NHS Winter Readiness

Jim Shannon Excerpts

Wednesday 30th October 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am just chewing a sweet, Sir Roger; my apologies. It is a pleasure to speak in this debate. I congratulate the hon. Member for North Shropshire (Helen Morgan) on setting the scene so well. Today, we had some good news in the Chamber: that £22 billion will be spent on the NHS. The good news for us is that, through the Barnett consequentials, some of that will come to Northern Ireland. We do not yet know how much, but we are sure that some of it will come.

As the DUP health spokesperson, I join colleagues in expressing concerns for my constituents and their access to good health care this winter. Everyone has spoken about that; we cannot ignore the issue. We hope what the Government have put forward today is a helpful financial solution that will go some way to addressing the issue. I am aware that health is a devolved matter, but funding is not devolved, nor is the obligation of Government to implement their promised NHS reform throughout the entire UK.

When I asked the Secretary of State for Health about that reform, he was very clear in his commitment that everyone in the United Kingdom of Great Britain and Northern Ireland would see the benefits. I hope today is a step in the right direction. The Department for Health has released the preparedness document for last year. I welcome some of the impetus, such as strengthening the urgent and emergency care system to provide alternatives to emergency departments, including urgent care centres, urgent streaming services, rapid access clinics and the local phone first services.

The hon. Member for North Shropshire, who set the scene, referred to ophthalmology. It is important to include that because there are some questions along those lines. We had an event yesterday called “The eyes have it”. As the party’s health spokesperson, I try to go to as many health events as I can in the House of Commons. Those attending outlined a number of things they wish to see. Perhaps the Minister can give us some ideas on how we can improve ophthalmology across the United Kingdom.

I welcome the £3.4 million funding provided to general medical and out of hours services, to support GP practices to increase their capacity in light of the anticipated increase in demand over the winter. A figure of £4.3 million has been provided to support GP practices across Northern Ireland to provide proactive support and care to those in nursing and residential care homes. That is again an example of what can be done. I will mention some of the other positive things. I am hopeful that some of the extra money allocated to the NHS today by the Chancellor will filter its way towards Northern Ireland.

The hon. Member for North Shropshire referred to the ambulance service. The Northern Ireland Ambulance Service is increasing its range, capacity and clinical expertise at the ambulance emergency control to help ensure that cases are appropriately managed, without time delays. The enhanced hospital capacity, with 45 beds opened for last winter in my local Ulster hospital, will continue to be funded. Those are some of the good stories and news.

Another is the rolling out of the Pharmacy First pilot service for uncomplicated urinary tract infections in women aged 16 to 64 years. That will expand the current pilot of 62 community pharmacies to the entire pharmacy network of some 500 pharmacies right across Northern Ireland through an investment of £410,000. Again, money is being allocated in the right places to do the right job, which will hopefully make lives better. Over the winter period, it is estimated that this will deliver 12,000 consultations, freeing up capacity in GP practices.

The whole idea of the Pharmacy First pilot service was to ease pressure on GPs, and I know the Minister has always been committed to that. There are good things that can happen, and hopefully after today even more good things will be able to happen. Some £265,000 has been allocated for a new Pharmacy First sore throat test and treat service, which is being piloted this winter. When winter comes, there are colds, flus, sore throats and days off, and everyone rushes to the GP. This will reduce the impact on GPs. These good schemes can be of overall benefit to the NHS. The sore throat service will be piloted in 40 pharmacies, and it is estimated that 8,000 consultations will be delivered this winter, which is good news.

All these measures were welcomed, but none brought the result of an NHS that was prepared last winter. Indeed, that has increased my conviction that we are in a more difficult situation this winter and that the pressure on the NHS cannot be relieved by these small measures. If the Minister can, will she say how the moneys announced by the Chancellor today will be allocated and how that will improve the NHS’s response to this winter?

We need GP practices to be able to refer their patients for an MRI and know that they will be seen in reasonable time, rather than making the referral and then telling the patient to go and spend the day in A&E to get the MRI. Such small but significant things would make a difference and improve the service overall. GPs also tell me that they do not trust the red flag system and that A&E is turning into that red flag system for tests. How can we blame GPs for trying to ensure that they do not miss anything and for using the system in this way?

We need more capacity for MRIs, CAT scans and mammograms, and we need more trained radiographers. One of the things announced today was a significant investment in radiography, but when it comes to allocating the funds we must consider the need to ensure that we recruit and retain radiographers. The Minister may not have the answers to these questions, but does she know what has been done to train more radiographers and improve our NHS?

As a result of there being too few radiographers, 188,881 people in Northern Ireland—nearly 10% of the population—are waiting for a diagnostic test. The wait means that treatment such as radiotherapy is delayed and cases become more complex. That is the nature of having a health problem; people should get seen early and respond early. For some patients, even a two-week delay can mean the difference between life and death.

This long-term issue needs a long-term vision. That is why I am asking the Minister to take seriously schemes that would encourage our intelligent and capable young people to train here and stay here. I have been a great advocate of this and have raised this issue on numerous occasions over the years. We want these young people to train here and stay here with their skills. University bursaries or forgiveness of student debt in return for a period of employment in the NHS would be a positive way forward. Could the Minister look at that too?

Young people go into debt very early on and find it hanging over their shoulders for years to come. If we offer them a job in the NHS and they commit to staying, we can improve things. We have incredibly capable, intelligent British students, and we need to invest in their long-term careers in the NHS and allow them to work alongside junior doctors. We must prepare them for the marathon of NHS life rather than give them sprints that they cannot sustain. We should get the system moving in that direction. I believe that there is work to do not simply for this winter but for every day of the winters yet to come.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for North Shropshire (Helen Morgan) for securing the debate and hon. Members for taking part.

We have all just rushed from the main Chamber and I think I am the only person here who has come out enthused and excited after what we heard about the massive support offered—particularly for the NHS. It is the first Labour Budget delivered after the 14 years of the coalition and the Tory party’s time in power, and it lays the foundations for fixing our economy.

Just in case people did not clock all the figures, there will be £22.6 billion in day-to-day extra spending on the health budget, including a £3.1 billion increase in the capital budget, £1 billion of which helps address the backlogs of repairs that have been allowed to fester over the past 14 years. There is also an additional £1.5 billion for beds, new capacity for diagnostic tests, surgical hubs and diagnostic centres, to address the key point made by the hon. Member for Meriden and Solihull East (Saqib Bhatti). Let us take some of that funding and not just stop the decline but fix the foundations, setting the path for the next 10 years, as we have clearly articulated in the few weeks that we have been in government. When I speak to my constituents in Bristol South, they are most concerned about the NHS spending every penny of taxpayers’ money wisely, properly and where it needs to be focused. That is why we have concentrated on our three shifts and launched this national conversation—I hope everyone takes part.

We all know the problems, and that is what Lord Darzi helped us address. We also know that winter is a difficult time for our health and care system. Although we cannot predict the severity of the weather, we can predict much of the activity, we know what is likely to hit us most of the time, and we can certainly plan better. I remember working on the issue as a NHS manager back in the day, across primary, community, and secondary care, as well as with ambulance services and local authorities. A systems response is needed, and it is important that we are all involved in preparing and planning.

I also remember just how demoralising it was for staff in the early 2000s, coming into work every day to fight fires and sort out the awful trolley waits—not to mention how unacceptable that was for patients and families. The point about the impact on staff’s mental health and morale was well made by the hon. Member for Winchester (Dr Chambers). I also saw, and was proud to be part of, the changes we made under that Labour Government to end those trolley waits, and we will do that again. That is what Lord Darzi’s report shone a searing spotlight on, including the chronic lack of capital investment that has put many hospitals into a perpetual bed crisis, particularly during peak periods such as winter cold snaps.

While we have inherited a broken NHS, it is not beaten. As we have just heard from the Chancellor, this Government have taken the first steps towards fixing the annual crisis with new capital investment. However, one Budget cannot undo the last 14 years of failure, so while we fix the foundations we are also mitigating the immediate risks. At the very least, going into this winter we will be better prepared than we were last winter. That is because the managers in the NHS will be preparing for winter rather than planning for strikes, which is what they had to do the last three years—already a significant improvement.

The health service does face challenges on all fronts, and the figures are sobering. We have heard some of them today. In September, provisional statistics showed that almost one in 10 A&E patients waited over 12 hours to be admitted, transferred or discharged. The mean category 2 response time in September stood at about 36 minutes—around double the NHS constitutional standard. I recently attended a meeting where officials highlighted the number of attendances requiring admissions are already up by 1.8% in September compared to 2023, which is continuing to place increased pressure of patient flow. Those are the results of deep structural issues in the NHS that will not be fixed overnight. But work is already under way to rebuild resilience and manage pressures across the health and care system this winter.

I will come on to the specific work being done, but I assure hon. Members that the Government are taking the issue extremely seriously. I am already meeting senior leaders in NHS England and the UK Health Security Agency every two weeks to ensure that the risks can be identified quickly and that pressures are managed effectively. Once the peak winter period hits, the meetings will move weekly and include the Secretary of State.

Local NHS systems are best placed to determine how to respond to issues in their local area. That is why NHS England has worked with local systems to ensure robust winter plans are in place at a local level. As someone who knows exactly what is involved in that planning, I pay tribute to the staff for their skill, motivation and commitment to protecting every patient this winter.

[Jim Shannon]

There is no better choice the Government can make than committing that money to the NHS—we all welcome that. Anybody who does not would be insane. I always try to be constructive in my contributions. I asked about staffing and made the suggestion to retain students wherever they do their training. Sometimes they come to the end of it and go somewhere like Australia or New Zealand to get a job. Instead of that, if Government were to consider a bursary-type system to retain the staff, I think we would be able to address some of the pressure that we have.

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

World Stroke Day

Jim Shannon Excerpts

Tuesday 29th October 2024 Commons Chamber

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I am grateful to have this opportunity to address the House on World Stroke Day. Stroke is the UK’s fourth biggest killer and the single largest cause of complex disability in the UK. On our current trajectory, the number of stroke survivors will increase by 60% over the next decade, which will swallow up nearly half the current NHS budget. By that time, one in three people in Glastonbury and Somerton will be 65 or older, so we will disproportionately feel the impact of the increase in strokes over the next decade.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. She mentioned the age of 65, which is really important; in Northern Ireland, there are some 2,800 new strokes every year. While the majority of strokes affect people who are over the age of 65, they can strike at any age. Some 25% of people who have strokes are under the age of 65, so does the hon. Lady agree that we must get away from the notion that stroke awareness is only for older people, and that we must be very aware of the FAST signs—face, arms, speech and time—that can make the difference between death and recovery? It can happen to young people as well.

[Sarah Dyke]

The hon. Member makes a really important point. Although we often assume that it is older people who suffer with strokes, so many young people suffer in the same way.

Unless there are major improvements, Somerset’s poor ambulance response times and poor life-after-stroke care will mean that a disproportionate number of the 42,000 people who will die from stroke in 2035 will be from my constituency.

Diabetes Treatments

Jim Shannon Excerpts

Tuesday 29th October 2024 Westminster Hall

[Sarah Bool (South Northamptonshire) (Con)]

I beg to move,

That this House has considered diabetes treatments.

It is a pleasure to serve under your chairmanship, Mrs Harris. On 21 May 2021, my world changed forever when I was diagnosed with type 1 diabetes at the age of 33. While my diagnosis was a shock, given its late onset, the feelings of fear, disbelief and sadness are shared by all those diagnosed—young or old, with type 1 or type 2.

Diabetes is a complicated condition that has been done the great disservice of being stigmatised through misunderstanding. It is not necessarily that we have eaten too many sweets or not looked after ourselves. Type 1 is an autoimmune condition—we did nothing to cause it—and people can develop it later in life; Mr Speaker and I can attest to that. Type 2 is not just for the over-40s and the unfit; someone can be slim and active, like Sir Steve Redgrave, and still be diagnosed. That is why I have secured today’s debate. Breaking down the stigma and investing in early treatment of diabetes is so important to allow patients to live fulfilled lives, and to do so in the most long-term, cost-efficient manner for the Government.

Our understanding of how to treat diabetes has come on leaps and bounds since the discovery of insulin back in 1921, but there is still so much more that we can do. Some 5.6 million people in the UK are diagnosed with diabetes. That includes 4,329 people in my constituency of South Northamptonshire—more than 6% of the population. However, last year, just 54% of my constituents with diabetes received all eight of their essential checks, which are important for identifying and preventing complications.

The total cost of diabetes to the NHS is estimated at £10.7 billion, and 60% of that is spent on the costs of diabetes complications. Every week, complications from diabetes lead to 2,990 cases of heart failure, more than 184 amputations, 930 strokes and 660 heart attacks. Those should be preventable with the right education, the right support, and the right attitude from individuals and the Government.

There is so much that I could talk about on diabetes, but this is a short debate, so my initial ask of the Government, on type 1, is that we end the postcode lottery, with equitable treatment for those living with diabetes wherever they live in the UK.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. I declare an interest: I am a type 2 diabetic. In our discussion before the debate, I informed the hon. Lady that, when I was first diagnosed some 18 years ago, believe it or not, I was at least 17 stone and probably getting bigger by the minute. I went on a diet because that was what the doctor recommended; I am down to a nice trim 13¼ stone.

I am thankful for the NHS and the treatment offered, but there is a clear disparity between the treatment offered in different areas of the United Kingdom. Does the hon. Lady agree that diabetes does not have to be a death sentence, but does not have to adversely affect quality of life either? We must ensure that, no matter where someone is in this great United Kingdom of Great Britain and Northern Ireland, they should get a level of diabetic care that enables them to live life to the fullest. Does the hon. Lady agree?

[Sarah Bool]

Absolutely. I totally agree, and the hon. Gentleman makes a very powerful point. It does not have to be a death sentence; it can even lead someone to No. 10 Downing Street, if they are Baroness May, so it should not prevent anyone from achieving anything.

Going back to my asks for type 1, we must also commit to greater access to technology for diabetes, such as hybrid closed loop technology, and increase awareness of the condition and treatments in schools and among the public. We also want to see the expansion of early testing for type 1 diabetes to identify children who are living with the condition and to make sure that they and their families get the right support.

I apologise in advance to hon. and right hon. Members if I suddenly start to beep during this debate, or in the Chamber in the future. They can be assured that it is not because I am some form of 21st century R2D2; it is because I wear an insulin pump and sensors. When my blood sugar is running low, it will alert me so that I can consume a lifesaving sugary treat. This hybrid closed loop system has dramatically improved the quality of my life with type 1. It does not just benefit adults with diabetes like me; there are parents of young children with a HCL who feel they can finally sleep at night without fear of missing a nighttime low blood sugar for their little ones.

Type 1 is also a condition that creates a serious mental burden on those who live with it and their loved ones. As a condition where someone’s pancreas stops working and no longer produces insulin, it requires constant thought and calculations alongside normal activities. Each day, a person with type 1 is assessing how many carbohydrates there are in their food and how much insulin they should dose, taking into account whether they have exercised, will be exercising, or generally rushing around; how hot or cold it is; how tired they are; how stressed they are, with public speaking adding to the mix for me; for women in particular, what their hormones are doing; and, when they have low blood sugar, how quickly they can access a sugar supply.

My insulin pump and sensor have ensured that many of those burdens have been eased. I just wish that more of my fellow diabetics had the same opportunity. I know of one lady from the south-west of England whose local integrated care board did not prescribe HCLs, so she had to move to London, away from her support network, just to access that vital technology. That cannot be right. As part of building an NHS fit for the future, Ministers should ensure that wherever someone is in the UK, they can access vital treatments for diabetes, such as the HCL.

There are other treatments that the Government should commit to fully exploring, such as early detection and new drugs. As with my diagnosis, more than 80% of type 1 diagnoses occur in people with no known family connection to type 1 diabetes. Many people are not aware of the four “T” symptoms that they should look out for: thirst, toilet, tiredness and thin. Early detection is vital in preventing complications such as diabetic ketoacidosis, which one in four children with type 1 are diagnosed with, and which can be lethal. Early detection can also identify people who would benefit from early intervention clinical trials and treatments.

The ELSA study is a programme funded by Breakthrough T1D that offers children between the ages of three and 13 a simple finger stick blood test to determine their risk of developing type 1 diabetes. The study is currently open to families across England, Scotland, Wales and Northern Ireland, with over 20,000 children having been screened so far. I ask that the Government work to have the programme expanded and implemented on the NHS nationwide, as it could drastically reduce the instances of future complications from type 1.

[Jim Shannon]

I thank the hon. Lady for giving way again. One of the things that we have noticed back home in Northern Ireland is that even if someone gets a type 1 diabetes diagnosis early on, it does not mean that their life is over—they can still go on. We have a high prevalence of young children in Northern Ireland who have type 1 diabetes, and for them it is rather scary but also a fact of life. I have seen some of those young boys and girls growing up and the diabetes has not affected their life at all. It is important to know that those being diagnosed early with diabetes can have a normal life and family.

[Sarah Bool]

I absolutely concur with the hon. Gentleman; people can live a fulfilling and fulfilled life, but they do need a little more help along the way. If we get that at the right time, it can literally transform a life so that they can live like everyone else.

One of the promising new treatments coming forward is teplizumab, which will delay the onset of type 1 in children by an average of three years. Approved by the Food and Drug Administration in the US in 2022, it is about to start a technological appraisal by the National Institute for Health and Care Excellence. In conjunction with the national early detection programme, teplizumab could drastically reduce the complications associated with type 1.

With the rise of social media, we have seen an ever-growing societal preoccupation with body image. Earlier this year Baroness May and Sir George Howarth released a parliamentary report into type 1 and disordered eating, also known as T1DE. T1DE is an eating disorder where someone might restrict their insulin to lose weight or experience an eating disorder such as bulimia or anorexia alongside type 1. Evidence suggests that up to 40% of women and girls and up to 15% of men and boys with diabetes experience some form of disordered eating, so we really must continue the work of Baroness May and Sir George in raising the profile of diabetes and its complications.

On type 1, I ask the Minister to ensure that the Government work with the NHS to increase awareness of the hybrid closed-loop technology, particularly among lower socioeconomic groups, and to fund its roll-out nationally; to provide comprehensive training for healthcare practitioners on HCL technology; and to establish a national diabetes registry to support technology adoption and track health outcomes.

Turning to type 2 diabetes, right hon. and hon. Members will have heard a lot about and might even have been tempted by Ozempic and Wegovy, known as the GLP-1 medications—seemingly magic solutions that have helped many in the public eye to shed unwanted pounds. However, that class of medication is an important treatment for those with type 2 diabetes as it is prescribed to lower blood glucose levels. My concern, and that of some of my constituents who have written to me, is that there is a real risk of a shortage of those medicines for type 2 diabetics while they are being prescribed for weight loss. It is therefore essential that the supply of those drugs is protected for diabetics. Will the Minister take action to ensure that everyone with or at risk of type 2 diabetes can access the medications that they can benefit from?

Alongside medications, we should ensure that newly diagnosed type 2 diabetics are given the right support. In some cases it is possible to put type 2 into remission, so it is essential that access to evidence-based services such as the NHS path to remission programme is increased for people in the first three years of their diagnosis. Likewise, people under the age of 40 with type 2 are at increased risk of developing diabetes complications, but are less likely to receive their essential care. The NHS type 2 diabetes in the young programme—T2Day—provides extra support for that group, including confirmation of diagnosis, additional checks, contraception and pre-conception planning, and assessment of cardiovascular risk. The Government must commit to sustainable long-term funding for the programme to ensure that the rise in type 2 diabetes in working age adults does not lead to a drastic increase in serious complications.

There are also inequalities across the diagnosis of diabetes. Those living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes but less likely to receive their diabetes care, and they go on to experience worse health outcomes. As the Government develop their plan for the NHS, they should use health inequality impact assessments for all diabetes-related policies to understand how reforms affect different groups.

As right hon. and hon. Members might have worked out by now, I could speak about diabetes all the way to the moment of interruption this evening, but I will draw my speech to a close. Acting as our own pancreas is hard and our illness requires 24-hour attention. Diabetes treatment is relentless, but so are we.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 15th October 2024 Commons Chamber

[Stephen Kinnock]

My hon. Friend is right. South Yorkshire has the highest level of hospital tooth extractions in England, and I want to assure him that we will target interventions at the areas of greatest need. For example, integrated care boards have started to advertise roles through our “golden hello” scheme, which will drive recruitment of graduate dentists to areas of greatest need for three years. We have inherited a mess and we are working at pace to clear it up.

[Jim Shannon (Strangford) (DUP)]

The Minister is right to underline the issues for children, but can I remind him of the issues for those above the state pension age—which is increasing to 67, including for ladies—in particular when it comes to certain benefits, such as attendance allowance? Will he look at the contract for those who are elderly and in receipt of such benefits?

[Stephen Kinnock]

We are in a situation where a staggering 28% of the country—13 million people—have a need that is unmet by NHS dentistry. There are so many issues that we need to resolve. We are looking at the contract with the BDA and I am more than happy to look into the issue raised by the hon. Gentleman.

Maternity Services: Gloucestershire

Jim Shannon Excerpts

Wednesday 9th October 2024 Westminster Hall

[Max Wilkinson (Cheltenham) (LD)]

I beg to move,

That this House has considered maternity services in Gloucestershire.

It is a pleasure to serve under your chairmanship, Sir Christopher. The hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) sends his apologies; he was due to be here but he is counting the votes somewhere else at the moment in an important internal election. He wanted me to start by saying that he gives his full support to the comments that I and others will make in support of maternity services in Gloucestershire, so I hope Hansard reflects that.

It is not controversial to say that NHS services across the country are struggling. One of the services that impacts all of us at least once in our lives is maternity care. This service is at the heart of women’s healthcare; it must be treated with the utmost seriousness. Pregnancy and childbirth is a special moment for families. It is a memory I cherish—obviously I was not pregnant myself. It is something to be cherished by all. But for pregnant women it can also be an extremely stressful experience. If there are failures in the system, the consequences can be dire.

Some of those consequences were laid bare in the recent “Panorama” documentary on maternity services in Gloucestershire. In that documentary we heard too many harrowing stories. Brave whistleblowers from within the system and brave mothers told their stories—one brave father told a story too. Those stories were told in the most heartbreaking terms, and will stick with me for as long as I live. Gloucestershire Hospitals NHS foundation trust apologised for those failings. It has invested in increased staffing, worked to reduce staff turnover and has made changes to leadership in maternity care. But so much more needs to be done.

The service at Gloucestershire Royal hospital was rated inadequate in 2022 and again in 2023. The findings of a further inspection earlier this year are still awaited, but a section 31 safety enforcement notice was served in May. Cheltenham’s midwife-led Aveta birth unit serves a large chunk of our county. It was closed for births in autumn 2022, some time before six of our county’s seven Members of Parliament were elected. The closure was due to a shortage of midwives. The reorganisation by the hospital’s trust was carried out to ensure that one-to-one care across Gloucestershire’s wider maternity services could be achieved. It is an entirely understandable response; nobody would want to put mothers and babies at risk.

We were told, however, that the measures were temporary. Two years down the line they are still in place, and that is not an acceptable situation for people in our county. The NHS hospital trust suggests that the Cheltenham Aveta centre will not re-open for births before April 2025. Even then, nothing seems certain. The trust states that it is committed to reopening the centre when it is safe to do so. However, the byzantine way in which the NHS sometimes works means that it is difficult to work out who will be the ultimate decision maker. Sometimes decisions on resources are made by the integrated care board rather than hospital trust staff, and that collaborative process makes it difficult to work out who must be held to account for statements that have been made in the past.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman on securing this debate. Everyone in this room will be very aware that the difficulties in Gloucestershire are unfortunately replicated in every part of the United Kingdom—certainly in my part of it. We have some of the best staff in the world in our maternity wards, and we rightly recognise the good work that they do, but they are being hampered in doing their job and caring by understaffing, budgetary restraints and an inability to get support from senior staff. I believe this needs a root-and-branch change across all the United Kingdom. Would the hon. Gentleman agree with that?

[Max Wilkinson]

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

Sepsis Awareness

Jim Shannon Excerpts

Wednesday 9th October 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

First, I thank the hon. Member for Ashfield (Lee Anderson) for raising this issue. He and I spoke this week, and his perseverance and hard work have given us a chance to make a contribution. I also commend Abbi for coming here today and for giving her personal story, which the hon. Member for Ashfield referred to. I salute her courage and bravery through all these hard times, as well as her wonderful smile, which the hon. Member for South Basildon and East Thurrock (James McMurdock) mentioned.

As the DUP’s health spokesperson, I add my voice to those of other hon. Members to raise awareness of sepsis. With superior hygiene and antibiotics available on tap, we have a tendency to think that sepsis is a disease of the past, when it clearly is not. The sad fact is that, during this one-hour debate, five people in the UK will lose their lives. This debate is to hammer home the need for people to be aware of the signs of sepsis.

My dad had sepsis in hospital a long time ago. It was a minor case, with the advantage that he healed quickly. He was right there in the hospital where the nurses were and the reaction was immediate to ensure that he survived.

Most parents are aware of the glass test for meningitis, which has been hammered home on multiple occasions. However, when I did a quick survey of my office staff—three of the five are parents and one had training from St John Ambulance—it shocked me that the only person who knew what sepsis was was the St John Ambulance volunteer; the others talked about extremities turning black, which is almost end-stage sepsis. We need to be aware of the symptoms before that, and that quick survey has pushed me into thinking that there needs to be more awareness among parents and communities as a whole. I know that the Minister will try to respond—he always does and he is assiduous in what he does.

The charity Sepsis NI said that we currently have no recovery protocols in place in Northern Ireland for sepsis, although that is not just a problem in Northern Ireland. When patients leave hospital, the fact that they may have been treated and survived does not mean that they are in any way better; in fact, most are still seriously ill and need both physical and psychological help. We still need to work on a GP and hospital after-care plan, and I hope the Minister will share some of his ideas with the Assembly back home. The situation must change, and we need a UK-wide strategy to deal with this issue across the UK.

Lastly, this statistic is a good one to put on record: the best guess for Northern Ireland is that 7,020 people will be affected by sepsis this year and 1,240 will die. If those facts do not scare us, they need to. People need to be aware of the symptoms: the fast breathing, dizziness, pale and mottled skin, high temperature and cold body. We all need to be able to call those to mind as quickly as we do with other major killers, such as meningitis.

This debate is a good step in raising awareness. I very much support my colleagues in asking for more to be done centrally, using a co-ordinated approach to raise awareness UK-wide of the killer that is sepsis. I again thank the hon. Member for Ashfield.

Health Services: Bridlington

Jim Shannon Excerpts

Tuesday 8th October 2024 Commons Chamber

[Charlie Dewhirst (Bridlington and The Wolds) (Con)]

I am grateful for the opportunity to debate this important subject. I thank the Minister for being here this evening, and I thank everyone I spoke to before the debate, particularly the Bridlington health forum and representatives of local NHS trusts and the integrated care board. Bridlington is not alone in needing improved access to health services, but I will seek to explain today why that has become an extremely acute problem in the town.

Constituents of mine living in and around Driffield, Hornsea, Market Weighton and the remote Wolds villages will have valid concerns about their own public services, but I hope they will forgive me for taking this opportunity to speak in depth about Bridlington and why it is in so much need of extra support. I will describe the demographic backdrop against which these issues have arisen, the challenges over supply of services, and, lastly, the need for a robust strategy to tackle the various problems faced by local people in the town.

Bridlington is a fantastic coastal resort on the edge of the rolling hills of the Wolds, and it welcomes millions of visitors every year. It is world famous for its seabird colony, and is the lobster capital of Europe. However, like many seaside towns it has significant challenges, and the demographic data is stark. It has the oldest and most deprived population in the East Riding of Yorkshire, and men living in the Bridlington South ward have a life expectancy 10 years lower than those living elsewhere in the county. Indeed, data shows that two of the three wards covering the town are the two most deprived in the county, and the other is the fifth highest of a total of 26. The age profile is equally stark. One third of the population are over 65, and that rises to 44% of residents in Bridlington North, where a significant number are over 80. Bridlington has the highest percentage of people with limiting long-term illness or disability in the York and Scarborough NHS Trust catchment area, and Bridlington residents have the highest levels of health inequality in that catchment.

The director of public health for East Riding of Yorkshire county council has said of the town:

“we have found that the inequalities are growing, they’re large and they’re serious.

In terms of length of life, quality of life and the amount of people with long term health conditions, Bridlington has got the worst levels in all of the East Riding…So this is a wake up call to do something about it.”

I certainly cannot disagree with that sentiment.

As for the supply of health services, the House will no doubt be shocked to hear that there are entire classrooms of children in Bridlington who have never seen a dentist. One patient needing emergency dental work was sent more than 60 miles to Doncaster, and in January there were 8,500 people on the waiting list for the only local NHS dentist. Many people have been forced to go private, but that is not a solution affordable to most. Will the Minister agree to look again at NHS dental contracts, so that they incentivise dentists to open practices in areas where there is such a clear and obvious shortage?

Access to primary care has seen some recent improvements, but the consolidation of GP practices from six to two has not been without its problems. Local patients still find it challenging to secure appointments at one of the two practices, but I know that GPs operating across the town have worked tirelessly to improve services in the wake of the pandemic and the shortage of local healthcare professionals. The direction of travel for secondary care, however, is not positive.

Bridlington is blessed with a fantastic hospital site, which opened in 1989. It recently enjoyed an investment of £4.7 million in 1,500 solar panels, making it one of the greenest NHS sites in the country. However, the site is chronically underused. I am not suggesting for a second that the Bridlington hospital site could be a major trauma centre or large infirmary, but it can and should be a vital community asset for health. It has the potential to be a health hub for the town, bringing together a wide array of local health services. York and Scarborough NHS trust might not be the owner of the site, but it is the provider of secondary care there. Many people in the town feel that its focus, which is naturally leaning towards North Yorkshire and not East Yorkshire, means that investment and new services are being prioritised in York, Scarborough and Malton.

Out-patient appointments are a particularly key metric, as they make up a large bulk of the interactions between the NHS and older people in Bridlington. The number of out-patient appointments at Bridlington hospital that are offered to residents in Bridlington, Driffield and the surrounding area has reduced from 46,500 in 2019-20 to just over 27,500 in 2023-24—a reduction of more than 35% in just four years. Ophthalmology appointments are down, audiology appointments are down and rheumatology appointments are down. Instead of recognising that an ageing population will result in greater demand for out-patient services locally, we are seeing these services being provided at sites away from the town.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing forward this issue. He and I knew each other long before he came to this House, as he was one of our advisers for the all-party parliamentary group for eggs, pigs and poultry. It is a real pleasure to see him in this place, and we look forward to his contributions.

The hon. Gentleman’s constituency and my constituency are very similar. He mentioned that Bridlington is a seaside resort and that he represents seaside areas, as do I. He also mentioned the fact that much of the population is over 70 years old—again, there are similarities with my constituency. Is the hon. Gentleman seeking a new rural strategy that addresses this issue in coastal areas? If he is, it is something we can all welcome.

[Charlie Dewhirst]

I thank the hon. Member for his contribution. I will come to that point shortly.

East Riding patients travelled an astonishing 2.7 million NHS miles to attend out-patient appointments in 2023-24, and two thirds of Bridlington residents attend out-patient appointments away from the town. That is not acceptable, and I will not stand by and let it continue. However, part of the problem is that local Members of Parliament have very little, if any, direct influence over the direction of our health services, which is why I am appealing to the Minister for his support. I believe that this is particularly timely.

In his recent report, Lord Darzi described the NHS as “broken”, and in the case of Bridlington he is correct. He states that:

“An ageing population is the most significant driver of increased healthcare needs since it is associated with the development of long-term conditions”

and that

“by the time people are aged 65-74, a majority will have at least one long-term condition and some 40 per cent will have two or more. By the time people are aged 75-84, this rises to nearly 60 per cent having two or more, and by the time people are aged 85 or above, 9 out of 10 will have at least one long-term condition.”

I remind the House that one third of residents in Bridlington are over 65.

Lord Darzi makes the following very pertinent observation:

“At the highest level, the NHS has had the strategic intention to shift spending from reactive care in hospitals to more proactive care in the community setting—but care has in fact moved in the other direction.”

That is very much the experience of my constituents. The report also makes it clear that “care should be more joined up, or more ‘integrated’…to reflect the fact the people living with long-term conditions”

need more support and

“a variety of different physical and mental health professionals and often rely on social care too. The frequency of their interactions with the health service means that their care is more complex and therefore requires coordination.”

Finally on this point, Lord Darzi is right to say that

“care should be delivered in the community, closer to where people live and work”,

and that

“hospitals should be reserved for specialist care. This is more convenient for patients—especially for those with long-term conditions who will need contact with the NHS more frequently.”

I would also like to refer the House to the chief medical officer’s 2021 annual report on health in coastal communities. In this insightful piece of work, Sir Chris Whitty noted:

“Given the known high rates of preventable illness in these areas, the lack of available data on the health of coastal communities has been striking whilst researching the report. Coastal communities have been long overlooked with limited research on their health and wellbeing. The focus has tended towards inner city or rural areas with too little attention given to the nation’s periphery.”

He went on to add:

“Data is rarely published at a geographical level granular enough to capture coastal outcomes, with most data only available at local authority or Clinical Commissioning Group (CCG) level. As a result, deprivation and ill health at the coast is hidden by relative affluence just inland which is lumped together.”

In conclusion, he recommended:

“Given the health and wellbeing challenges of coastal communities have more in common with one another than inland neighbours, there should be a national strategy to improve the health and wellbeing of coastal communities.”

Unfortunately, and perhaps as a result of the health service working its way through the impact of the pandemic, the report has been somewhat sidelined and the recommendations have yet to be acted upon, so what should be the solution?

We need a comprehensive strategy, bringing together all parts of the health service, that recognises the challenges and put together an immediate action plan. The Humber and North Yorkshire integrated care board is trying to address these issues, but I am concerned about exactly what its role is, or should be. Some ICBs interpret their population health duties as requiring them to act upstream of healthcare needs on the social determinants of health, where the NHS has few direct levers. Other ICBs interpret their duties as requiring them to understand and adjust healthcare services to match the needs of the population that they serve, in line with the NHS operating framework. Some interpret them as both and others as neither, preferring to focus on what they see as their traditional role of performance managing providers. Ultimately, their roles and responsibilities need to be clarified so that they can be better held to account. This is not a criticism of the performance of my local ICB, which is working hard to tackle the challenges, but I think we would all benefit from greater clarity of purpose.

In conclusion, we cannot escape what is in front of us. As one senior local authority figure commented to me:

“The health crisis in Bridlington is not a car crash waiting to happen, it is happening right now.”

My appeal to the Minister today is simple. I have no doubt that he has the very best of intentions when it comes to improving the nation’s health, but realistically many of those ambitions will take decades. If he wants to make a real difference today, will he please focus some of his Department’s collective effort on tackling the enormous health inequalities in seaside towns such as Bridlington, and will he please take the recommendations of Lord Darzi and Sir Chris Whitty and apply them to our town? We are happy to be his pilot scheme or his trailblazer.

I know that with the right energy and direction, we will not be left with a generation of children who have never seen a dentist and we will not have elderly people travelling long distances for regular routine appointments. Instead, we will have a health service to be proud of and a happier and healthier local population. I implore the Minister and his Department to work with me to ensure a better future for the brilliant people of Bridlington.

NHS Performance: Darzi Investigation

Jim Shannon Excerpts

Monday 7th October 2024 Commons Chamber

[Wes Streeting]

I am grateful to the hon. Member for her intervention. I wish that this was a challenge only in her constituency; it is a challenge right across the country. As I said to the Royal College of GPs last week, it will take time to rebuild general practice, so that it is back where we want it to be. We would be delighted to hear more from her; I will ensure that my Department makes contact, and that a Minister is in touch about the challenge in her constituency.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for today’s debate. The whole House, and indeed the whole of the United Kingdom of Great Britain and Northern Ireland, wishes him well in bringing forward the changes that we wish to see. An issue that comes to my attention regularly is research and development. We hear in the press every day about new advances in treating diabetes, heart disease, cancer, Alzheimer’s, dementia and rare diseases. When we look at the bigger picture of the NHS, we see the big problems, but sometimes there are smaller issues. Will he reassure us that research and development will be encouraged?

[Wes Streeting]

I strongly agree. Although health is devolved, I look forward to working constructively and closely with Governments right across the United Kingdom of Great Britain and Northern Ireland, because every part of the health system in every part of the UK is going through challenges. We are determined to do that. [Interruption.] I think the hon. Member wants to come in again.

[Jim Shannon]

National Institute for Health and Care Excellence recommendations go from here to Northern Ireland, and then we endorse them; if we do not get them from here to start with, we cannot make people better. That is the point that I was trying to make.

[Wes Streeting]

The hon. Member’s point is taken.

The NHS stands at a fork in the road. There is a choice before us, and the parties represented in the House have different opinions on the best way forward. The first option is for the NHS to continue on its current path—to head down the road to ruin, on a mismanaged decline, with a status quo so poor that patients are forced to raid their savings to go private, and with the worst yet to come, because many Opposition Members believe that all patients should have to put their hands in their pockets when they fall ill. Reform UK has openly stated that it wants to change the funding model and replace it with an insurance-based system, and plenty in the Conservative party want to head in the same direction, chasing Reform UK down the hard-right rabbit hole.

--- Later in debate ---

[Victoria Atkins (Louth and Horncastle) (Con)]

On this, the first anniversary of Hamas’s horrific attack on Israel, our thoughts are with Israel, the victims of that horrific attack and their loved ones, and with all those who are trying to rescue the hostages, get aid where it is needed and bring peace to the region.

Day 95 of this fumbling Labour Government, and yet another general debate to talk about a report that we talked about three weeks ago. That seems to be the golden—or Gray—thread running through this Government: lots of talk, but where is the action? If the Secretary of State for Health and Social Care wanted to make a meaningful contribution to the nation’s health, why did he not bring forward the Second Reading of the Tobacco And Vapes Bill this evening, to help our children and bring about the first smokefree generation? That Bill is ready to go; why are the Government not?

The right hon. Gentleman could have provided an update to the House on the 40,000 more appointments that he promised many times during the campaign, which the latest answer from his Minister to a written parliamentary question suggests is nowhere near happening. It is perhaps about as likely as the Prime Minister paying for his own glasses. The right hon. Gentleman could have set out the steps that his Department is taking to prepare the NHS for winter. In the spring, I asked the system to start planning for this winter. How many beds, ambulances and care packages has he put into the system to prepare it for winter? He could have set out the terms of the royal commission on social care. We in the Conservative party stand ready to help on that royal commission, because we believe in constructive opposition, yet we have heard nothing from this Government. The right hon. Gentleman could have launched the much-hyped 10-year plan, which he promised before the election was “oven-ready”, but appears to be in the deep freeze. How many more Government resets will there be before that 10-year plan is launched?

Instead, in their first 95 days, this Labour Government have talked down the economy and the NHS, stopped new hospitals from being built, scrapped NHS productivity improvements, overseen GPs entering industrial action, been exposed in a health cronyism scandal, and opened a dispute with hundreds of thousands of nurses and midwives. They seek to justify all of that with the Darzi report. That report, from a former Labour Health Minister, has sunk as quickly as it was briefed out. It looks backwards, but not far enough to mark the last Labour Government’s policy and operational failures. If this Government are serious about reforming the NHS—and I genuinely hope they are—they and the Secretary of State need to transition quickly from opposing to governing.

[Jim Shannon (Strangford) (DUP)]

Will the right hon. Lady give way?

[Victoria Atkins]

I will finish this point. That transition must begin with the language that the Secretary of State is choosing to use about the NHS. Interestingly, we have heard a little bit of nuance for the first time tonight, perhaps because health leaders are raising concerns that his “broken” narrative is damaging public confidence and will lead to people not coming forward for care, as was reported on the day that the right hon. Gentleman gave his speech to conference. That narrative is hurting the morale of staff who are working tirelessly for their patients. As the confected doom and gloom of the new Chancellor damages business confidence, so too does the Health Secretary’s relentlessly negative language risk consequences in real life.

Let me say what the Health Secretary refuses to acknowledge: the NHS is here for us and is ready to help. Its dedicated staff look after 1.6 million people per day, a 25% increase from the days of the last Labour Government. That is why I am always a little concerned whenever the right hon. Gentleman harks back so far; I do not think he has quite understood the change in capacity and scale of the national health service since we inherited it from the last Labour Government. The majority of those 1.6 million people will receive good care. [Interruption.] These are just facts, but I know the Health Secretary finds them difficult to receive.

--- Later in debate ---

[Victoria Atkins]

First, I am very sorry to hear that. Again, the way we were trying to deal with the enormous increase we have seen in mental ill health across our country was first of all to boost mental health services for children and young people. Indeed, the hon. Member may not be aware of this, but we rolled out mental health support teams across nearly 45% of schools. We wanted to complete that to 100% of schools by the end of the decade, and I very much hope that the Secretary of State will be taking up that policy and delivering it.

The hon. Member for Bournemouth East (Tom Hayes) might know that there seems to have been a real increase in eating disorders since the pandemic. We know, for example, that the impact of social media sites, and the algorithms that sit behind them, can lead people who are already feeling very vulnerable into even darker places. So when the Secretary of State says that there should be a cross-Government piece of work, I very much agree with him—I hope he will achieve that through his mission board. But we really have to look at how we as a society can deal with some of these causes, because I do not think anyone is happy with seeing such a huge increase in anxiety and mental ill health among our young people since the pandemic.

[Jim Shannon]

One of the things that came up at our party conference some time ago was a recommendation from the British Medical Association and the General Medical Council to encourage medical students into local trusts by paying their fees, which would pay for itself given the cost of locum doctors in each of our health trusts. Would the shadow Secretary of State support that, and would she in turn encourage the Government to do likewise?

[Victoria Atkins]

I hope the hon. Gentleman knows by now that when he makes a suggestion, I will take it away. He will appreciate that, as part of a constructive Opposition, I want to look carefully at the ramifications—both the intended and unintended consequences—of policies suggested in the Chamber, but that sounds very interesting. I thank him for his contribution, as always.

NHS: Independent Investigation

Jim Shannon Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. I feel really sorry for NHS staff for what they have been put through over more than a decade of mismanagement and political incompetence, and we will work with them to clean up the mess. She establishes exactly the right test, which is whether we would want our loved ones to be treated in our local health and care services, and whether we would have confidence that, in every case, on every occasion and in every interaction, they would have access to the best-quality care. The truth is that we do not have that certainty, and too often it feels like chance. That is why we will always put the patient voice, the patient interest and the patient experience at the heart of our reform and modernisation programme.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for the honesty in his statement, and for his contact with the regional Minister responsible at the Northern Ireland Assembly. Those are the first actions of a Secretary of State who, I suggest, does not run away from issues but takes them head on. I congratulate him on that.

I appreciate the terminology used in the report, which outlines the seriousness of conditions in the NHS but also highlights the fact that the vital signs are still strong. Will the Secretary of State outline how he intends to address the fact that the NHS in devolved regions is in an arguably worse condition? Will he confirm that the review will incorporate Northern Ireland and will he ensure that the findings, new practices and standards will be in place for Northern Ireland, along with increased funding in a new funding formula?

[Wes Streeting]

I thank the hon. Gentleman for what he said; coming from him, that means a great deal to me. I reassure him that I am committed to working with Ministers in all devolved Administrations to improve health outcomes for everyone in every part of our United Kingdom. I know that the system is particularly pressed in Northern Ireland and I will do whatever I can, working with Ministers in Northern Ireland, to help that situation and create the rising tide that lifts all ships right across the UK.

Government Policy on Health

Jim Shannon Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

I am grateful to my hon. Friend for his question. We know that the NHS is broken, and is going through the worst crisis in history. We will shortly hear from the noble Lord Darzi about the outcome of his investigation into the true state of our national health service, but against that bleak backdrop of political failure are stories across the country of triumph against the odds, and of some outstanding public servants doing extraordinary things, showing what the future of our health and care services could look like with a Government on their side. I am pleased that such a Government is here—this Labour Government—and I would be delighted to hear more about my hon. Friend’s constituency.

[Jim Shannon (Strangford) (DUP)]

I wish the Secretary of State all the best in his new role, and in the task that he has taken on. With great respect to my Conservative colleagues, the downfall of the Tory Government was due in part to the fact that people did not trust the background politics behind closed doors. I want the Government to succeed, as do most people in this House. Stability and direction are much needed, but that can happen only with openness, transparency and a desire to put nation before party. How can the Secretary of State assure us that this Government will do things differently, and that policy will be proposed by those with know-how, and passed with scrutiny in this place, not simply due to pressure from lobby groups?

[Wes Streeting]

I strongly agree with the hon. Member. In the short time that I have been in post, I have been delighted to have had virtual meetings with the current Northern Ireland Minister of Health, as well as with his predecessor, the hon. Member for South Antrim (Robin Swann), who now sits over there on the Opposition Benches—I am delighted to see him in his place.

Ministerial meetings attended by third parties are declared in our quarterly transparency publication. People will want to lobby and influence Government, and Members of Parliament, all the time. Members of Parliament regularly receive correspondence—let alone the deluge of advice that we receive in government. The important thing is that Ministers take decisions on the basis of the best possible advice available, that they weigh up carefully the evidence and arguments in a fair and proper way, and that advisers may advise but Ministers ultimately decide.

This Government are aware of the deep crisis in trust in our politics. That is why, on his very first day, the Prime Minister talked outside Downing Street about restoring Government to service. It is why it should be no surprise whatsoever that many people who have given outstanding public service to this country, such as my right honourable friend Alan Milburn—and the same is true of Patricia Hewitt, Alan Johnson, my noble Friend Lord Reed, the Mayor of Greater Manchester and many more—want to roll up their sleeves and help the Government. They can see the state that the Conservative party left our country in, and are willing once again to roll their sleeves up to get our country back on its feet, turn the situation around and ensure that everyone in our country can look forward to the future with optimism and hope after 14 years of abysmal failure.