some elements of which are in the recommendations. However, in order to be able to do that, we need to first prep the patients—the general public. We need to convince them that the proposed changes are for the better. We need to do a better job of preparing the public and explaining exactly what the plans are.

As the report was at pains to show, people do not fully understand how the NHS works. Information is not shared between emergency services and GPs in the detail and with the connections that it should be, and healthcare is provided from different sections who are not working together as well as they should. The integration referred to in the report can only work through partnerships that are truly trying to work together. When there is no understanding there is fear, and while people may not understand the current system, by and large they trust it. They trust that when they dial 999, an ambulance will arrive and bring them for care to their local emergency unit. When we tell them things are changing and we abbreviate terms using initials that save time but increase complexity, they fear that the very thing that they can trust no longer exists, because it is different from what it was five or 10 years ago, and they do not quite understand what is being said. That is why it is important to keep it simple. Of course, however we change the NHS, an ambulance will always be sent in response to a 999 call, but the simple fact is that people do not trust to that, so they will be unsure about what will unfold.

As a lay person, without the expertise that many on the Committee have—I bow to their knowledge and expertise—it is my humble opinion that we must do better in informing people how things are working now and how they can improve with changes, but understanding takes time and it is better to bring the public along, clarify uncertainties and address the issues at an early stage. Such corrective surgery has to take place, but the theatre must be prepped. People must be allowed to understand and that has to come with co-ordination and better working relationships with the press, as well as one-on-one discussions with patients when possible. It must happen with easy-to-understand information and it must happen before the changes are implemented.

I congratulate the hon. Members involved in preparing the report. I look forward to the Minister’s response, as well as the contribution of the shadow Minister.

Nurse Training

Jim Shannon Excerpts

Wednesday 5th September 2018 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a great privilege to be drawn for one of these end-of-day Adjournment debates, as they give Back Benchers such as me the opportunity to debate a subject dear to their heart. Tonight’s topic is fairly dry, but it is very important. I hope the House and those watching will forgive me if I plough into a lot of detail, because the detail is important on this issue. I welcome the Minister, for whom I have a high regard, to his place. Another advantage of these debates is that the poor Minister has to sit there and listen to me, and there is nothing he can do—he cannot escape. So I hope my words will fall on receptive ears.

This debate follows a recent public meeting on Portland hospital in my constituency; the beds at the island’s much-loved community hospital have been closed, but more on that shortly. We have heard it before, and it needs to be said again: we are facing a desperate shortage of nurses. Health Education England believes there are 36,000 nursing vacancies in England, whereas the Open University says it is 38,000 and the Royal College of Nursing gives a figure of 40,000. That last figure equates to an 11% vacancy rate, with learning disability and mental health nursing the most affected, followed by community nursing. These gaps may be filled by bank or agency staff on a temporary basis, but Health Education England estimates that 1% remain permanently unfilled. The knock-on effect places nurses under “relentless pressures”, according to a report this January by the Select Committee on Health. It added that

“nurses felt their professional registrations were at risk because they were struggling to cope with demand.”

Meanwhile, any increase in nurse numbers is swallowed up by the demand for more of them. For example, although the number of new nursing positions created between 2012 and 2015 rose by 8.1%, the number of those who actually joined the profession increased by only 3.2%. What is the consequence? Well, obviously, costs rise. Temporary nursing staff are expensive, with NHS trusts paying an average of 61% more for every extra hour they worked compared with that paid for a newly qualified, full-time, registered nurse. A Freedom of Information Act request by the Open University in January revealed that, if the hours worked by temporary staff were instead covered by regular nurses, the NHS could save as much as £560 million a year. The independent health think-tank, the King’s Fund, revealed that on average NHS trusts were spending nearly 7% of their salary budgets on agency staff, with the figure rising to more than 25% in some cases. Dorset HealthCare, which covers my constituency, forecasts an overall spend of £4 million this year on agency staff alone. That is down from a staggering £12 million three years ago but still represents a significant share of the healthcare budget.

As I mentioned at the start, 18 beds were closed at Portland Community Hospital last month due to a lack of nursing staff.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way: I sought his permission to intervene beforehand. He is outlining the shortage of nurses in his constituency, but there are nurse shortages in many other parts of the United Kingdom, including in Northern Ireland, which has a shortfall of some 1,800 in nurse numbers. Does he agree that the training of nurses must be a priority for trusts and the Department of Health and Social Care? Part of the way to attract new nurses is to show how we value our current nurses through decent pay and working conditions. It is important to ensure that nurses are regarded highly for the work that they do—and paid accordingly.

[Richard Drax]

I do not disagree with anything that the hon. Gentleman has just said, and I will come on to his points a little later in my speech. Of course all nursing staff should be appreciated and paid properly. One of the issues, as I shall describe in a minute, is the work environment, which is one of the factors leading to fewer nurses—or insufficient numbers—entering the profession.

Before the intervention, I was talking about my community hospital in Portland, where almost half of all nursing positions were unfilled this summer. Agency staff, costing as much as £58 per hour—and £135 per hour on bank holidays—were still hard to find. The trust’s chief executive, Ron Shields, for whom I have enormous respect, decided he could no longer safely keep the beds open. So, despite the understandable protestations from islanders who wish to keep their frail and elderly relatives close by, the beds were migrated to a hospital in Weymouth, where the nursing staff available can be consolidated. I suspect that that situation is not uncommon across the rest of the country.

The crux of the matter is the recruitment and retention of nurses. Recruitment depends mainly on training new nurses for the future. The numbers required are traditionally set by Health Education England, which then commissions the nursing places from further education and training establishments, including colleges, universities and the Open University. Standards are set and approved by the Nursing & Midwifery Council, ensuring uniformity across providers. Those establishments, in turn, invite applications, for registered nurses, nursing associates, nursing apprenticeships and Nurse First.

The first role requires a degree, the second a prior healthcare qualification, the third is a joint initiative between individual health trusts and further education establishments and the fourth is a new initiative for high-flying graduates and follows the lines of Teach First. The three-year degree option remains the main route into nursing. While many, including me, dispute the need for a degree, the Nursing & Midwifery Council says that that is to misunderstand modern nursing. Registered nurses are now an “officer class”, according to Geraldine Walters, the NMC’s director of educational standards, with much of the work for degree-level nursing now highly technical and demanding. In some cases, registered nurse prescribers replace doctors and indeed even run their own primary care clinics in London.

So far the nursing associates programme has been a success. In December 2017, 2,000 nursing associates were in training. This year, it is hoped that figure will be 5,000, rising to 7,500 in 2019. The Nursing & Midwifery Council is clear that more recruitment and widened access into nursing training are essential, as is the diversity of training provision.  The Open University, for example, provides for those who, for a variety of reasons, would not gain access to the profession via the traditional, campus-based route.

Since 2002, the Open University has offered a four-year registered nurse degree apprenticeship in addition to the straightforward apprenticeship. This is aimed specifically at existing healthcare support workers who welcome the chance to earn while they learn. So far, it has trained more than 1,000 applicants as registered nurses, with 940 more currently on the programme in England. One huge benefit to the scheme is that participating trusts seem better able to retain the nurses they have trained. Compare this with the 24% drop-out rate for student nurses on the degree course. As the NHS is the nation’s biggest contributor to the 5% apprenticeship levy, it would be odd for it not to participate.

The loss of the bursary scheme has been keenly felt, with the Royal College of Nursing saying that it is a serious own goal. It was a support package including tuition fees, a non-means-tested maintenance grant, a means-tested bursary itself, and other elements designed to help students with placement, travel and childcare costs. It was overwhelmingly popular, attracting more applicants than there were places. It was replaced by the student loan scheme, requiring students to borrow money to pay for their training.

The problem is that nursing is a vocational training and does not cater for school leavers unsuited to the profession. Significantly, following the removal of the bursary, the number of applications for nursing through UCAS has fallen by a third since March 2016. Although the Department of Health and Social Care says that there are 52,000 nurses in training—more than ever before—the number of those accepted on to courses is still down by 9.3% in England. That threatens the pipeline of new nursing talent and, at the very least, should and could have been anticipated. Much-needed mature applicants, many with care experience, are also deterred by the burden of debt and loss of earnings, and Ms Walters told me that these are exactly the people the profession needs. Mature applicants also tend to choose careers in specialist areas worst hit by the staffing crisis, such as learning disability and mental health.

New figures from UCAS show that applications for nursing degrees and from mature students are down by 33% and 42% respectively since March 2016. As the latter group are the very people who would be grateful for any support given, and probably remain in the organisation until retirement, Mr Shields suggests that trusts should provide some form of financial support in the absence of bursaries. A recent survey by the Open University showed the effect of the loss of the bursary on recruitment. Only 30% of nurses asked said they would have been willing to self-fund or partially self-fund their initial nursing education. In addition, more than half of those surveyed believed that applications would continue to fall.

Attracting nurses back into the NHS after they have left is another crucial focus for recruitment. The return to practice campaign, run by the Nursing & Midwifery Council, which provides refresher training and a re-entry route back into the NHS, has already recruited almost 2,500 former nurses and is currently registering another 1,800. However, as the Health Committee report states,

“too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”

The Committee cites many causes, including workload pressures, an inability to meet patient expectations, concerns about providing adequate care, poor access to continuing professional development, poor organisational culture, pay restraint and budget cuts. The impact of Brexit was another reason, although—interestingly—briefings from the Library show that overall EU staff numbers in the NHS have, in fact, fractionally risen since the referendum, with numbers of EU nurses falling by just 0.3%.

Another issue is the current pensions arrangements. Senior and experienced staff who might want to work beyond 55 are leaving because their pensions reduce in value if they stay on. Mr Shields has recently lost two senior and valued members of his team, and believes the Government must look at this urgently.

A partial solution to increase nurse numbers is to recruit from abroad, including Commonwealth countries. However, this was, until recently, severely limited by immigration rules, which were wisely relaxed in June after an intervention by the Home Secretary.

In December 2017, Health Education England published its draft health and care workforce strategy for England to 2027. “Facing the Facts, Shaping the Future” anticipates a significant shortfall in nursing numbers due to an increase in the number of posts needed. The Health Committee has emphasised that future projections of demand for nurses should be based on demographics rather than on affordability alone. A final workforce strategy is expected from Health Education England at any minute. Perhaps the Minister can enlighten us, as it was expected, as I understand it, at the end of July.

Finally, I thank all those who work in our NHS for the wonderful job they do, not least the fantastic teams in South Dorset.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

My hon. Friend makes a good point, which he made in last week’s debate. Public Health England and NHS England will continue to work with local areas in our constituencies to promote evidence-based ways of identifying and supporting pregnant smokers to quit. The overall ambitions in the tobacco control plan, which I published a year ago last week, will touch the general population, which of course includes the partners of pregnant women.

[Jim Shannon (Strangford) (DUP)]

Has the Department carried out investigations into the effects of vaping during pregnancy? If so, what are the results?

[Steve Brine]

Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.

Perinatal Mental Illness

Jim Shannon Excerpts

Thursday 19th July 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), and I thank the hon. Member for Stockton South (Dr Williams) for setting the scene so well. He obviously has a passion and a knowledge of the subject—not just as a father, but from his previous job. I have a knowledge of it through people who work for me and who I have social involvement with, including the lady who writes all my speeches—she is a very busy girl—who always wanted to be a mother and had two miscarriages. I am very conscious of her story, and I will tell that today.

The wife of my hon. Friend the Member for Belfast East (Gavin Robinson), Lindsay Robinson, who set up a charitable group in Northern Ireland, has also given me permission to tell her story, which I will do in the way she told it to me. It is important to record those stories. We have come together on a Thursday afternoon to tell the story of why perinatal illness is very real, and to think about how we can help, which is the real reason for being here. I always say that we try to provide solutions so we can do things better. For the record, I should say that I have already apologised to the Minister and the shadow Minister, and to you, Mr Davies, for having to leave early, because I am committed to a later debate.

The work of the NCT is vital and a great support to parents all over the world. In Northern Ireland, we have three active branches that offer local mums, dads and families vital information, resources, connection points, community and friendship when they need it most. I thank the charity for the time and energy it has put into the research for the #HiddenHalf campaign, which has focused our attention on the issue of maternal mental health. It is clear from its work, and that of all those in the maternal mental health arena, that too many women go undiagnosed and unsupported. This debate must be a way to address those issues verbally, and we look forward to the Minister’s response about how she will help us.

NCT’s #HiddenHalf statistic that the problems of almost 50% of women who were surveyed, and who struggled, were not identified by a healthcare professional and that they did not receive any help or treatment is shocking. We must work together to change that. All the hon. Members who have spoken so far have reiterated that point.

My parliamentary aide, Naomi Armstrong-Cotter, who is also a local councillor, has spoken out in a personal way about her experience of miscarriage, of successful pregnancies afterwards, and of the fact that a leaflet handed to someone is not enough to give them the tools to deal with the emptiness of that loss. Our local paper, the Newtownards Chronicle, gave her an opportunity to tell that story; coincidentally, that appeared last week. Her plea was for greater support during and after pregnancy; for a network whereby someone did not have to search for help, but it was ready and waiting; and for follow-ups to be given more effectively. She is now blessed by God with two children, and I have no doubt that her family’s support kept her life together when she was having great difficulty trying to adjust to what was happening to her.

My party fully supports the #HiddenHalf campaign and I attended an excellent event in Parliament two weeks ago to raise awareness of its work on the issue, where I heard stories from mums whose lives have been marked by the illness and by not receiving the timely help that was necessary to make a difference. The event was hosted by my hon. Friend the Member for Belfast East, who understands only too well the devastating impact that maternal mental illness can have on women and the wider family unit. He was the other half who lived with the difficulties that his wife Lindsay was having. She struggled and suffered for two years before getting help. She has given me express permission to use her experience in this place to highlight the failings and the need for a brighter future.

From her experience, Lindsay spearheads the campaign in Northern Ireland for mums, dads and their families to get the support they need and deserve via her movement, “Have you seen that girl?” At the event that I and others attended, the impact of the NCT NI volunteers was clear. She also plays a role in the Maternal Mental Health Alliance’s Everyone’s Business campaign, of which NCT is also a part. Many charities and bodies have come together to offer support.

From the point of view of the two ladies whom I have referred to—my permanent parliamentary assistant and speechwriter and the wife of my hon. Friend the Member for Belfast East—the Church has also helped. It is important to have a faith and to have access to that at an important time.

Having met Lindsay—I spoke to her this morning, just before she left here—I understand that 80% of Northern Ireland still does not have access to specialist perinatal mental health services and that funded community-based peer support is limited. I understand that the Minister is not responsible for Northern Ireland, but from a Northern Ireland perspective, unfortunately, I would be surprised if we were not behind the rest of the UK, which is not good. We need to be up alongside and equal to other countries across the United Kingdom, as the hon. Member for South West Bedfordshire said, but treatment and support is a postcode lottery with too many mums and families being let down when they are at their most vulnerable.

The campaign for change is based on three areas. There should be provision of a mother and baby unit. Unlike in England, Scotland and Wales, a mother and baby unit is not available in Northern Ireland, which is disappointing—nor is it on the whole island of Ireland. The Minister is not responsible for that either, but it shows hon. Members that across north and south Ireland, we have not moved to make that happen. That means that mum and baby have to be separated should in-patient treatment be required. That is a very negative thing. I want to give a perspective on where we are in Northern Ireland and also say what has happened there recently. Some headway has been made—not enough, I have to say, but some at least.

The situation is simply not good enough and can have further negative effects on the mum and the family. There are five health trusts in Northern Ireland, but such specialist services for mothers are currently only available in one: the Belfast Health and Social Care Trust. Although that trust’s services are fantastic, they cannot meet the needs of the whole population of Northern Ireland; that would be impossible for one trust. Mums and families outside the Belfast trust’s area also deserve access to specially designed care and support.

Community-based peer support is also important. I am informed that currently great support is provided in the community and in the voluntary sector, often by mums themselves. How often do mums all come together to support each other? My wife had great support when we had our children; that was not only family support but support from other mothers who had had children at the same time. Again, however, in Northern Ireland we are without proper funding to successfully grow that kind of work.

I make a plea. I am aware of the NCT’s Parents in Mind programme, which is running very successfully here in England—on the mainland—and doing tremendous work. MPs from the mainland will know that and welcome it. NCT Northern Ireland volunteers are keen to source funding to bring that programme, or a similar one, to parents in Northern Ireland. We look forward to the day when that happens. For many parents, peer support is a lifeline, offered by those mothers who have faced a similar battle and who are keen to receive training so that they can provide help to others.

I am also aware from my party colleagues in Northern Ireland that Lindsay Robinson and Tom McEneaney, working with the Maternal Mental Health Alliance, led a team of campaigners to meet the all-party working group on mental health at Stormont; although Stormont and the Northern Ireland Assembly are still not functioning as they should, meetings still take place. The campaigners presented the information and asked all the Northern Ireland parties to sign a consensus statement, pledging their commitment to action all of the issues that I have mentioned as soon as possible. I am delighted that my party—the Democratic Unionist party, for which I am the health spokesman—has signed up to that, and I am assured that other parties have also signed up to it. We are keen to meet further with the team and give them our support. I hope that we are considering a strategy that will take us right through the next period, hopefully with a functioning Assembly. However, the strategy will certainly work, whether or not the Assembly is up and running.

I will close now, Mr Davies; I am always very conscious that there are other speakers to come. In closing, I again offer my full support to the NCT’s #HiddenHalf campaign and its goals here in England—on the mainland—and I thank the NCT for its continued support for the campaign in Northern Ireland. The NCT is supporting our campaign in Northern Ireland and we thank it for that, because it is very important that we have that support. As I have said often, we are better together—the United Kingdom of Great Britain and Northern Ireland—with all regions working on things that are of mutual interest to us all. I understand that the NCT is fully behind all that is happening and will become further involved in the coming months, and I look forward to that.

Also, I commend Lindsay Robinson and all those who have been campaigning in Northern Ireland for improvements to maternal mental health. We know that they are making a difference, both to the parents in their communities and also with decision makers. However, we must also take action in this House. We must do what we can to honour the bravery of those who lay their experience on the line for people to see and bring about changes that support mothers and families across the UK.

Again, I congratulate the hon. Member for Stockton South on securing this debate and other Members who have spoken or who will speak; I look forward to hearing all the contributions to the debate.

Tobacco Control Plan

Jim Shannon Excerpts

Thursday 19th July 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

First, I thank the Minister for bringing forward the plan. As always, he is very active in health matters, and he certainly has a passion for this. I also thank right hon. and hon. Members who have spoken. Their information and evidence-based contributions have added greatly to the debate. Their knowledge is certainly greater than mine, but I must say that the hon. Member for Stockton North (Alex Cunningham) and the right hon. Member for Rother Valley (Sir Kevin Barron) have made significant contributions.

I am my party’s health spokesperson in this House, and I want to provide a bit of background about Northern Ireland. The right hon. Gentleman referred to some of the facts from Ireland, and I will look at this from a Northern Ireland perspective. We in the Democratic Unionist party set out our health policies in “Our plan for a world class health service”. When we had a functioning Assembly, that was one of the things we were very proud of; I hope we will get back to those days very soon. One of the aims was to improve the health service, and one of the pillars and listed successful health outcomes over the past few years was a decrease in smoking.

We have clearly had a policy and a strategy to address this issue. In 2012, the Northern Ireland Public Health Agency published its public health strategy “Making Life Better” for 2012 to 2023. In 2015, it published “Tobacco Control Northern Ireland”, which stated:

“Smoking has been identified as the single greatest cause of preventable illness and premature death in Northern Ireland”.

The tobacco control paper noted that in 2014, about 16% or one in six of all deaths in Northern Ireland were attributable to smoking. Over the ten years to 2015, smoking caused between 2,300 and 2,400 premature deaths per year. That indicated how important it was to reduce tobacco smoking and its take-up.

Across Northern Ireland, the standardised death rate due to smoking-related causes in the most deprived areas was 54% higher than the overall regional rate and 129% higher than the standardised death rate in the least deprived areas, and relative health inequality was getting worse. A general theme coming through from all those who have made contributions is the take-up of smoking in areas of deprivation across the whole of the United Kingdom of Great Britain and Northern Ireland. There is also a related gender gap. The standardised death rate due to smoking-related causes was highest among males in the 20% most deprived areas, more than twice that of males in the 20% least deprived areas, and almost five times that of females in the 20% least deprived areas. According to the report, smoking cost Northern Ireland some £450 million a year.

We quite clearly had a big issue that we were trying to address, and I believe the strategy implemented through “Tobacco Control Northern Ireland” was a methodology to do just that. Reducing smoking prevalence remains central to Northern Ireland’s public health policy, and we clearly support what the Minister has said, and what other Members have said, because they also recognise that. Although health is a devolved responsibility, many other areas of public policy relevant to reducing smoking prevalence remain the responsibility of the Government in Westminster, and our contribution takes that into consideration.

If I may, I want to comment on e-cigarettes. The right hon. Member for Rother Valley very clearly outlined the advantages of e-cigarettes and vaping. Some of the figures are incredibly important. Vapour particles from e-cigarettes are 73% water, which means that they quickly evaporate into the atmosphere, and the evidence of experts shows that 99% of the nicotine is retained in the vapour. It is very important to appreciate the advantages of e-cigarettes.

According to the UK national health service, there is no evidence of direct harm from passive exposure to e-cigarette vapour, and if we look outside the United Kingdom, evidence from other countries—France is one example—suggests there is no harm from passive vaping, based on current scientific knowledge, facts and figures. In 2016, the UK Government issued advice to employers to encourage workplaces to adopt pro-vaping policies so that it would be as easy and convenient as possible for workers to switch. That was on the basis that international peer-reviewed evidence indicates that the risk to the health of bystanders from exposure to e-cigarette vapour is extremely low. Again, there is an evidential base. Not so long ago I asked the Department of Health and Social Care whether it would consider introducing vaping areas in hospitals. People who are visiting hospitals go outside to smoke, and those who want to vape do not necessarily want to go to those smoking areas. I hope that the Minister will consider that idea.

In Newtownards, the major town of my Strangford constituency, a number of shops sell e-cigarettes. I suggest that those shops function because of the take-up of e-cigarettes—that is why they can pay their bills and why they exist. Very often, someone walking down the high street in Newtownards and elsewhere can see puffs of smoke. They are almost taken aback, and then they get the smell of strawberry, raspberry or cashew nuts, and realise that someone is vaping.

I want to comment on that point because it is important. The hon. Member for Harrow East (Bob Blackman) mentioned the US, and a survey carried out there suggested that vaping flavours may discourage smokers from returning to cigarettes. It stated:

“The results show that non-tobacco flavours, especially fruit based flavours, are being increasingly preferred to tobacco flavours by adult vapers who have completely switched from combustible cigarettes to vapour products.”

That was a survey of 20,000 adult frequent vapers in the United States, and of those 20,000, 16,000 had completely switched from smoking to vaping, and 5,000 were dual users who smoked and used vaping products—I want to add that point to the debate, because we must consider those results and look at the best ways to tackle this issue.

Hon. Members have asked how we can advance our strategy further. The Tobacco Control Northern Ireland report stated that exposure to smoking behaviour

“continues to occur in films deemed by the British Board of Film Classification as suitable for children and young people…this tobacco imagery extends beyond the film industry into mainstream television broadcasts”.

More than 60% of incidences of tobacco use occur before the 9 pm watershed, thereby providing a possible source of young people’s exposure to tobacco. A clear causal link has been established between smoking initiation among young people and smoking on screen in the entertainment media. The impact is down to the amount of smoking that young people see, not whether it is glamorised or not. The greater the exposure to smoking—however it is depicted—the greater the risk of smoking uptake, and I am sure that the Minister will come back with his thoughts about that.

Will the Minister ask his colleagues who are responsible for the regulation of film and TV in the Department for Digital, Culture, Media and Sport to work with the Department of Health and Social Care, and press Ofcom and the British Board of Film Classification to ensure that their codes effectively tackle the portrayal of smoking in films and television programmes that are likely to be seen by children?

In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the Tobacco Register of Northern Ireland, with a final deadline of 1 July 2016. That built on a similar scheme already in place in Scotland—the hon. Member for Linlithgow and East Falkirk (Martyn Day) referred to that—and a scheme is due for implementation in Wales. Lessons can be learned from such schemes, and I believe that we can learn greatly from the other regions of the United Kingdom of Great Britain and Northern Ireland, and bring our thoughts together to do something collectively that will benefit us all. Although registration schemes have the benefit of enabling public health authorities to identify where tobacco is sold, as currently constructed they appear to have had limited impact in preventing the sale of tobacco to underage children, or the sale of illicit tobacco.

I know this point is not the Minister’s responsibility, but I would just like to put it on record. In Northern Ireland, paramilitaries are involved with illegal tobacco smuggling and cheap cigarettes flood the market. The Police Service of Northern Ireland and the customs authorities are involved in trying to address the issue, but if I may I would suggest that Her Majesty’s Revenue and Customs could be more involved across the whole of the United Kingdom.

In conclusion, will the Minister ensure that his officials and their counterparts in HMRC talk to their opposite numbers in Northern Ireland, Scotland and Wales about their experience of the retail register scheme, and the lessons to be learned from the experience of the devolved Administrations? We can look at live these issues collectively, bringing our knowledge from the regions we represent. Hopefully, out of that we can construct a tobacco control policy that can help us all.

NHS Whistleblowers

Jim Shannon Excerpts

Wednesday 18th July 2018 Westminster Hall

[Dr Whitford]

I utterly agree. It is important to be clear that a disclosure in the NHS, which is what we are focusing on, regarding patient safety as opposed to employment issues, which are quite separate and dealt with differently, is in the public interest. The problem is that in cases where whistleblowers have been punished and have suffered detriment, what starts as reporting becomes a bullying and harassment issue that ends up in a normal employment tribunal setting, and the original concern is not dealt with.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall for consideration. Some 7,000 staff raised concerns about bullying or patient safety in 2017-18. Over the same period, some 356 whistleblowers said that they had experienced repercussions, ranging from subtle persecution, such as career opportunities being closed off, to being fired unjustly. That is truly shocking. Does she agree that the Minister may have to look at a full investigation into just how far-ranging these matters are?

[Dr Whitford]

I thank the hon. Gentleman for his intervention. I hope that this is just the first little step towards putting the matter on the agenda. The tragedies at Gosport brought the whole issue back. A nurse had come forward years and years ago, and could have saved hundreds of lives had she been listened to. Not being listened to is almost the least that can happen to a whistleblower, in that often they suffer detriment or reprisals and even lose their jobs.

The one change that Sir Robert Francis suggested to PIDA that has been made in England and Scotland is redress for discrimination regarding new employment—that is, applying for a new post within the NHS. Work is under way to introduce that in Wales as well. However, the main Act remains as it was. The first key weakness of PIDA is that it does not ensure an investigation of the whistleblower’s concern. Given the risks they take when they come forward, the detriment they may face, and the months or years of tribunals or other stages, it is crucial that the concern that made them step forward is not either overshadowed or completely ignored. I think that is their biggest frustration.

The Act most certainly does not protect whistleblowers. It describes itself as protecting whistleblowers from detriment, intimidation and reprisals, but PIDA can be used only for litigation after the detriment. Once someone has lost their job they can take their employer to an employment tribunal and attempt to have redress. The problem at that point is that the whistleblower has to prove that it was their disclosure—their coming forward and speaking up—that drove the loss of their job. Of course, employers will find all sorts of other excuses, such as, “Oh, they didn’t get on with their colleagues,” or, “They were a trouble maker,” or, “They were late for work.”

The success rate of litigation under PIDA is 3%, which is appalling, and shows how utterly weak the law is. Whistleblowers suffer further detriment while going through litigation. They know that they may face being landed with the costs. They may face bankruptcy, and stress that could go on for extended periods. Furthermore, between 2013 and 2017, people had to pay for employment tribunals. That, of course, closed that avenue off to many whistleblowers.

I make the simple case that we need a new public interest disclosure law. It should not sit inside employment law. It should not be a tweak to what we have now. We should recognise that the Public Interest Disclosure Act covers all sectors. The NHS may be one of the most common sectors to have whistleblowers, but the Act covers finance, research and business. We need a specific law.

It must be utterly clear that such disclosures are in the public interest, and that is where I disagree with the hon. Member for Stirling (Stephen Kerr), who may speak later. I do not agree with paying bounties to those who would disclose. Whether or not it creates a conflict of interest, it certainly gives the impression of doing so. It is utterly important, in the defence and protection of whistleblowers, that they can show that the only reason they have come forward is to protect patients or whoever the consumer is in their service.