Unpaid Carers

Jim Shannon Excerpts

Thursday 15th October 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to serve under your chairship, Mrs Barker. You always have a wonderful smile and you give us encouragement when we come along. That helps us to talk about subjects that are sometimes quite difficult to talk about—this is one of them. It is also a pleasure to see the Minister in his place. I look forward, as we all do, to his response to the debate.

Over my years as an elected representative—it has been a long time—I have met some young carers and unpaid carers. I have to start my contribution by paying tribute to them—those who quietly, tirelessly and selflessly dedicate their lives to looking after loved ones. What have I seen? I have seen the profound exhaustion. I have seen the absolute devotion. I have seen the immense financial and emotional toll. It is a fundamental truth that unpaid carers are filling a massive breach that the state simply cannot afford to fill. Without them, our health and social care system would collapse overnight.

I always give a Northern Ireland perspective. I wish I could say that it would not be replicated in what others will say today, but on this it is the very same. We have some 220,000 carers providing vital support to sick, elderly or disabled family members and friends. That is roughly one in eight adults. It breaks my heart to note that we also have roughly 17,500 children and young adult carers in Northern Ireland carrying a physical and emotional burden that no young shoulder should ever have to bear, but they are bearing it.

The latest research from Carers NI reveals that unpaid carers save the Northern Ireland Executive an astronomical £5.8 billion every single year. That is because if staff were doing that work, it would cost £16 million every single day, or more than £660,000 every single hour. That is equivalent to 80% of the entire day-to-day Department of Health budget.

In my Strangford constituency, in the Ards and North Down area, the local reality hits even closer to home. We have some 18,000 unpaid carers in our local communities, from the streets of Newtownards and Comber right down to the most isolated parts of the Ards peninsula. They are ordinary people doing extraordinary things. They are the partners, the parents and the children who have stepped into the breach because their love for their family overrides everything else.

How do we reward—I say “we”, but it is not us personally; it is government—that immense contribution? We reward them with poverty. We reward them with isolation and institutional neglect. The poverty rate among young carers in Northern Ireland stands at a shocking 28%. For those trying to survive on carer’s allowance, the situation is dire. The cost of living crisis has pushed them to the absolute brink, with more than half struggling to pay basic utility bills and over a third being forced to skip meals just so that they can look after their loved ones.

More than 52% of carers in Northern Ireland report that their physical health has suffered due to their responsibilities. Their days have a sense of fear and dread. Our carers in Northern Ireland do not even have the statutory baseline of protection. They are forced to reduce their hours or leave the workforce entirely, with nearly 30% of local carers having to give up their jobs to care. The impact on the carers is massive; poverty, for 28% of carers in Northern Ireland, is extreme.

This is the responsibility of the DWP, not the Minister, but every week in my office, sometimes more than once, my staff and I have to take on the case of someone who has had an overpayment. Sometimes they are a carer, and we have to intervene and help to get a repayment system that they can cope with, and it is all because of a mistake that was made. I am not talking about those who blatantly take advantage of the DWP system; I am talking about the ones who come to me—and probably to you, too, Mrs Barker—on a regular basis, who have to repay a statutory payment. It is a disgrace that we penalise those who want to work a few extra hours while managing their care duties. Does the Minister agree that it is high time that we stop treating unpaid carers as a free resource to prop up a failing social care system?

I welcome the fact that the Prime Minister says he will address this, but my goodness me, do it not just in England but in Northern Ireland. Will the Government commit to a comprehensive cross-departmental review of carer’s allowance thresholds and work closely with the Stormont Executive to deliver a ringfenced financial package and proper respite care, to ensure that those who care for our society are finally cared for themselves? That is what I want; I think it is what everybody wants.

Burnout is a real thing. Without support, we risk carers not only being unable to care for their loved ones but needing care themselves. That is what the ones I meet tell me. All we need to do is look at them. I am not better than anybody else, but when I engage with them, I can quickly understand how things are. This precarious house of cards around carers must be sheltered from the wind, and the Government must do that or pay an ultimate, unfathomable cost.

--- Later in debate ---

[Helen Maguire]

Absolutely. I referred to that, and the care also affects their career prospects.

The care that unpaid carers provide is worth an estimated £152 billion annually, which is equivalent to the annual NHS budget. The 2021 census also found that in England and Wales, women are more likely to provide unpaid care than men, with women accounting for 59% of unpaid carers.

The number of unpaid carers has risen by 70% in the past two decades, according to the Institute for Public Policy Research, and 1.7 million of the 5.8 million unpaid carers provide 50 or more hours of care every single week. In England and Wales, women aged between 75 and 79 are most likely to provide 50 or more hours of care a week, while among men it is those aged between 85 and 89.

The sacrifice to step up and work as an unpaid carer is not without significant impact. Evidence consistently shows that unpaid carers experience worse health outcomes than non-carers. The 2021 census in England and Wales found that around one in four carers reported “not good” health, compared with fewer than one in five non-carers. The GP patient survey in 2025 found that 72% of carers said they had a physical or mental health condition or illness. An academic study that analysed the GP patient survey data found that for those providing care for 50 or more hours a week, the health impact of being a carer is equivalent to their losing 18 days of full health each year.

The economic and employment prospects of unpaid carers are also heavily impacted. Census data shows that nearly 3 million people in the UK balance unpaid care with paid employment. Polling by Carers UK suggests that the number could actually be much higher, with one in five workers, or 6.7 million people, providing unpaid care. In addition, 69% of carers who are employees report not having focused on their career as much as they would have liked to, 61% said that caring has impacted the type of employment they have taken on and 21% said that they had taken on a lower paid or more junior role that better fitted with their caring responsibilities.

This polling also found that in the past two years 1.1 million people have left employment to provide care. That is equivalent to around 1,500 people leaving the workforce every single day, which is an increase of 150% compared with polling in 2019 that showed the figure was 600 a day.

[Jim Shannon]

I thank the hon. Lady for her contribution to the debate. She is focusing clearly on those in work. I was sitting there thinking about the young carers I first met, who were between 11 to 17 years old. The impact on them is clear and graphic. Their work and their education suffers. When they go home from school they have to do their homework and have to look after their mum, dad or siblings, so the impact on them is even greater than normal. Does the hon. Lady agree that for those in education, there is a big impact as well?

[Helen Maguire]

I absolutely agree.

WPI Economics research found that being out of work is the single strongest quantitative predictor of poverty for unpaid carers. Those negative impacts of caring are particularly felt among under-represented groups. Ethnic minority carers are more likely to be struggling financially and have concerns around services not meeting their needs in comparison with white British carers. Similarly, LGBT+ carers are more likely to be struggling financially and more likely to say that caring has impacted on their mental health in comparison with their heterosexual counterparts.

The Liberal Democrats have always been the party of carers. We have campaigned to ensure that they have the financial resources, training, support, rights, respite and access to services that they need to live their own lives to the fullest and look after their loved ones. We are proud of the successes that we have had so far in helping unpaid carers, including introducing the Carer’s Leave Act 2023 and securing increasing carer’s allowance in 2024.

However, much more must be done. We are happy to see that social care has moved up the agenda under the new Labour leadership, and we look forward to continuing to work constructively with the Prime Minister on this topic. However, the failure in social care is devastating family finances, forcing thousands to sell their homes, crippling the NHS with delayed discharges and unnecessary admissions and bankrupting local authorities. We will make sure that unpaid family carers are not overlooked as the whole system is reformed. They cannot continue to be seen as a never-ending source of labour that will always be there to cover the shortcomings of state support.

Our first test of Labour’s social care reforms will be whether family carers are front and centre with guaranteed rights. Those must include respite care and a full replacement of the broken carer’s allowance so that families can afford the care. Could the Minister clarify whether working-age adults will also be in scope for the national care service?

The Liberal Democrats will ensure that unpaid carers have a fair deal by increasing the carer’s allowance by £20 a week and expanding the eligibility for it; introducing a statutory guarantee of regular respite breaks for unpaid carers; establishing paid carers leave and building on the entitlement to unpaid leave previously secured by the Liberal Democrats; creating a carer support service in every hospital to support carers before, during and after a loved one leaves hospital and to involve them in their discharge planning; making caring a protected characteristic under the Equality Act 2010; and requiring employers to make reasonable adjustments to enable employees with caring responsibilities to provide that care and launching a young carers pupil premium as part of an education guarantee for young carers. We also want to see the NHS do more to identify and support unpaid carers, including by promoting the health and wellbeing of carers as part of integrated care board plans.

We are also calling on the Government to establish a new £75 million a year national scheme that would fund guaranteed respite care in every part of the country. That would alleviate the burden on carers and prevent hospital admissions due to carers becoming too exhausted to look after their loved ones. Unpaid carers deserve the right to a break. Many are overwhelmed and at breaking point because of their caring role. Being able to take a break is often described by carers as the No. 1 way to prevent burnout and in turn reduce pressure on our health services. That is particularly important as one in three NHS workers are unpaid carers themselves, and 65% of us will become unpaid carers at some point in our lives.

I urge the Minister to reflect on all the contributions and calls made by myself and other Members here today. We cannot let this crucial opportunity to strengthen support for those who provide essential care to others and reduce the risk of burnout among the millions of unpaid carers on whom our health and care system depend pass by. We must ensure that unpaid carers and the people that they care for receive the long-overdue support that they truly deserve.

Smoke-free UK

Jim Shannon Excerpts

Thursday 15th October 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for introducing the debate. Both their contributions set the scene incredibly well on an issue that concerns the health of people across the United Kingdom of Great Britain and Northern Ireland.

The information published by the Library ahead of the debate reminded us that the Conservative party published a Green Paper on this topic in 2019 and that the Labour party has committed to the smoke-free by 2030 ambition. The major political parties and all of us in this Chamber want the same thing: to achieve a smoke-free UK. The introduction of the Tobacco and Vapes Act 2026 has made possible what is hoped to be a smoke-free generation, by prohibiting the sale of tobacco to anyone born on or after 1 January 2009. That will undoubtedly contribute to the continuing decline in the number of adult smokers.

I only ever had a cigarette once. I tell the story because I was only about six years old. You know the way, when you are small, you look at your granda? He was not a big man, but he was my hero because he was my granda. Granda smoked the cigarettes. They were Gallaher’s, and I do not think there was any filter on them. I looked at my granda and said, “Granda, you’re always smoking cigarettes—can I have one?” My granda says, “Yes, you can. Take that there and then take a really deep breath.” And I did—with no filter. Those of a certain generation will remember whenever the po was under the bed; well, I went green and I was violently sick into the po. I always remember that introduction, from my granda—that was a cigarette. Never, ever have I wished to smoke a cigarette, all my life. The Government do not have to worry about me; it will never happen. Nor, I am glad to say, did it happen to any of my children. That is a story with, perhaps, a poignancy—a reminder of what it was like years ago.

In 2024, those aged 45 to 54 had the highest proportion of current smokers, at 12.4% UK-wide. Many of that age group are addicted beyond their control, and deterrence measures alone are likely to be a bigger challenge and potentially less successful. The hon. Member for Harrow East referred to the mother—it is not a condemnation; it is a fact—who would buy a cigarette before getting food on the table. We must recognise that smoking is a serious addiction and acknowledge that many in that age group began smoking without fully understanding the long-term health consequences. Our focus must extend beyond prevention. We must advocate for accessible addiction treatment and practical support for those who want to quit smoking but are struggling to do so.

I understand that the consultation on the tobacco and vapes regulations ended on 2 October. Will the Minister give us some indication of the timescale for the release of the responses to the consultation, and the timescale to take action on those responses? I should have welcomed the Minister to her place; it is always a pleasure to see her and we wish her well in her role.

It was estimated that in 2024 smoking contributed to 15% of all deaths in Northern Ireland, and the costs of treating smoking-related illnesses was estimated at £218 million annually. Those figures are worrying. They indicate that if we achieve a smoke-free United Kingdom of Great Britain and Northern Ireland, it will clearly reduce the financial impacts on the NHS. The same report reflected UK-wide concerns regarding young people vaping, estimating that in Northern Ireland alone 9% of 11 to 16-year-olds use e-cigarettes. Although e-cigarettes may help some adult smokers to move away from tobacco, it is increasingly the case that young people who have never smoked are becoming addicted to vaping. There is a real need to address that in the Government’s consultation on vaping.

I call on the Government to take further action to reduce the appeal of e-cigarettes to children by introducing controls on flavouring and advertising. Alongside stronger enforcement against the illegal sale of e-cigarettes to those under 18, that will contribute to a smoke-free United Kingdom of Great Britain and Northern Ireland, which will ease pressure on our already burdened health service and ensure that the next generation—the ones who come after us—will grow up free from the harms that we have seen smoking cause.

Underperforming NHS Trusts: Government Oversight

Jim Shannon Excerpts

Wednesday 14th October 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Stuart. I thank the hon. Member for Chelmsford (Marie Goldman) for raising this issue and giving us a chance to participate in this debate.

The new intensive recovery programme has identified several NHS trusts in England that are underperforming as a result of waiting lists, persistent financial difficulties and leadership instability. The trusts identified include North Cumbria, Mid and South Essex, Hull, North Lincolnshire and Goole, and East Kent. Performance across those trusts and beyond has raised serious questions about whether patients in England are receiving consistent access to cancer treatment.

I want to focus on cancer treatment in particular. The NHS has a long-standing target that 85% of patients should get treatment within 62 days of an urgent referral for suspected cancer. However, the performance at many trusts is substantially beneath that, and it is having serious consequences on patient outcomes. For example, in 2023, the death of a patient admitted to Mid and South Essex was linked to the trust’s failure to meet any of NHS England’s cancer waiting time targets. At that trust, only 47.7% of patients began treatment within 62 days, and by 2025 the number had further declined—in other words, it was getting worse.

At the County Durham and Darlington trust, which the hon. Member for Darlington (Lola McEvoy) referred to, the situation is similar. Significant failings were identified in breast cancer care, as she illustrated very well. A review of the care received by women between 2023 and 2025 found that 32 women had undergone unnecessary surgery, 20 had experienced a late diagnosis and a further 78 patients were found to have suffered moderate or severe harm. A review has been committed to, demonstrating that the true scale of the issue is likely much bigger than we know.

Analysis of NHS cancer waiting time performance found that nearly every English NHS trust missed cancer targets. In Northern Ireland, we have also experienced serious concerns regarding cancer care. For example, recently there has been a call for a public inquiry into urology services at the Southern Health and Social Care trust, where it was identified that cervical screening services had reported some results incorrectly. Patients were told their scan was clear, and then shortly afterwards told it was not. That is an absolute scandal, and it caused patients and families considerable distress. Northern Ireland’s waiting time statistics further illustrate the pressure on cancer services. Some 30% of patients began treatment within 62 days, and that percentage has been on a downward decline.

I know the Minister has no responsibility for Northern Ireland, but she has responsibility for the trusts here. I look to her to ensure the promotion of effective oversight and accountability in all our trusts. Underperformance is widespread and must be addressed. These failures are undermining public confidence in the health service. A suspected cancer diagnosis is already a distressing experience, and patient outcomes are not being helped by lack of clarity and reassurance.

[Graham Stuart (in the Chair)]

Last but not least from the Back Benches, I call Adam Dance.

--- Later in debate ---

[Helen Morgan]

I do agree, and I echo my hon. Friend’s call. The estate that people work in is part of the fundamental problem that we are trying to tackle across the NHS.

I hope all the Members here who have made excellent speeches highlighting shocking failures in their own trusts can take heart from the fact that it is possible to tackle the issues in underperforming trusts. In my time as the MP for North Shropshire, I have seen meaningful changes for my constituents. From 2018 to 2023, Shrewsbury and Telford hospital trust was obviously underperforming, with CQC inspections consistently rating it as inadequate. That included inadequate levels of safety and services—reflected in the horrifying stories received at the time in my inbox and those of the other Shropshire MPs, and on doorsteps—and a churn in the management team that led to constant uncertainty about what was going to happen there. The human consequence of those stories was devastating.

When I was first elected, the overwhelming issue was the abysmal ambulance waiting times, related to poor handover times, as the hon. Member for Stoke-on-Trent South (Dr Gardner) highlighted. I will never forget the letter I received from a headteacher: after a pupil dislocated his knee playing football, he and the teachers waited so long for an ambulance in the dark and cold on a winter night that he was at risk of developing hypothermia by the time the ambulance arrived. We heard countless devastating stories, including ones where the ambulance had taken so long to arrive that it was too late, and the outcome was fatal.

Following a targeted campaign, which included me joining the West Midlands ambulance service team for an eye-opening shift, wait times have significantly improved, and we see far fewer of these cases in our inboxes. But challenges remain, not least in corridor care in the accident and emergency department, which has at times been rated one of the worst in the country.

A constituent told me of the shocking experience of her aunt Cath during this period, who was admitted to Royal Shrewsbury hospital following a serious stroke. One night, Cath fell out of her hospital bed and broke her hip after staff had failed to put up the necessary guardrails. She spent nearly half an hour trying to attract the attention of staff on the ward with the alert bell, but they were so overworked that they did not respond, and in the end she was forced to dial 999 from the floor of the ward. She was left in the ridiculous position of explaining to the call centre staff that she was actually on the floor of a ward in Royal Shrewsbury hospital before the staff reached her. That cannot be right. We heard of many heartbreaking situations where cancer patients’ scans could not take place because waiting lists had meant that they were booked in the wrong order and of fatally long waits for diagnosis in some cases, with the trust failing to hit key targets across the board.

Finally, the 2022 Ockenden report shook my community with its devastating finding of over 200 preventable deaths of babies and unimaginable harm done to families. Campaigning and voicing justified anger, which everyone has done today, and working with Ministers on the failings can bring about change. That was essential in Shropshire, and though things are not perfect, it is encouraging to see the improvements that have been made so far. It has been a really difficult environment for staff to work in. I pay tribute to them and the new leadership team for all the hard work that they have put into turning this extremely difficult situation around. The trust’s CQC rating has recently been upgraded, although it still requires improvement, with emergency department waiting times and understaffing as key focuses. However, there is much to be pleased with. Reviews have noted a positive culture, and the trust has recently been shortlisted for several awards for its performance improvements.

We must celebrate the many trusts in the UK that provide high levels of care and innovation, and support those making significant improvements. For underperforming trusts, it is our duty to our patients and constituents to ensure that we campaign to bring them up to good standards, and I congratulate everyone here today on doing just that. However, if conditions for care are stretched and staff are expected to deliver the impossible with limited time and resources, it is patients who suffer. How can we transform patient safety? To start, we need to hold failing leaders to account, as I have discussed. Reports have pointed to a culture of unaccountability among NHS leaders, which has accompanied recent scandals and undermines public confidence. Failing trusts need to be held to account, and our amendments to the Health Bill would help do that by retaining the necessary structures for accountability.

First, we must retain the independent patient voice, Healthwatch, which was established in the wake of the Mid Staffordshire scandal. Although still in its infancy, HSSIB, the Health Services Safety Investigations Body, should also be retained because it promises to improve the patient safety environment. Our amendments would also introduce duties and a standardised framework for the reporting of suspected health system failings and medical malpractice by coroners, medical examiners and members of ICB and NHS trust boards.

Whistleblowing routes to the CQC, the Department of Health and Social Care, HSSIB and the police would be accompanied by statutory protections. We would also place a corresponding duty on senior leadership to escalate any concerns they have about safety or malpractice to the relevant boards. My colleagues in the other place will be re-tabling those amendments at the next stage of the Health Bill, and I urge the Government to accept them.

[Jim Shannon]

The hon. Lady referred to whistleblowing, as did the hon. Member for South Basildon and East Thurrock (James McMurdock) before her. Does she agree that there should be more encouragement for those who want to blow the whistle, but also protection for their jobs?

[Helen Morgan]

I fully agree, and that is why HSSIB has a role to play, because it provides a safe space for people to raise concerns without fearing for their jobs. The National Guardian’s Office, which is also being removed by the Health Bill, enables and encourages safe whistleblowing across the NHS, and it is important that we retain it.

The Thirlwall inquiry highlighted constant reorganisation as a problem as well. I received a notification in my inbox this week that Shropshire, Telford and Wrekin ICB had clustered with Staffordshire and Stoke-on-Trent ICB to get ready for a merger, but that it is all on hold now because it does not line up with local government reorganisation. It is really problematic for local health services when their management teams do not know whether they are coming or going from one month to the next. I urge the Minister to deal with that problem as well.

It is clear that urgent action is needed to turn around underperforming trusts for the safety of their patients, the welfare of their staff and the value delivered for the taxpayer. I hope the Government will look at the measures we have outlined and accept some of them in the Health Bill as it passes through the House of Lords, so that we can really affect people’s lives and put back their confidence that the NHS will be there for them when they need it most.

Bone and Joint Health

Jim Shannon Excerpts

Tuesday 13th October 2026 Commons Chamber

[David Reed (Exmouth and Exeter East) (Con)]

It is a real pleasure to lead this evening’s debate during Bone and Joint Week, raising awareness of an issue that affects millions of people, but receives nowhere near the attention it deserves. I start by thanking Arthritis UK and the Arthritis and Musculoskeletal Alliance, known as ARMA, for their work raising awareness of these conditions, for the information they have provided ahead of this debate and for the parliamentary event they put on today.

Musculoskeletal conditions or MSK conditions affect our bones and joints and the muscles and tissues that hold them together. They include arthritis, osteoporosis, chronic back pain and joint injuries. For some, these conditions are manageable. For others, they are utterly debilitating, leaving people struggling to walk, to work or to carry out basic everyday tasks.

More than 20 million people in the UK live with an MSK condition. Some 10 million have arthritis, including an estimated 15,000 people in my constituency. Such conditions are the single biggest cause of pain and disability in this country, accounting for around one in seven GP consultations, yet I fear that we underestimate their seriousness, perhaps because they are rarely immediately life-threatening. While they may not kill people, however, they can slowly rob them of their mobility, independence, ability to work and quality of life.

I want to explain why this issue matters to me personally. Six years ago this month, my life changed significantly, although I did not know it at the time. It is something that I have avoided talking about publicly, and if I am honest, I have struggled to accept it. However, I believe we should draw on personal experience in this place, particularly when it might help improve our country.

In October 2020, I was an extremely fit and physically robust former regular Royal Marine with multiple operational tours behind me. I was also competing at the highest level of wingsuit skydiving as a member of the Team GB squad. I can see Members thinking that those activities and MSK injuries are natural bedfellows, and they are probably right, but nothing prepared me for the debilitating consequences of what happened that October.

On a grey and windy day in Devon, I decided to go parachuting, which was a near weekly occurrence. As a reservist member of the Royal Navy parachute display team, I needed to keep current for the following season. I had completed around 700 jumps, and I was not frightened—this was like any other day—but I had something far more dangerous: complacency. The winds were strong and the parachute centre had restricted jumping to experienced parachutists only. I was practising precision landings and convinced myself that it would be good training. I also chose to wear trainers, rather than my usual military boots that provided ankle support. The plane took off and we climbed to 15,000 feet. The green light came on and I jumped.

Everything went to plan until the landing. Rather than landing in the middle of a muddy field away from obstacles, I decided to land closer to where I would be picked up. It was a lazy decision, and it was a stupid one. As I approached the ground, gusting winds caught my parachute, lifted me and slammed me into the side of an aircraft hangar. My left foot took the initial impact, before the rest of my body smashed into the building. My parachute went over the roof, leaving me dangling from the hangar. Fortunately, I remained conscious, managed to release my harness and fell the remaining 5 feet or so to the ground. I remember lying there in shock, checking everything was still attached. Then came the searing pain in my left ankle. My wife came and picked me up and drove me straight to accident and emergency. After examinations and scans, I was told that I had suffered a severe sprain. I was advised to get the ankle moving and seek physiotherapy, because timely NHS support was unlikely to be available. Having had little experience of the NHS, I trusted that advice.

Over the following months I worked hard at rehabilitation. Gradually, I regained strength, but I remained in considerable pain. I took the classic Royal Marine approach: crack on and hope it gets better. Having served alongside men who lost limbs in Afghanistan, I considered myself lucky, and I certainly was not going to complain about a sore ankle, but six months later, something was clearly wrong.

My physiotherapist recommended an MRI scan, which I paid for privately—again, I was advised that the NHS process would take too long—and, when the results came back, I had to catch my breath: my ankle had been broken the entire time. The fracture had been missed at A&E and I had spent six months rehabilitating an injury that had never been properly diagnosed.

I was advised to see a private consultant—again, because of the time it would take to access specialist help through the NHS. This is where I was incredibly fortunate. By complete chance, the consultant whom I went to see happened to be ex-forces himself. Having discussed my injury and background, he suggested that I see him through his NHS practice, where he could continue to oversee my treatment, and I am enormously grateful to him for doing so. After months of uncertainty, pain and frustration, I finally felt that someone understood the problem and could help me to work out what came next. I want to make an important point here: my experience has left me deeply frustrated with parts of the NHS and particularly with the difficulties in accessing timely diagnosis and treatment, but it has also shown me that there are some outstanding people working within it who go above and beyond for their patients.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for raising this issue. I spoke to him this morning to ensure that it would be okay for me to intervene in the debate.

Arthritis UK has said that there is an “escalating musculoskeletal health crisis”. In Northern Ireland, some 550, 000 people—nearly a third of the population—are now living with arthritis or a similar condition. Those living in chronic pain face long, painful waits—the very thing the hon. Gentleman referred to—with some reporting having to wait for up to eight years for a rheumatology appointment. Many are unable to work or live independently as a result, and almost 80% report that their mental health has deteriorated significantly, so it is not just a physical problem. Does the hon. Gentleman agree that while more must be done to reduce waiting lists, we must also ensure that, in the interim, patients living with chronic pain have timely access to appropriate mental health support?

[David Reed]

I will come on to the points that the hon. Gentleman has made, but he is completely right. We must look at these problems in the round, because this is an issue of not just physical but mental health. People who were once fit lose that fitness, both physically and mentally, and then they become a bigger burden on the state.

Let me return to the subject of the surgeon who helped me out. I have been fortunate to benefit from that care, but I recognise that I was lucky. At the time, I had the means to access private treatment, and through that process happened to find a consultant who could help me back into the NHS system. That should not be a matter of luck, and it certainly should not depend on someone’s ability to pay.

Six years on, despite the excellent care that I now receive, I am left with osteoarthritis that can, at times, be severely debilitating. I can no longer run. I avoid activities that cause my arthritis to flare up, and I face the prospect of eventually having the bones in my ankle surgically fused. For the first few years I held on to the hope that I would recover and return to the active life that I once had, but I have now accepted that it is likely that I will not. That is difficult when physical fitness and independence have been such an important part of one’s life. At times, it has been an incredibly lonely journey. My current NHS consultant gives me hope that advances in medical technology may offer better options, but because I limp, other bones and joints are now beginning to suffer. I know that I am likely to place increasing demands on the NHS in the decades ahead.

My experience has shown me a health service that can be brilliant at dealing with life-threatening emergencies, but pretty poor when it comes to conditions considered less serious, even when they fundamentally change someone’s life. I was fortunate enough to be able to afford private care, but millions of people cannot. They are left waiting, living with pain and sometimes watching manageable conditions develop into lifelong disabilities. That brings me to the wider purpose of this debate. People living with musculoskeletal conditions are about one and a half times more likely to experience mental health problems, and I understand why. When pain becomes part of everyday life and you can no longer do the things that you enjoy, it takes a toll. However, there is another dimension that we must urgently address in the House: the economic cost of doing nothing.

In 2024 alone, 26.5 million working days were lost to musculoskeletal conditions. Arthritis UK estimates that working days lost to osteoarthritis and rheumatoid arthritis cost £2.58 billion in 2017, with the figure projected to reach £3.43 billion by 2030. About 646,000 working-age people claiming sickness or disability benefits cite a musculoskeletal condition as their primary reason. I am not suggesting that they can all return to work, or that every disability is preventable, but I do believe that too many people deteriorate when early intervention might have kept them healthy, independent and economically active.

Let us consider someone working in construction, hospitality or healthcare. They develop a back problem or knee injury but cannot access timely treatment, so they carry on through the pain. Eventually, they cannot carry on. They fall out of work, their health deteriorates and they become increasingly dependent on public services. The taxpayer potentially picks up the bill several times over through NHS treatment, welfare payments and lost tax revenue, and the individual pays an even greater price. We focus too much on the immediate cost of treatment, without considering the potentially much greater cost of failing to treat someone early. Surely that is economically illiterate. If timely physiotherapy, imaging or specialist intervention can prevent lifelong disability or someone losing their job, we should see it as an investment, not simply another NHS cost.

However, it is not all doom and gloom, and there is reason for optimism. In my constituency, the Royal Devon University healthcare NHS foundation trust held its first MSK community appointment day in Exmouth. More than 100 people attended, accessing clinical assessments, rehabilitation advice and community support together. Patients particularly valued being listened to, and early results suggested fewer unnecessary follow-ups. One pilot does not provide all the answers, but it does show what can happen when services are organised differently and patients receive joined-up support.

That brings me to my questions for the Minister. First, where is the national leadership on MSK health? The previous Government recognised MSK as one of six major conditions in their major conditions strategy, yet we have not received a firm commitment that the current Government will develop a dedicated modern service framework. Will the Minister commit to establishing such a framework, with clear accountability and measurable outcomes? Will the Minister also commit to a national approach, with clear responsibility and measurable outcomes, and meet the Arthritis and Musculoskeletal Alliance to discuss it? I thank the shadow Health Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), for tabling an amendment to the recent Health Bill that calls for just such a framework.

Secondly, what more can be done to improve early diagnosis and timely access to rehabilitation to prevent avoidable deterioration while patients wait? Thirdly, will the Government work across the Department of Health and Social Care, the Department for Work and Pensions, and the Treasury to properly assess the economic case for early intervention?

Lastly, as a veteran, I want to raise veteran issues. MSK injuries are a major reason for medical discharge from the armed forces, and their consequences can follow people long after they leave service. Will the Minister work with Defence colleagues to improve access to rehabilitation for veterans, and examine whether the armed forces covenant properly addresses their long-term MSK needs? It cannot make sense for any one part of Government to save money by delaying treatment, only for another part to spend considerably more in dealing with the consequences.

I will finish where I began. Six years ago, I was able to soldier. I could run for miles, jump out of aircraft and represent my country in sports. Today, I have to think about every physical activity and the associated cost in pain. I do not share that to seek sympathy; I share it because I understand how profoundly an MSK condition can alter someone’s life. Millions of people across this country are living with far worse circumstances than mine.

[The Parliamentary Under-Secretary of State for Health and Social Care (Mr James Frith)]

I start by congratulating the hon. Member for Exmouth and Exeter East (David Reed) not just on bringing this debate on bone and joint health to the Floor of the House during Bone and Joint Week, but on sharing his personal insights and testimony. I thank him for his service and give him an assurance that I am very happy to talk about veterans, about the specifics and about his insights into how we can deliver on the armed forces covenant. I signed Bury’s first armed forces covenant when I was an armed forces champion, and although it was not the service level that he was accustomed to, I take very seriously our need as a country to pay our respects to the men and women who have put themselves in harm’s way or given the ultimate sacrifice in service to their country, so I thank the hon. Gentleman.

[Jim Shannon]

I was trying to intervene before the hon. Member for Exmouth and Exeter East (David Reed) sat down. While one door closed when he had his injury, another door opened. The door that opened was to be an MP coming here to represent his constituents, so he has an opportunity to speak up for all those who have such injuries, and that is a voice he has now.

[Mr Frith]

As ever, the hon. Member sees the upside—the glass half full—of all life’s experiences.

I thank and pay tribute to the charities, clinicians, researchers, carers and campaigners who support patients and refuse to let these conditions be overlooked. Bone and joint conditions are too often overlooked or dismissed as an inevitable part of ageing or frailty, but they are not; nor should we accept them as such. Arthritis, osteoporosis, fragility fractures and other musculoskeletal conditions can mean relentless pain, lost mobility, lost confidence, lost work and lost independence.

In 2024, almost one in five adults in England reported a long-term MSK condition. This is not a niche issue; it is a national challenge. Our task is clear: diagnose earlier, treat faster, prevent more illness, and help people remain active and independent. The Government’s 10-year health plan is built around three decisive shifts: hospital to community, analogue to digital and sickness to prevention. For people with MSK conditions, that means simpler access and the ability to refer themselves through the NHS app to services, including physiotherapy, pain management and orthopaedics.

The hon. Member for Exmouth and Exeter East sought advice on how we educate sooner and inform sooner, but the work we are doing with the single patient record, the new iteration of the NHS app and the development of NHS online—or the digital doctor, as I am calling it internally—is about providing that useful information in a timely manner. It should be as accessible as we have become accustomed to for information we consume online, whether through retail or consumer habits. That is the level of expectation we should have for services such as this, which can give future patients the certainty and knowledge they need, when otherwise they may endure pain while waiting to access services at a later point. That is an important distinction.

On osteoporosis, we are acting before the fracture, not merely after it. This March, the Government invested £2.6 million in 20 new DEXA scanners across England, following £1.9 million for 13 scanners last year. Earlier scans mean earlier treatment and fewer painful life-changing fractures, especially for older people and women. Patients must also benefit from effective medicines. Since 2022, the National Institute for Health and Care Excellence has recommended Eladynos and Evenity for osteoporosis in post-menopausal women—an important distinction within the debate—both of which strengthen bones and reduce fracture risk. The UK National Screening Committee is reviewing the case for screening women for osteoporosis. Its consultation closed last week, and we will consider its independent recommendation carefully when it reports.

We must be frank: community waiting lists for MSK remain the longest of any community service. Every delay can mean more pain, less mobility and a greater risk that somebody leaves work or loses independence. I agree with the hon. Gentleman’s point about having a cross-departmental approach to ensure that support is timely to prevent people going off work and losing their income, identity, self-esteem and worth, and everything that we understand comes with a forced departure from work. That is why the Getting It Right First Time MSK community delivery programme is backed by about £6 million in 2026-27. It is redesigning services, improving referrals and connecting patients to wider support. The first cohort saw waits of over 18 weeks fall by about 20% in participating systems. That is real progress and we must spread it.

We are also expanding MSK physical activity hubs. They use the skills of the leisure and fitness workforce to improve mobility, reduce pain and fatigue, and help people stay in or return to work. The principle is simple: care should come to people, not force people to navigate the maze. Throughout neighbourhood health, community MSK services, physiotherapy and occupational therapy will support recovery, protect mobility and manage long-term conditions closer to home. We have set a clear national ambition that by 2028-29, at least 80% of community health services activity should take place within 18 weeks. National guidance will define a consistent core offer and bear down on unacceptable variation or postcode lottery.

General practice is often the front door. We are increasing capacity so that patients are seen sooner and urgent cases are directed to the right care on the same day. Elective recovery matters. We remain committed to meeting the constitutional standard by March 2029: 92% of patients treated within 18 weeks. For bone and joint conditions, that means stronger links between primary, community and hospital care, and faster access to specialist advice.

Women’s health must be central to this argument as well, not peripheral. Menopause-related hormonal changes raise the risk of osteoporosis and frailty. The renewed women’s health strategy therefore focuses on earlier recognition, easier access, better treatment and practical support at work.

Bone and joint health is an inequalities issue as well. Chronic MSK conditions are a major cause of poor health and work limitation, often occurring alongside mental ill health—as the hon. Member for Exmouth and Exeter East described—and obesity, which is often concentrated in poorer communities. A postcode must not determine whether pain is relieved, mobility restored or independence protected. Reducing delays and unwarranted variation is not an optional extra; it is a matter of principle and fairness.

In conclusion, let us reject the idea that these conditions are simply to be endured. Pain is not inevitable. Disability is not inevitable. A life-changing fracture is not always inevitable. Earlier identification, effective treatment, rehabilitation and prevention all change lives and save the NHS the greater cost of acting too late.

I again thank the hon. Member for his service and for securing this debate, and all those working through Bone and Joint Week. The Government will work with the NHS, local government, clinicians, charities and patients to turn ambition into action: fewer fractures, shorter waits, better mobility and more people living independently for longer.

Question put and agreed to.

Youth Suicide Prevention and Mental Health Support

Jim Shannon Excerpts

Tuesday 13th October 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Mr Wishart. A big thank you to the hon. Member for Blaydon and Consett (Liz Twist) for setting the scene so incredibly well. This profound and heartbreaking crisis touches almost every community, school and street across the United Kingdom of Great Britain and Northern Ireland.

When we talk about the mental health of our young people, we are talking about our future. The world our young people have inherited is one of intense and inescapable pressure: social media follows them everywhere, there is no place to hide from cyber-bullying, and the continuous distortion of self-worth is pulling our youth into dark, isolated corners. In Northern Ireland, one in 10 have engaged in self-harm, and we have lost 290 to suicide in a single year. Every one of them represents an empty chair at a family table, a shattered home and a life of potential cut tragically short.

Regional figures from Ards and North Down council indicate that the number of suicides in Ards and North Down increased by a shocking 40% over the last four years. Our local youth services and schools are overwhelmed. Grassroots groups are doing an angelic job, but they are fighting an uphill battle against rising demand and unstable funding.

Our young people in Comber and Newtownards, and right down the Ards peninsula, which I represent and where I live, deserve better than a system in which they have to wait months on end just to speak to a mental health professional. That is not satisfactory. Early intervention is not a luxury; it is a life-saving necessity.

[Pete Wishart (in the Chair)]

Order. I am going to have to reduce the time limit to a minute and a half to try to get everybody in.

Baby Loss Awareness Week

Jim Shannon Excerpts

Monday 12th October 2026 Commons Chamber

[Andy MacNae]

I agree wholeheartedly, and as the hon. Member will see, I will focus on that significantly later in my speech.

On miscarriage data, Scotland is expecting to begin routine data collection on miscarriage from this year. England should match that ambition. Linked to that, we also need to address anomalies in how stillbirth is defined and recorded. However, targets and data are only meaningful if someone is responsible for monitoring progress and challenging failure.

That brings me to my second point. The maternity and neonatal commissioner, as recommended by Baroness Amos, must be independent, empowered and properly resourced. The commissioner could provide a strong national voice for women, babies and families, monitoring whether recommendations are implemented, holding the system to account and ultimately helping to rebuild trust. The commissioner should report regularly to Parliament on progress against national targets, identify where improvement has stalled and require public bodies to explain what corrective action they will take. That must include being able to challenge the regulators. Long-terms issues with the Care Quality Commission and the General Medical Council are well recognised, but effective, trusted and fit-for-purpose regulators are a crucial element of any maternity safety system and a maternity commissioner should be able to demand better of them.

The commissioner’s potential will be realised only if they can act independently of the system being scrutinised. The system cannot be allowed to mark its own homework. The commissioner should have a statutory basis, independent publication rights, the power to obtain information and make formal recommendations, and a duty to monitor their implementation. The office will also need protected funding and a dedicated team. The Government must explain how the commissioner will work alongside the taskforce and other bodies, what powers the office will possess and how its independence will be protected. That will be particularly important if the role is to be based within the Department of Health and Social Care. If that is the case, the Government should present a clear rationale as to why it is the best option and provide specific assurances around independence. Ultimately, families will judge the maternity commissioner role by whether it can ask difficult questions, publish uncomfortable findings and demand proof that change has occurred.

[Jim Shannon (Strangford) (DUP)]

I was hoping the hon. Member would mention this point. When there is a tragedy, a loss, a heart aching and a family grieving a child they have lost, that really hurts. Does he, and ultimately the Government, feel that there should be access to a person of faith—perhaps a chaplain, a man or woman of the cloth—who could come forward to provide succour and support whenever they need it?

[Andy MacNae]

I think this connects to the issue of personalised care. When it comes to bereavement support, it is the care and support that works for that individual. I will talk later about personalised care plans and personalised support plans during bereavement, but it is about reflecting on what the individual needs, not what the system says someone needs.

--- Later in debate ---

[Sir Jeremy Hunt (Godalming and Ash) (Con)]

I thank the hon. Member for Rossendale and Darwen (Andy MacNae) for that excellent opening speech. I also thank him and the hon. Member for Sherwood Forest (Michelle Welsh) for co-sponsoring the debate with me.

Most of all, however, I thank the parents who have lost children, and who took me on a journey on this issue when I was Health Secretary. I am thinking of James Titcombe, who lost his son Joshua at Morecambe Bay; of Carl Hendrickson, who lost his wife Nittaya and his son Chester at Morecambe Bay; of Richard Stanton and Rhiannon Davies, who lost their daughter Kate at Shrewsbury and Telford; of Derek Richford, who lost his grandson Harry at East Kent. They, and many others, are watching this debate and can see that the Health Secretary is here. I thank her for being here for this Backbench Business debate; it means an awful lot, and I know that she cares about the issue.

I start by recognising that some progress has been made. Since I first stood at the Dispatch Box in 2014 with the Morecambe Bay inquiry, which was the first of many maternity safety inquiries, the neonatal deathrate has fallen by 21%—about 700 fewer deaths a year—but that is not good enough. The fall in death rates plateaued in 2020 and has not got much better, and since then we have had a worrying rise in maternal deaths. The 2025 target to halve neonatal deaths that I set in 2017 was missed.

There are three problems behind our lack of progress. First—and this is something for which I am partially responsible—there are too many recommendations. Earlier this year, Baroness Amos counted 748 maternity safety recommendations, mainly since 2015. The NHS is a world champion at doing reports into maternity safety, but sadly not a world champion at implementing the recommendations made.

It is encouraging that the Health Secretary says that there will be a recommendations hub, but could she give it real teeth, so that there is a timescale within which the NHS will decide if it is going to adopt a recommendation and, if it is going to, a person responsible for implementing it within the vast labyrinth that is the NHS? Could she give a timescale so that we and our constituents all know that something really is going to happen?

[Jim Shannon]

I know the right hon. Gentleman will be aware of the research that suggests that giving women access to specialised care after their first miscarriage can help prevent baby loss. Currently, specialist care is only offered after three miscarriages. It is estimated that supporting early intervention could prevent around 10,000 baby losses a year—that is one thing that could be done right now.

[Sir Jeremy Hunt]

I absolutely agree with the hon. Gentleman, and his point closely links to the second of my three reasons, which is that we have still not, after all this time, implemented proper continuity of care. That should mean that every mother, from the moment she is told that she is pregnant, is assigned one team of doctors and midwives to be with her throughout pregnancy, birth and even after the birth. Clinical teams that know their patients are much more likely to identify risk when it happens and to avoid tragedies. That lack of continuity of care sits behind the feeling that we heard about in the speech by the hon. Member for Rossendale and Darwen: parents saying time after time that they feel forgotten in the system.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for Morecambe and Lunesdale (Lizzi Collinge). I thank her for sharing her personal story, as many others have in this Chamber. Those personal stories remind us all of the grief, the loss and the pain. Thank you, Madam Deputy Speaker, for allowing this important debate to be brought forward.

Baby Loss Awareness Week provides an important opportunity to raise awareness and to reflect on loss. Everyone who has spoken tonight has reflected on loss, whether directly or through friends and family. However, we must recognise that the impact of baby loss extends beyond this week. It is not just this week; it is every other week of the year. Families continue to carry their grief long after this campaign ends.

Losing a baby, both before and after term, is devastating. Parents speak of the potential of what could have been, of the hopes and dreams they had for their child and the milestones that they believed they would celebrate, but that were not to be. With this loss comes immense grief and anxiety, and the impact, not only on the mother but on the wider family circle, cannot be overestimated.

I know that the mums, the dads and the siblings will probably feel the pain more, but the grandparents, aunties, uncles, sisters and brothers all feel it as well, because they are all living through their family member, hoping that the new life will be something they can enjoy as well. For many families, this continues to affect future pregnancies. Parents report feeling constant fear and anxiety, waiting with grim anticipation for this tragic event to happen again. Sadly, for some families it does.

My mother had four children, but she also lost four. My speechwriter Naomi, who is a very busy girl, also lost her first baby. Many of my constituents tell me of their loss, and this debate allows me to express, on their behalf, their sorrow and the fact that it means so much to them.

Supporting women through and after this loss should be a priority. We must advocate for open communication among friends and family, as many women have shared that talking about their loss has helped their healing and made them realise that they are not alone in this experience—and they are not alone in this experience. They have their family, and many others have been through the same pain.

Supporting women in this loss is essential, but we must also do everything we can to prevent loss, where possible. I drew attention in an earlier intervention to the research suggesting that giving women access to specialised care after their first miscarriage could help to prevent baby loss.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

My daughter is a rainbow baby. It is amazing that we managed to have her, but the hurt and the pain to get to that position, when you have lost children in between, is absolutely unbelievable. Does the hon. Gentleman agree with me, based on what he has just said, that it is so important that after that first loss, as Tommy’s has suggested, intervention and professional support is given immediately, both in terms of investigating and understanding the cause and in terms of mental health support?

[Jim Shannon]

I totally agree with the hon. Gentleman, as I think does everybody in the Chamber. Currently, specialist care is offered only after three miscarriages. Estimates suggest that if early intervention were offered after one miscarriage, potentially around 10,000 losses could be prevented each year in the UK. That is the magnitude of just one step in the right direction. I look forward to the Minister’s response, and I hope that she can give us some encouragement. She is compassionate, and she understands how all of us in the Chamber feel about this issue, so I hope we can get that reassurance.

I want to speak about Northern Ireland, as the hon. Member for Lagan Valley (Sorcha Eastwood) already has done. I sincerely welcome the recent changes in Northern Ireland. We became the first region in the United Kingdom of Great Britain and Northern Ireland to provide paid leave to both parents affected by miscarriage. It is really important that our Minister took that step in the right direction. Maybe it is something that the Secretary of State would consider implementing here on the mainland where it would help many people. It is estimated that around 9,000 people per year in Northern Ireland are affected by miscarriage, which leaves me in no doubt that the change will have a real impact on families in Northern Ireland.

Further efforts have been made in Northern Ireland, including through the baby loss certificate scheme—perhaps a small thing but it is has a big effect. Certificates are now available to anyone who has experienced a pregnancy loss before the end of the 24th week of pregnancy. The formal recognition of the loss offers families, who previously went unrecognised, a degree of comfort and closure.

In an intervention on the hon. Member for Rossendale and Darwen (Andy MacNae), I spoke about the importance of having a chaplain or minister available to give the succour and care that is sometimes needed. There is a spiritual dimension to loss. As a Christian, it would mean a whole lot to me, but I think it would mean a whole lot to others as well if they had that opportunity. Perhaps the Secretary of State can provide some reassurance on that as well.

We must ensure that the impact of these schemes is properly evaluated so that we can understand how effective they are in supporting bereaved families. If the evidence shows that measures are making a meaningful difference, this House must consider how similar support can be implemented across the UK.

It is clear that baby loss has a lasting impact. Every baby lost represents a life that could have been lived and a future that might have been. We must show compassion and understanding to those affected, not only during Baby Loss Awareness Week but every day of the year.

[Several hon. Members rose—]

Goods Trading: Great Britain and Northern Ireland

Jim Shannon Excerpts

Tuesday 15th September 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I commend the hon. and learned Gentleman on introducing the debate. One of the greatest issues we all face is the crisis in the supply of veterinary medicines following Brexit. They continue to be subject to additional EU regulatory requirements, and farmers continue to face potentially serious consequences for animal welfare and the responsible management of antimicrobial resistance. Does the hon. and learned Gentleman therefore agree that Northern Ireland cannot continue to be economically cut off under the regulatory burdens placed on farmers and vets? Those burdens must be reduced.

[Jim Allister]

I think all that is self-evident, but sadly, we have a Government who are deaf to those issues, and sadly, the hon. Member’s party seems to have come to terms with them, because in Stormont, the DUP is now prepared to implement the Irish sea border and the Windsor framework, but let me be very clear: the integrity of our single market has been utterly destroyed.

Among the practical consequences of that are unimaginable levels of trade diversion. We were once a wholly integrated part of the United Kingdom. Once barriers are erected, trade is discouraged. Various surveys show that that has happened. From the Federation of Small Businesses survey, we know that 34% of GB companies that used to trade with Northern Ireland have ceased trading. Why? Because this paperwork and this checking is such a disincentive that it is not worth the bother.

This week, I received figures from the Department for Transport that I find quite astounding, and they make the point with great clarity of what it means to have had trade diversion. According to the Department for Transport, in 2022, 8.6 million tonnes of goods were distributed in Northern Ireland by GB-registered vehicles—in other words, GB haulage companies bringing goods into Northern Ireland. Last year, that figure fell to a staggering 2.2 million tonnes. In just four years, there has been a fall of 75% in the quantum of goods coming from GB to Northern Ireland by GB-registered vehicles.

--- Later in debate ---

[The Minister for Science, Innovation and Investment (Chris McDonald)]

It is a pleasure to see you in the Chair, Dame Siobhain. I congratulate the hon. and learned Member for North Antrim (Jim Allister) on securing this important debate—its importance was reflected in the urgency and tone of his remarks. I thank him for his comments, particularly those on the importance of the Union, with which I agree.

That is why I would like to start by very much refuting the hon. and learned Member’s assertion that it is the policy of this Government to enable Northern Ireland to step out of the United Kingdom. I am sure that he does not fully mean that, although he is clearly very concerned about these issues of trade. I acknowledge those concerns, but the situation is more complex than his remarks have perhaps allowed for. Clearly, if there were a simple solution to this that would deliver all the benefits he has described for Northern Ireland, the Government would want to move to that solution, but it is more complex than that. Through my remarks, I will try to address the many points that he and other colleagues have raised, and I will perhaps be able to elaborate on some of that complexity.

First, I will address the hon. and learned Member’s point about unfettered access. The Government remain fully committed to unfettered access for qualifying Northern Ireland goods moving from Northern Ireland to Great Britain. I also want to be clear about the importance of the UK internal market and Northern Ireland’s place in that market. The Office for the Internal Market highlights the importance of the internal market and of the sales to the rest of the United Kingdom, equivalent to around a quarter of Northern Ireland’s economic output in 2021. In 2024, which is the last year for which we have published data, Great Britain accounted for 52% of Northern Ireland’s trade in goods, and that figure is broadly the same as it was in 2018, indicating the robustness of Northern Ireland’s place in the United Kingdom internal market.

[Jim Shannon]

Shops in Newtownards that have always bought their goods from a certain company across the water have been unable to do so because of the bureaucracy. By not being able to trade with that company directly, they are not able to offer the prices they once did. Nurseries and those that buy plants and seeds have also been restricted in what they do. DIY stores have been restricted by the bureaucracy and their ability to be competitive has been reduced. Has the Minister given any thought to that? I write to the Secretary of State for Northern Ireland regularly about these matters, although not to the Minister in particular, but has the Minister had a chance to understand the issues and problems that my businesses in Strangford are feeling?

[Chris McDonald]

I thank the hon. Gentleman for raising that. He raises concerns around bureaucracy and paperwork, essentially, for small businesses, and the hon. and learned Member for North Antrim mentioned our own House of Commons gift shop as well for low value items. I very much want to come on to this point in my speech, so I am grateful to the hon. Gentleman for raising it.

I will start by talking about the general performance of Northern Ireland trade with the rest of the United Kingdom. Northern Ireland’s goods exports within the UK and with the European Union have been strong. In fact, Northern Ireland’s exports to the European Union have outperformed the rest of the United Kingdom, increasing since 2019, whereas in the rest of the United Kingdom, exports have decreased in that period. It is therefore important to note that Northern Ireland does benefit from being a fundamental part of the UK internal market and having unique access to the EU single market. Of course, I do recognise—and the point was made by the hon. and learned Member for North Antrim—that this experience varies across sectors, companies and individual constituents, which is why this debate is so valuable. I will go on to talk more about that.

I understand the challenges around this, but public authorities have a statutory requirement to have special regard for Northern Ireland’s place in the United Kingdom internal market under section 46 of the United Kingdom Internal Market Act 2020. That guidance gives real statutory power to ensure that policymakers within the United Kingdom actively consider Northern Ireland’s place in the internal market when they are implementing the Windsor framework or making policy involving the movement of goods in the United Kingdom. Where that is the case, the statutory guidance ensures that those policymakers must have special regard for Northern Ireland’s place in the UK internal market.

Most importantly, one part of having special regard means the need to facilitate the free flow of goods between Great Britain and Northern Ireland, with the aim of streamlining trade between the two, and maintaining and strengthening the integrity and smooth operation of our internal market. The guidance ensures that policymakers must give that special regard considerable importance and weight above other factors in policymaking. That represents how this Government have implemented a key commitment in the “Safeguarding the Union” Command Paper published under the previous Government to ensure that proper process is in place to always consider both Northern Ireland’s place in the UK internal market and the flow of goods between Great Britain and Northern Ireland.

Members have spoken in detail about the Windsor framework and the challenges it brings. I would like to stress that the Government are wholly committed to the Windsor framework. The framework supports the peace and prosperity brought by the Good Friday agreement, one of the proudest achievements of our last Labour Government, and it plays a vital role in ensuring the smooth flow of goods between Great Britain and Northern Ireland, but of course I recognise the concerns raised by hon. Members.

It is clear that the Windsor framework is delivering benefits and smoothing the flow of goods between Great Britain and Northern Ireland. I have already noted how the Northern Ireland-Great Britain supply of goods has been maintained through the implementation of the framework. Over 15,000 traders are now signed up to the UK internal market scheme, and more than 1,100 operators are registered for the Northern Ireland retail movement scheme and the Northern Ireland plant health label. Northern Ireland traders are benefiting from these facilitations, and businesses are choosing to invest in the dual market access that Northern Ireland uniquely offers.

The hon. and learned Member for North Antrim is concerned about the level of investment and believes that businesses will not wish to invest in Northern Ireland for that reason. On my recent visit to Northern Ireland, however, I saw significant investment from Boeing, Airbus, Navantia and many other businesses. It is clear that this is not a uniform experience across all businesses, but it has been possible for Northern Ireland to attract significant inward investment.

Vascular Sector Reform

Jim Shannon Excerpts

Thursday 10th September 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the potential merits of reform of the vascular sector.

It is a real pleasure to serve under your chairship, Dr Huq. Last night, you were in the Adjournment debate, and today you are chairing a Westminster Hall debate. Your talents are incredible—well done to you. We appreciate all the efforts that you make for us in this House in all ways.

It is, too, a pleasure to introduce this debate on something I am particularly interested in. A number of people in the Public Gallery have much more medical talent than I have—I am interested in the subject, but in the Gallery are some of those who carry out some of the operations and so have a deep interest. I pay a special thanks to Roger Greer, who is the administrator for the all-party parliamentary group for vascular and venous disease, which I chair—I declare that interest. That gentleman and others with him make the effort on this subject matter, which I am interested in.

Back home, I have had the opportunity to visit the Royal Victoria hospital. On vascular health, unfortunately some of the statistics for Northern Ireland, which I will mention, are worrying. I suspect that they will illustrate where we are in Northern Ireland, and that what is happening there will be mirrored here on the mainland.

It is a real pleasure to see the Minister in his place. We had a wee chat beforehand, and I think—although I am not a prophet or the son of a prophet—we will all agree on the subject matter of this debate. I very much look forward to the Minister’s response, and to his encouragement in some of the responses that we need as we move forward.

I am speaking on an issue vital to thousands of families across our great nation, the United Kingdom of Great Britain and Northern Ireland, and yet one that too often remains hidden in the shadows of our health service. I just said that to the Minister before—this is one of the issues that is slightly hidden. We might not always know everything about it, unless we have a particular interest. I know that other Members present—I thank them for coming—will have a particular interest in the pressing need for comprehensive reform of lower limb vascular care.

This debate gives this Westminster Hall Chamber the opportunity to highlight an often forgotten health issue. Vascular disease affects the very network of life within us, the arteries and veins that carry blood around our bodies, and encompasses peripheral arterial disease, chronic limb-threatening ischaemia, venous disease and devastating diabetes-related foot complications. I declare an interest as a type 2 diabetic, although I Richard in the Gallery might say, “Well, after that cake you had the other day, perhaps you’re not as careful as you should be with your diabetes”—but I do try to be careful and look after it.

Those are not mere clinical terms; they represent real human suffering, unbearable pain, non-healing wounds, severe loss of mobility and, in far too many cases, major limb amputation and premature death. I will put a bit of focus on that for us in Northern Ireland, because some of the figures for amputations in Northern Ireland are scary. I think they are probably scary here on the mainland as well. We have seen inspiring progress in cardiac and stroke care, which is very much welcome, but outcomes for vascular patients have simply failed to keep pace. That is the issue I want to highlight, if I can.

The risk of developing PAD is four times higher among smokers than non-smokers, and two to four times higher among people with diabetes than people without diabetes. That is another reason for this debate and the importance of where we are. One in five people over the age of 60 is affected by PAD, and more than 80% of amputations among people with diabetes are preceded by a foot ulcer. People might say, “A foot ulcer? That is not too bad”, but it can well be. Often, it is the precipitation of a disorder in your blood, which ultimately could lead to amputation. That statistic clearly demonstrates the enormous opportunity we have in prevention and early intervention.

One of the main thrusts of my comments today will be about early intervention and how we do that. We have experts in the Chamber who will speak, and I thank all hon. Members for coming along to make their contributions.

Approximately 4,200 major lower-limb amputations are performed every single year due to PAD, each representing, I believe, a personal tragedy, and an average cost of £28,000 to the NHS. We have to consider the costs, because they are part of what the NHS has to look at. Managing CLTI alone costs our health service an estimated £244 million annually, while the overall bill for NHS wound care reached a staggering £8.3 billion in 2017-18. That included some £5.6 billion spent on wounds that failed to heal. That perhaps gives a clinical look at where we are.

The human toll, of course, is tragic. Patients suffering from CLTI with rest pain or tissue loss face a 60% risk of death within five years, a prognosis that is worse than for many end-stage cancers. Following an above-knee amputation, a quarter of patients die within 90 days, and median survival among diabetic patients is just 1.68 years. Those stats illustrate the extent of the problem and, I believe, confirm the importance of where we are.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

The statistics that the hon. Gentleman highlights should shock us all. If those were the statistics for dealing with any cancer, we would simply find them unacceptable. Does he agree that vascular disease, because it is not treated in the same way as cancer, in some cases ends up being treated as a “second-class” disease, and that we should be mindful of that?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. He has rightly said that, when it comes to vascular disease, while it is equal with cancer in its severity and in the numbers who lose their lives, it is not treated the same. Today’s debate perhaps gives us a chance to illustrate that, and I am hopeful that the Minister responsible for answering can give us some encouragement in relation to it.

Furthermore, this crisis starkly reinforces health inequalities. Just as an example, among individuals aged 45 to 54, those in our most deprived communities face above-knee amputation rates nearly five times higher than those in the least deprived areas.

I thank the Library, as always, for the information that it made available to us. It said that

“gaps in vascular care are resulting in avoidable harm for patients. In particular, the report highlighted ‘delayed diagnosis, inconsistent referral pathways and variable access to specialist care’ for people with PAD, venous disease and diabetes-related foot complications. It said these problems are resulting in ‘thousands of avoidable lower-limb amputations each year.’”

If we were to achieve something from today’s debate, it would be first to ensure an improvement in vascular health, but secondly for the issue of amputations to be addressed through early diagnosis and looked at much more significantly and strongly than it has been.

As the Member for Strangford in Northern Ireland, I feel a particular responsibility to shine a light on how this national crisis presents itself in Northern Ireland. I do that because I think it will help add to the debate; I am ever mindful that the Minister here today has responsibility for the United Kingdom but not directly for Northern Ireland—I understand that—but I use the figures, stats and information from Northern Ireland as an illustration of the issue. What I want to see, and what I think the Minister will want to see as well, is an improvement in this across the United Kingdom and elsewhere.

My job is to shine a light on how the national crisis presents itself in Northern Ireland. While the briefing outlines the systemic challenges across the UK, the reality on the ground in our region underscores an even more acute urgency. Across Northern Ireland, hundreds of patients undergo limb amputations each year due to vascular complications and diabetes-related foot ulcers. In fact, diabetes prevalence in Northern Ireland continues to rise steadily, with local health trusts treating thousands of individuals at high risk of developing severe foot complications.

People sometimes think that diabetes is not that serious. I used to be almost 17 stone. I realised, when the doctor confirmed that I had diabetes some 18 years ago, that I had to lose weight. I lost 4 stone and I have kept it off, but I have to work hard to ensure I do not develop any other complications, which can quite often happen.

The stats in Northern Ireland reflect stark and unacceptable regional inequalities, and they are mirrored by the stats and figures from the mainland. On healthcare inequality, patients from the most socio-economically deprived communities in Northern Ireland face significantly higher amputation rates, nearing the alarming national trend here on the mainland, where deprivation increases the likelihood of a major amputation nearly fivefold.

Hopefully, when the Minister responds, he will tell us how the issue of higher levels of deprivation can be addressed, because it must be done. The lack of hospital bed capacity, dedicated wrapping access and community foot protection services forces vascular patients into prolonged, acute hospital stays. Managing severe vascular conditions and non-healing wounds accounts for millions of pounds annually across our health and social care costs. Those resources could be saved through early preventative community intervention. Again, that means early diagnosis, early community intervention and savings to the NHS, which can then be used in other parts of the health service.

Turning to survival rates, a patient in Northern Ireland who undergoes a major lower limb amputation faces a staggering mortality risk within their first year post surgery. It is the same across the UK. Preventative care is quite literally a matter of life and death. I could not express that any better than the hon. Member for Glasgow South West (Dr Ahmed), who underlined that in his intervention.

If we are to relieve pressure on local hospitals in the United Kingdom of Great Britain and, ultimately, in Northern Ireland and protect our most vulnerable citizens, we must ensure that any national reform framework, including the national foot attack pathway, and standardised waiting times are fully integrated across all HSC trusts, and we cannot allow postcode lotteries to dictate whether a patient keeps or loses her limb depending on where she lives.

I hope the Minister can address the issue of postcode lotteries, which seem to happen with unfortunate regularity. I know he will be keen to change that, and this House is keen to hear what he says. The cardiovascular disease modern service framework rightly focuses on shared risk factors and acknowledges PAD, but its immediate priorities lack the explicit, detailed pathways, treatment standards and outcome measures urgently required for lower limb vascular care.

To close that gap—because that is what we are trying to do—clinicians, patient representatives, professional bodies and NHS leaders across the vascular sector are coming together to publish a definitive best-practice document this autumn. I am sure that document will be made available to the Minister, hopefully in advance. I think that will be helpful for the Minister and others in this debate who want to make changes.

The APPG on vascular and venous disease has highlighted a practical programme for reform, which I endorse. Obviously, I would endorse it because I am its chairman, but it is a positive, focused vision for the future that, if delivered, could make a difference. It includes the national foot attack pathway, backed by public awareness; same day or next day triage for urgent foot issues; and a multidisciplinary foot protection service in every integrated care system linked directly to specialist arterial centres.

When I go for my diabetes test once or twice a year—I have one next Wednesday—they make me close my eyes and do that wee prick of my foot to see if I react and if I can feel it. I am glad to say that I always do. The point is that if someone cannot, that is a serious problem. That is an issue for diabetics, in particular, and it is really important that they are checked regularly, especially their feet.

Thirdly, there should be national maximum waiting times enforcing urgent vascular assessment within five days for in-patients and two weeks for out-patients. Setting a standard to be achieved and having a clear focus on outcomes that reward early diagnosis, fast healing and reduced amputations, are ultimately about patients having a better quality of life—a more normal life—without their health deteriorating. There should also be faster adoption of innovation, including community diagnostics, compression therapies and digital wound monitoring.

When it comes to research and development, the Minister is always very keen to know about advancements in vascular health and how the Government are helping. One of the people involved from one of the hospitals back home in Northern Ireland is with us today in the Public Gallery. She is clearly very aware of these issues and I thank her for her work. There is some great work being done in our hospitals, particularly in the Royal Victoria hospital back home, and in the rest of the Northern Ireland health service.

Will the Government ensure that the cardiovascular disease modern service framework includes distinct pathways and outcome measures for vascular conditions? Will the Minister support a national foot attack pathway and clear waiting time standards? With respect, standard rhetoric and warm words will not heal a failing wound; nor will they save a limb. Thousands of our fellow citizens face devastating, life-altering amputations—tragedies that are, in so many cases, entirely preventable if they are caught early enough.

As a type 2 diabetic myself, I know the personal anxiety that comes with those risks. I also know about early intervention. For me, that was losing 4 stone, taking the medication and being careful about what I eat. Cake became a once-a-week treat—my doctor told me we are allowed to have a wee treat now and again—and I am allowed to have a fry on Saturday morning, but the rest of the week it is best to abstain and not have any of those things. I know that early intervention, proper community pathways and timely care can work. They have worked for me and I know that they have worked for many others.

The Government have rightly pledged to shift the focus of the NHS from sickness to prevention and from treatment to early intervention. Today, I am asking the Government and the Minister to produce a clear and actionable blueprint to do precisely that. The vascular sector is coming forward this autumn with clear solutions, and I am very impressed by the sector’s ideas and suggestions about how to improve the strategy, including a national foot attack pathway, dedicated foot protection services and enforceable maximum waiting times, because we need to make sure that waiting times reflect the needs of those seeking help. The real test for the Minister is whether the Department can step up, grab this opportunity with both hands and deliver the system-wide reform that our patients deserve.

I thank all hon. Members for coming along to participate in the debate. I also thank those in the Public Gallery for being part of this work and for their expertise and input into the strategy. I think that the Minister will see that it can bring about the change that he and we all want.

--- Later in debate ---

[Mr Frith]

I concur fully with my hon. Friend’s point. I noted his earlier remark about the commissioning of outcomes, and I think that one of the developing themes adjoining my own thinking and my brief is the need to get better at commissioning outcomes, considering whole populations, communities and places, and determining how we spend our money based on outcomes, not just activity. My hon. Friend makes a very powerful point with his question.

The hon. Member for Strangford and other members of the APPG feel strongly about the establishment of a national foot attack pathway. The Government’s ambition for integrated care boards to act as strategic commissioners focused on the needs of local populations is very much determined to assist that. The prevalence of vascular disease is not evenly distributed, as the hon. Member for North Shropshire (Helen Morgan) mentioned. ICBs are expected to use their nationally supported local commissioning power and their local data and intelligence, which includes user feedback and outcomes data, to develop a deep understanding of local need as well as local plans to develop and deliver.

[Jim Shannon]

I thank the Minister very much for that response; it is incredibly helpful. There seems to be a postcode lottery, where those who need care get it in some places but not in others. Does the Minister feel that his policy will ensure deliverability across all postcodes, not just in single places?

[Mr Frith]

That is a very fair and right challenge. This is not about endorsing patchwork provision; it is about understanding that, whether because of the physiological, social, environmental or behavioural differences that exist, care is not evenly distributed. We should have standards that we expect nationally, but we should also commission and empower local ICBs to commission, and we should hold them accountable through the frameworks and the work that we do in the Department.

[Mr Frith]

I hope that my further remarks will address that very point; I am happy to pick it up with the hon. Member in due course if they do not satisfy.

ICBs will use national modern service frameworks set by the Government and guidance to create the right services for their areas. That means local systems coming together to create neighbourhood services that reform the health and care system and are rooted in the needs of people and communities.

On the issue of maximum waiting times for vascular disease, this Government recognise that it is imperative that any patient requiring a vascular assessment receives that in a timeframe that reflects their condition and enables the best possible health outcome. The Government are committed to making progress on NHS waiting times, including returning by March ’29 to the NHS constitutional standard of 92% of elective care patients’ waiting times from referral to treatment being within 18 weeks. Of course, that includes those patients waiting for vascular services.

The NHS met the first interim target of 65% in March ’26, and we are now focused on driving improvements to achieve our second interim target of 70% by 2027. To help support the commitment to reduce waiting times, the podiatry workforce pipeline is currently being strengthened through NHS England’s focus programme for small and vulnerable professions, with the NHS workforce plan to be published shortly.

The health service also has clear guidance on what is required in delivering services for people with vascular disease or at risk of developing it. In March ’26, NHS England published guidance on standardising community health services. That guidance identifies podiatry, diabetes and tissue viability, and wound care as core components of ICB-funded community provision. People who need urgent wound assessment—for example, those with suspected infection, rapid deterioration, or diabetic foot ulcer—should be seen within 24 hours. The guidance also makes it clear that routine assessments should occur within five to seven working days, with data collected on healing and complications. The purpose and goal of community health services must be to support people as well as to avoid their needing to be admitted to hospital and, critically, the need for amputations.

[Jim Shannon]

I thank the Minister for his generosity in giving us a chance to ask questions. One of the areas that the APPG and we elected representatives have identified is that there are areas of deprivation where levels of vascular ill health and amputations are higher. What can be done to reduce that in areas of deprivation? I know I have them in my area. I am sure the hon. Member for Glasgow South West (Dr Ahmed) and others have them in theirs. I would like a focus on that, please, if the Minister does not mind.

[Mr Frith]

The hon. Member is absolutely right. We have to keep ICBs and their commissioning powers accountable to local jurisdictions. I will say a bit more on that in due course, but we are on the same page.

To facilitate faster assessments we also need to speed up and make earlier diagnoses, which is why the Government plan to open four new community diagnostic centres during ’26-27. That expanding capacity will help meet our March ’29 target that no more than 1% of patients should wait over six weeks for a diagnostic test.

On reforming commissioning to reward outcomes, as set out in the 10-year health plan, we want to develop new ways to pay healthcare providers based on clinical practice that maximises productivity and outcome, as my hon. Friend the Member for Glasgow South West mentioned. Under the best practice tariffs, providers receive payment when they follow agreed standards of care. On the adoption of proven innovation, the APPG report rightly identifies the importance of the NHS being able to quickly adopt new innovations.

As part of my responsibility to oversee further development and enhancement of the use and usability of the NHS app, one development coming through the House at the moment is the creation of the single patient record. The future exciting development of NHS online, or digital doctor, as I might yet call it, is about the digitisation of our NHS service—embracing innovation, personalising healthcare and responsive to individual need—as well as the innovator passport, delivered through a phased approach to accelerate access to and adoption of technologies.

The APPG’s report says that preventing vascular disease and its deterioration should be at the centre of the system, and I agree. Identifying people with vascular diseases and providing care centred on their needs is critical to ensuring vascular disease does not progress to the point where somebody needs incredibly serious interventions, such as a leg needing to be amputated. In this modern era, such amputations are wholly avoidable and should be prevented.

The distinction between the APPG’s report and the Government’s most recent announcement of the MSF has been mentioned. I was delighted to join the British Heart Foundation yesterday at the celebration event for the MSF ahead of the delivery plan later in the year. It is a reasonable challenge to ensure that we distinguish between conditions, a point made by the Opposition spokesperson, the hon. Member for Solihull West and Shirley. It was a point made to me—and a point I thought was likely to be raised with me—by stroke and diabetes charities at the event yesterday. We are on the same page on that. He made an excellent point and challenge on the distinction that is needed.

As hon. Members will know, prevention is at the heart of the Government’s health agenda—the prevention of health conditions and the prevention of them worsening. The cardiovascular disease modern service framework, which was published in July, sets a clear direction for how health and care systems should accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade.

My hon. Friend the Member for Broxtowe (Juliet Campbell) talked about irregularity and different areas having different levels of heart failure, which she said was four times more likely in the area she represents. I would be very happy to have conversations about how we can embrace that insight and intervene. Prevention is fundamental to the Government’s efforts around an annual heart failure review, improving access to rapid diagnosis and embedding heart failure support in cardiac rehabilitation, as well as the wider Government goal to reduce premature mortality by a quarter within the next decade.

Central to the cardiovascular disease modern service framework is a holistic approach with a strong focus on reducing inequalities. The principles apply here, too: the missing millions; the need for healthy intervention and to understand the difference between the physiological, behavioural, environmental and social; an appreciation that living standards and the cost of living have as much impact as any knowledge of what to eat and when; and looking after each other. It is about commissioning for outputs, not just diktat, which means recognising that several conditions and risk factors share common causes and contribute to most heart attacks and strokes. Members have described them in their speeches: high blood pressure, smoking, diabetes, high cholesterol, unhealthy diet and lack of exercise.

At its core, the framework is about a fundamental shift towards proactive, whole-person, preventive care that is located in communities and neighbourhoods and makes better use of hybrid, traditional, in-person and digital models to increase uptake and treatment. Podiatry and related foot-health services align with the shift towards local community hub delivery. The framework’s approach is backed by wider Government, including the creation of the first smoke-free generation, which began under the Conservative Government.

[Mr Frith]

In the humblest of terms, I would be very happy to visit and speak to my Scottish counterparts to ensure that they take that opportunity, and that any development, whether on compatibility, operability, the learnings from the NHS app in how we then develop NHS Online—that sounds a bit too much like building a website; we have to be more ambitious and describe it as what it is, which is the digitalisation of our NHS—helps to ensure that our brothers and sisters in Scotland get the same level of digital access that we expect to deliver across the NHS in England.

[Jim Shannon]

The hon. Member for Glasgow South West (Dr Ahmed) has nabbed my request—it is not about green cheese, by the way, Minister. My request is that the kindness the Minister has extended in respect of the hon. Gentleman and the Scottish health service is also extended to us in Northern Ireland, because expertise gained here can be shared so that we can all benefit.

[Mr Frith]

I will take any excuse I can to come to Northern Ireland, and I hope my private office has noted that.

In closing, our approach to improving the treatment of vascular diseases is closely aligned with the reforms in the APPG report and the APPG’s ambitions. I know that, of course, there will be other areas in which the APPG, and the hon. Member for Strangford, will rightly continue to push for further progress. I thank hon. Members for their contributions, and I thank the APPG for its important work and report. I look forward to continued dialogue on this issue to improve the NHS, especially services for vascular disease.

[Jim Shannon]

I thank everyone for their contributions, including the hon. Member for Broxtowe (Juliet Campbell). It is perhaps disquieting to understand that the hon. Lady has four times the number of people with vascular health issues in her constituency compared with elsewhere. That indicates a level of deprivation that is seen in certain areas of my constituency, across Northern Ireland, and in Glasgow South West. I thank her for outlining those issues. The hon. Lady also said that investment needs to go further, and was very kind to share the experiences of her constituency.

We are pleased to have the hon. Member for Glasgow South West (Dr Ahmed) here. He brings vast knowledge. The great thing about these debates is that everybody brings their expertise. The hon. Gentleman has done that, and we are very pleased that he shared some of his lifetime of knowledge, which resonated with some of those in the Public Gallery. The hon. Gentleman learned the business, so to speak, and is now able to contribute to others along life’s way. That is incredibly helpful.

Glasgow has one of the largest hospitals in the country, and there is a need to ensure that some of the highest stats in Scotland are addressed, such as those relating to lower life expectancy, the diabetic foot protection service, vascular community waiting times and improvements, and pay for output and outcome. There was an incredible focus on all those things in the debate, and we thank the hon. Gentleman for that.

Over the past few days in the Chamber, the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), has made valuable contributions and proven herself be an expert on all health subjects when it comes to the Health Bill. Today, she referred to vascular disease as being as “common as cancer” and a “preventable disability”, and spoke about a “postcode lottery” of care, the issue of “delayed diagnosis” and how her county has one of the highest rates of lower-limb amputations. She also mentioned the issues of waiting times and care for those with long-term diseases.

We do not always think about the mental health impact of this issue—its impact on someone’s anxiety, depression or ability to cope with life. If someone is able to walk about and do things and then suddenly something happens and they lose a limb, their mental health will be affected.

The Conservative spokesperson, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst), also brings his interest to this place. We spoke about this in the morning and the other day. He referred to the treatment and the access for services. He referred to the five recommendations from the APPG—getting it right first time, the foot care teams and all those things. If ICBs’ budgets are to be reduced, how will the vascular and venous strategy be delivered? The Minister gave us some indication of how that was going to happen, and there is certainly a commitment to it. We appreciate that.

When will national waiting times be addressed? When will the needed national foot attack pathway be in place? Again, it is about better use of NHS resources.

I am very pleased to have a Minister who responds to us, takes the subject matter on board and gives us the reassurance that we seek. He focused on the APPG report and committed to a national foot attack pathway, with ICBs and neighbourhood services having accountability. The Government are on the same page. The Minister talked about deprivation of access, and we all see that it is harder for people in some areas to get the treatment that they need.

I welcome the four new diagnostic centres that the Minister referred to. There will be further development and enhancement. “Digital doctor” is becoming a common phrase. I suspect we will hear it very often—I might even use it the odd time myself. The Minister is embracing innovation, as we all have to do. He spoke about prevention policy, accelerating the progress, targets set by the Government, a holistic approach, sorting out the outputs, and ensuring that we have facts about risk factors.

The hon. Member for Glasgow South West talked about the reform of systems and leadership. It is really important that the APPG focuses on that.

The APPG would be very pleased to have a meeting with the Minister—I think he will agree to that, although I will not judge him—and other Members here who have brought their expertise. That would be a beneficial meeting, because we are all on the same page, trying to achieve the same goals. If we can help the Minister to do that, we would be very pleased to take that forward.

I again thank everyone for taking part. Thank you, Dr Huq, for having patience with a fella who was supposed to have only two minutes—I think you have given me five.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of reform of the vascular sector.

Pharmacies: Government Funding

Jim Shannon Excerpts

Wednesday 9th September 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Mr Betts. I say a big thank you to the hon. Member for Leicester East (Shivani Raja) for bringing this subject to our attention.

As the DUP’s health spokesperson, I am particularly concerned about the amount of support available to our local pharmacies. As an indication of that, I used the opportunity of the first statement today, on summer health and resilience—the Minister was there, not to answer the question, but to support the Secretary of State—to ask the Secretary of State what discussions she is having with her counterparts in the devolved Administrations, particularly in Northern Ireland, to assure a UK-wide co-ordinated approach to summer resilience.

I also asked what targeted support has been made available for community pharmacy networks, which so often act as the first line of defence when GP surgeries are stretched to capacity as we prepare for the cold and flu season. To be fair to the Secretary of State, she answered my question very well and assured me that discussions are ongoing with the Minister back home in Northern Ireland, and that reassured me. That example underlines the importance of community pharmacies to me, those in my Strangford constituency and every one of us here.

Just last year, the National Pharmacy Association said that it was left with no choice but to recommend that its 6,000 members take collective action for the first time in its history, citing significant new costs and inadequate funding. About 90% of the work carried out by the average community pharmacy is funded by the NHS. This time last year, the National Pharmacy Association issued the stark warning that up to 63% of pharmacies were likely to close in 2026. We are still in 2026, so that threat hangs over all our heads. In response to a survey, 94% of pharmacies stated that the latest funding settlement did not provide stability to their finances. Those figures demonstrate the effect of persistent financial uncertainty on the sector.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

The hon. Member mentions the closure of pharmacies, but this is also about the ending of some services. It is sometimes the things that are noticed the least that matter the most once they are gone. For example, people with neurological or mental health conditions rely on Nomads to have the right tablets on the right day, and that really important service is sometimes provided by our pharmacists. Does the hon. Member agree that we do not want the wonderful services that pharmacies provide free of charge to be lost because of financial pressures? They matter too much for the lives of our residents.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Gentleman for giving me a chance to get a wee glass of water. His comments are incredibly important, and he is right to say that those services are almost impossible to bring back once they are lost.

Local pharmacies are under ever-increasing pressure. My particular concern is for small, independent pharmacies in rural constituencies such as my own. These businesses are facing rising costs, increasing workloads and the real risk of insolvency, and that is not to mention the personal toll on local pharmacy owners. The impact on those individuals and their health is sometimes forgotten.

[Shockat Adam]

I thank the hon. Member for making that point about how much stress is put on pharmacists and small business owners. In the last year, there was a 2.3% increase in items reimbursed by the NHS, a 17% increase in service volumes, a 3% increase in inflation, and increases in operating costs such as national insurance and business rates. That all adds to the pressure when pharmacists should be concentrating on providing a vital service to the community.

[Jim Shannon]

The hon. Gentleman is a Leicester City supporter, as I am; we do not have to seek our sorrows at this moment in time, but that is by the way. More importantly, his comments underline the issues for local independent pharmacy owners.

As the hon. Member for West Dorset (Edward Morello) said very clearly, at the heart of this issue are the patients—sometimes we need to remember that. Pharmacy closures are leaving many people, and particularly those in rural areas, with greater difficulty accessing their medication. Those concerns are felt deeply in Northern Ireland. The chief executive of Community Pharmacy Northern Ireland has warned officials that medicine shortages are having a greater impact on Northern Ireland because of systemic funding pressures, with pharmacies being forced to use their own money to bridge the gap in funding. That is the reality for these people, who have consciences, feel compassion and want to care for their patients and customers. The impact is clear, because almost 90% of pharmacies in Northern Ireland were unable to pay their wholesaler bill in January. Think about what that means for a second: that is real pressure. Further demonstrating the pressures is the number of pharmacies operating in Northern Ireland, which at 506 is the lowest ever recorded.

I know that the Minister is a compassionate lady who understands these issues incredibly well, and she will be aware that those figures raise serious concerns about the financial sustainability of our pharmacies and the security of the medicine supply throughout this United Kingdom of Great Britain and Northern Ireland. Our pharmacies need certainty about their funding arrangements. They need to know well in advance what support will be available to them, so that they can plan effectively, manage costs and pay their bills, and not be forced to close.

I have often highlighted the fact that pharmacies’ ability to provide first-line defence in the fight against minor injuries is not used enough. The right hon. Member for Richmond and Northallerton (Rishi Sunak) outlined some of the things that pharmacies do; they are frontline defence. These things are perhaps not seen by everyone, but they are seen by the patients and customers who come in. Every person who gets advice on treatment for warts, headlice, thrush or another ailment from the pharmacy rather than the GP is helping to ensure that GPs are not overwhelmed, and that A&Es are not overwhelmed by people who cannot see their GPs. We perhaps do not always see that, but it is very important.

Pharmacies are a vital cog in the health service, and we must fund them to do the job that they are able to do, yet are prevented from doing. I look to the Minister for that funding and for assurance. The Minister always tries to give us the reassurance we need and to answer the questions that we pose. These are hard times financially, but pharmacies are important for everyone. They produce savings for GPs and the NHS. Let us support them.

--- Later in debate ---

[Gregory Stafford]

I entirely agree with the hon. Gentleman. I think that we can use pharmacists and pharmacies much more creatively and in a manner that would in no way put patient safety at risk. In fact, it would allow patients more choice, and free up GPs and other health professionals to do other parts of their job, so he is right.

Community Pharmacy England’s 2026 pharmacy pressures survey makes the scale of the challenge facing pharmacies clear. Drawing on responses from nearly 4,000 pharmacy owners and staff members, it found that 75% of pharmacies are currently losing money, while only 14% reported being profitable. There is little value in providing additional funding for services without recognising the wider cost and workforce pressures facing the sector: 30% of pharmacies have reduced their opening hours and 76% report an impact on patient care, including longer waits and delays in accessing medicine.

That brings me—briefly—to the issue of business rates and the wider cumulative costs facing pharmacies. A pharmacy might occupy a storefront on a high street, but it is not simply another retailer; it is part of the national health service and is an essential provision in our community. As the hon. Member for Strangford (Jim Shannon) outlined, pharmacies are also part of our national resilience. The Government want pharmacies to take on more responsibility, but they face rising costs that have been caused by the Government.

Pharmacies need to be properly considered within the system and not treated simply as another high street retailer. The same issue applies when we consider national insurance increases, and indeed the national living wage. These cumulative increases are having a real impact. Unlike a high street retailer, a pharmacy has contractual obligations to the NHS and a moral responsibility to its patients, so it cannot just increase prices or stop providing a service like other businesses could. As my hon. Friend the Member for South West Hertfordshire (Mr Mohindra) rightly put it, the Government have to recognise the cumulative impact of these terrible decisions when considering future policy.

[Jim Shannon]

I want to underline a point I made in my speech: some of my community pharmacists back home are using their own money to subsidise their pharmacy and keep the business going—because of their compassion, their understanding and their concern for their customers and patients.

[Gregory Stafford]

The hon. Gentleman is entirely right, and his point goes to the heart of the debate. Pharmacies are businesses that must make a profit, and pharmacists must pay their staff and make sure that they can feed their own families, but they are also public servants. They are people who have decided to work in our national health service to provide for our patients, and the Government should recognise that.

The hon. Member for Leicester South (Shockat Adam) mentioned independent prescribing. If properly supported, it will give patients quicker access to treatment, but it brings greater clinical responsibility, greater governance requirements and greater pressure on pharmacists’ time. Given the limited capacity that we have already talked about, I want to ask the Minister three questions on independent prescribing. Does she believe the sector is ready? Does it have the workforce and the capacity to do it? What additional funding and support will be provided? We also need clarity on the timetable. Pharmacists have trained to prescribe, and they should be able to use that skill.

That brings me to the pharmacy workforce, because none of these reforms—independent prescribing, Pharmacy First or any other idea—will work without a sufficiently large and properly supported workforce. We have heard from right hon. and hon. Members about recruitment and retention pressures, including concerns about the number of full-time equivalent pharmacists. At the same time, the demands placed on existing staff are increasing. We cannot continue to add responsibilities to community pharmacy without considering whether there are enough people to deliver them safely and effectively.

The previous Conservative Government’s NHS long-term workforce plan included an ambition to increase pharmacist training places by 29%, taking them to around 4,300 by ’28-29. That ambition will clearly not be met under this Government, and we are still waiting for the long-promised NHS workforce plan. Despite my asking the then Secretary of State for Health, the right hon. Member for Ealing North (James Murray), in July when the plan was coming out, we still have no answer.

Finally, I will move on to medicines supply. Pharmacies are facing global supply chain disruption and rising medicine costs, with repeated price concessions adding further pressures. They cannot absorb these pressures indefinitely, so what are the Government doing to mitigate the impact of geopolitical disruption on medicine supply and prices, and what assessment has the Department made of the financial burden that these pressures are putting on community pharmacies? They are being felt by pharmacies across my constituency, including Vaughan James and Lalys in Farnham, Chase and Headley pharmacies and Day Lewis in Haslemere, and Grayshott pharmacy, all of which have contacted me about the issues that I have raised.

In conclusion, community pharmacy has a crucial role to play in the future of our NHS. We all want to see care delivered closer to people’s homes. Pharmacy First has shown what can happen when we give pharmacists greater responsibility and trust them to use their expertise, but ambition needs to be matched by capacity. The Government cannot say that community pharmacies are central to the future of neighbourhood healthcare while making it harder for those pharmacies to remain financially sustainable. I urge the Government to recognise the cumulative impacts of their policies on businesses, to look again at the treatment of business rates for community pharmacies, to ensure independent prescribing is properly supported, to protect the supply of medicines, and to provide clarity on when the NHS workforce plan will be published.

The fact is, we cannot ask pharmacies to take on more responsibility and deliver more NHS care while simultaneously making it harder for them to survive. The Conservative party believes that community pharmacy is absolutely central to the future of the NHS. If the Government agree, they must make sure that pharmacies have a future, too.

Summer Health and Resilience

Jim Shannon Excerpts

Wednesday 9th September 2026 Commons Chamber

[Yvette Cooper]

The hon. Member is absolutely right to raise this issue. It is one of the first issues I raised with the Department of Health and Social Care teams during some of the first meetings I had after being appointed; at the height of some of the heatwaves, we were looking at what could be done to ensure that the right advice and requirements were going out to social care across the country. Many care homes did a phenomenal job, sometimes in difficult circumstances because of old buildings, but the hon. Member is absolutely right to point out areas where things did not happen in the way they needed to. We are looking further at this issue as part of the heat taskforce.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for her statement, and welcome the commitment she has made. Strangford’s ageing population rely heavily on robust community care and swift access to their GPs, so can the Secretary of State outline what specific discussions she is having with her counterparts in the devolved Administrations—particularly in Northern Ireland—to ensure a UK-wide co-ordinated approach to summer resilience? What targeted support has been made available for community pharmacy networks, which so often act as the frontline of defence when GPs’ surgeries are stretched to capacity, as we prepare for the cold and flu season?

[Yvette Cooper]

I can reassure the hon. Member that regular meetings and discussions take place, involving not just Ministers but chief medical officers across the devolved Administrations, to ensure there is co-ordination. There are areas where we can learn from each other, but there are also areas where we need proper co-ordination, particularly on some of the public health and information issues and—as the hon. Member rightly says—some of the issues that link into our economic supply chains, including community pharmacies.