Diethylstilbestrol: Intergenerational Impact
Jim Shannon Excerpts(3 months, 3 weeks ago)
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Jessica Toale (Bournemouth West) (Lab)
I am grateful to have secured this important debate.
I begin by asking the House to imagine a young woman in Britain in the 1950s. She is pregnant, she may have struggled to conceive and she may already have experienced the heartbreak of miscarriage, so she is desperate to do everything that she can to protect her baby. She goes to the doctor, as many of us would. She is prescribed a drug and told that it may help to prevent miscarriage, help her carry that baby to term and even give her the healthy child she so desperately wants. Of course she takes it—why would she not? She trusts her doctor, she trusts the health system and above all she wants to do the best she can for her child. But then imagine her finding out, decades later, that the very medicine that she took to protect her child had in fact harmed her, harmed that child and may even have harmed her grandchildren as well. That is the reality of diethylstilbestrol or DES.
DES was widely prescribed as an anti-miscarriage drug between the 1930s and the 1970s. It was used to treat pregnancy complications and to supress breast milk, and it was prescribed to women who were looking to the medical profession for help. But DES was not the miracle drug they were told it was. Evidence emerged in the 1950s that not only was it ineffective, but that it was also dangerous. It has since been linked to breast cancer, cervical and vaginal cancers, infertility and a range of other serious reproductive and gynaecological issues. Yet despite the warning signs, the evidence of harm and the fact that other countries moved to withdraw or restrict its use, DES continued to be prescribed in Britain for decades. Around 300,000 women are estimated to have been given DES in the UK between 1939 and the 1970s.
Jim Shannon (Strangford) (DUP)
I commend the hon. Member for Bournemouth West (Jessica Toale) for securing the debate. I spoke to her beforehand to obtain her permission to intervene. As she rightly says, over 300,000 women in the UK were prescribed DES in one of the worst medical disasters in NHS history. Repercussions of the use of the drug, as the hon. Lady says, are intergenerational, as evidence shows negative effects on third generations. Does she agree that further research is needed to study the long-term effects of DES exposure to better understand the extent of its impact and ensure effective medical treatment for those affected by the drug? I commend her again and I look forward to hearing the Minister’s reply.
Jessica Toale
Yes, I agree that research is needed and that is one of the things that DES campaigners are calling for.
One of those 300,000 women was Rita, the mother of my constituent, Jan Hall. Rita was prescribed DES when she was pregnant with Jan, but when Jan was just a toddler, Rita died of breast cancer. She was only 32. Jan herself later developed cervical cancer in her twenties. Because of the surgeries she had to undergo, she was told she may never be able to have children. She lived not only with that physical consequence, but with decades of uncertainty, fear, grief and anger. Her daughters have experienced significant gynaecological health problems, and now Jan worries about her grandchildren as well.
Jan is not alone. Across the country, men, women and their families have come forward to share their stories and their experiences as victims of this scandal. Some of them are in the Gallery with us today and have allowed me to share some of their painful testimonies.
National Lung Cancer Screening Programme
Jim Shannon Excerpts(3 months, 3 weeks ago)
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Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairship, Sir Alec. We will be together all afternoon if you are here for the next debate as well. I welcome this debate on the national lung cancer screening programme. I thank the hon. Member for Wokingham (Clive Jones) for securing it, and for his dedication to anything to do with cancer. The hon. Gentleman has made a name for himself in this House for putting forward these topics. I thank him for his knowledge and for his interest.
The lung cancer screening programme was set up to find lung cancer early, before symptoms appear, especially in people with a history of smoking, who are the group with the highest risk. The UK’s biggest ever early diagnosis initiative for lung cancer, the programme is delivered through targeted lung health checks. The hon. Gentleman referred to how the scheme delivers checks. They take place in local hospitals and in the community, and in vans in settings such as supermarket car parks, so nobody can say they have not had the opportunity to have the check done.
The checks are designed to target those aged 55 to 74 who are current or former smokers, as identified from their GP records, who are registered with a GP and who live in an area where the programme has been rolled out. I understand that the programme is expanding rapidly, region by region and is expected to be fully rolled out across England by 2030. That is welcome. Indeed it is, I would say, almost there.
We do not know how many people have attended the checks, but the United Kingdom National Screening Committee noted that more than 1.9 million have been invited to the programme, which is operating across 25% of England. NHS England has stated that, to date, some 5,037 lung cancers have been detected early since 2019; 76% of those were found at stage 1 or 2. Early-stage diagnosis improves five-year survival nearly twentyfold compared with late-stage diagnosis, so again that is a success of the programme.
The screening programme has been an outstanding success, and I commend the Minister and all those involved in the Department and NHS England on such an extraordinary achievement—they deserve every accolade for it. It has fitted perfectly with the 10-year health plan. We should give credit to the Minister and the Government for the plan and for all they have done to improve health; there are many things they can point to as being successful. It is also nice to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), in his place; it would not be a health debate if he and I were not here together—and here we are again.
As chair of the all-party parliamentary group for respiratory health, I warmly welcome the three shifts arising from the 10-year health plan. The screening programme is an excellent example of how well they have worked in practice. The first shift was from analogue to digital: most of the reminders for eligible patients are by text message—that is the new way of doing it; I may not be entirely geared into it, but I understand the process. The second shift was from hospital to community: running the tests in mobile units means they are less intimidating and closer to home. In fact, around 70% of initial screening was delivered via mobile units, improving access in deprived areas where smoking rates are highest. If we want to address the issue, we must go to the coal quay, as we would say, and meet and speak to the people.
The third shift was from treatment to prevention. Early-stage detection dramatically improves survival. The lung checks programme has crucially identified over 100,000 incidental findings of emphysema, one of the key conditions of COPD. However, those incidental findings are not generally followed up, nor do they lead to referrals for further investigation or treatment. Will the Minister ask his Department to consider a follow-up? If incidental findings are identified and there is a chance of curing or addressing the issue, that is the time to strike. The men’s health strategy called for better incidental outcomes, and it contains the ambition of
“ensuring incidental findings from the NHS Lung Cancer Screening programme, including respiratory illnesses such as COPD, are followed up according to the NHS Lung Cancer Screening programme incidental findings protocol and relevant NICE guidance”.
Can the Minister update us on how that is progressing within the men’s health strategy?
We have discussed the outstanding FRONTIER Hull trial with Professor Mike Crooks from Hull, who is piloting an integrated pathway that links screening findings to respiratory assessment and treatment in partnership with the NHS. I commend the work he is undertaking. So far, 383 of the 819 people—47%—recalled to the clinic have received a new diagnosis of COPD and started treatment through a streamlined one-stop clinic, meaning that those patients could begin treatment immediately rather than waiting while their symptoms progressed and their condition deteriorated.
I underline again that it has been shown that a one-stop diagnostic clinic is feasible, can be achieved and fits well with the three shifts. The approach can be tailored to meet local needs, helping integrated care systems to reduce hospital demand and improve patient outcomes. It has been estimated by Chiesi that integrating COPD case finding into lung cancer screening could save the NHS some £33 million over 10 years. That saving cannot be ignored, especially at a time when every pound counts. If it is possible to save some £33 million, it should be in part because of the screening programme.
I urge the Minister to look closely at the outcomes of the trial. This topic deserves a full debate; but more than that, it deserves an outcome. Screening saves lives, ultimately saves money and, importantly, saves needless heartbreak and pain. Let us invest in ourselves and in the process that we are discussing today.
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairmanship, Sir Alec. I congratulate the hon. Member for Wokingham (Clive Jones) on securing this important debate and on his continued and relentless advocacy for people affected by lung cancer. I am grateful to the hon. Member for Strangford (Jim Shannon); to the Liberal Democrat spokesman, the hon. Member for Didcot and Wantage (Olly Glover); and to the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), for their comprehensive and constructive contributions. I pay tribute to my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), the lead Minister on this policy area.
There is a great deal of consensus across the House on this issue. We all want to see more lung cancers diagnosed earlier, more lives saved and fewer families affected by the devastating consequences of a late diagnosis. Lung cancer remains one of the greatest cancer challenges that we face. More than 42,000 people were diagnosed with lung cancer in England in 2023, and about 35,000 people lose their life to the disease across the United Kingdom each year.
Lung cancer is also one of the cancers most strongly associated with deprivation. People living in the most deprived communities experience higher rates of smoking, a higher incidence of lung cancer and poorer health outcomes. That is why tackling lung cancer is about not only improving cancer survival, but reducing some of the most persistent health inequalities in our society. For too long, outcomes for lung cancer have lagged behind those for many other cancers. The reason for that is well understood: too many people are diagnosed when their cancer is already at an advanced stage, limiting treatment options and reducing the likelihood of successful outcomes.
That is why early diagnosis is absolutely critical. When lung cancer is diagnosed at stage 1, five-year survival is over 60%. By stage 4, it falls to just over 4%. Those figures alone demonstrate why finding lung cancer earlier remains one of the most effective ways of improving survival. The Government fully recognise the importance of this challenge. Improving outcomes for lung cancer and other less survivable cancers will be critical to achieving the Government’s ambitious objective that 75% of people diagnosed with cancer should survive for at least five years. That is why the national cancer plan places a strong focus on earlier diagnosis, reducing inequalities and ensuring that people with less survivable cancers receive the attention and support that they deserve.
Jim Shannon
This debate is about lung cancer, but I noticed a story in the paper today about an increase of between 5% and 10% in the number of people who now have breast cancer. Does the Minister agree that that underlines the issue that while there are many advances in cancer, and we welcome all of them, there is still a long way to go?
Stephen Kinnock
The hon. Gentleman is absolutely right. There is a lot more work to be done, and it is a priority for the Government: it is right up there in the 10-year plan and the priorities. As he said in his excellent speech, we need to mobilise every one of the shifts—from analogue to digital, from hospital to community and from sickness to prevention—in the battle against cancer, because it is a formidable enemy and we need every single weapon we can deploy to defeat it.
We are determined to break the historical pattern of slow progress and finally give people with less survivable cancers the focus, urgency and outcomes that they deserve. That commitment is already being translated into action through the NHS lung cancer screening programme. The programme is designed to identify cancers at an earlier stage among those at highest risk, particularly people aged 55 to 74 with a history of smoking. Smoking remains responsible for about 72% of lung cancers, which is why a targeted approach is both clinically effective and evidence-based.
The results so far have been extremely encouraging: more than 1.8 million people have attended a lung health check through the programme, and more than 11,000 people have been diagnosed with lung cancer. Most importantly, 77% of cancers detected through the programme have been diagnosed at stage 1 or stage 2; outside the programme, the equivalent figure is about 30%. That means that thousands of people are receiving a diagnosis earlier, accessing treatment sooner and benefiting from significantly improved prospects for survival.
The programme is already demonstrating how earlier diagnosis can transform outcomes. Recent NHS England data shows a significant improvement in early-stage diagnosis in areas participating in the programme. That means more people are being diagnosed when treatment is most effective and when there is the greatest opportunity for curative intervention.
The hon. Member for Wokingham and others have spoken about the importance of a truly national programme. I agree that every eligible person should have the opportunity to benefit from lung cancer screening. That is why the Government are committing more than £650 million to complete the roll-out of lung cancer screening across England by 2030. Through the national cancer plan, we have committed to ensuring that every eligible person in England receives their first invitation for a check by 2030, helping thousands more people to benefit from earlier diagnosis and improved outcomes.
This investment reflects the Government’s confidence in the programme and the evidence supporting it. By 2035, lung cancer screening is expected to diagnose up to 50,000 cancers and identify at least 23,000 cancers at an earlier stage, helping thousands more people to receive potentially lifesaving treatment. This represents one of the most ambitious cancer screening programmes anywhere in the world.
Puberty Blockers
Jim Shannon Excerpts(3 months, 4 weeks ago)
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Dr Johnson
The hon. Gentleman is exactly right, and he expresses my point succinctly. Why is the Secretary of State going ahead with a trial—experimenting on more children unnecessarily—when he has the data to analyse already? Why has he chosen to fund this trial? Is he worried about the children who will be put on a medical pathway that may lead to cross-sex hormones and a lifetime of medicalisation when they would have got better by themselves anyway?
I want to talk about the age of these young people. The Medicines and Healthcare products Regulatory Agency warned in February that the youngest patients are at the greatest risk, and may end up on puberty blockers for a much longer period. They have a higher risk to fertility because sperm and eggs have not yet fully developed at Tanner stage 2, but this Government have chosen to include children of 11 or 12. Some will wonder why it is 11 for girls and 12 for boys—indeed, I was asked that question yesterday—but as a paediatrician I am aware that puberty starts earlier in girls than in boys. It is somewhat ironic that a trial based on the premise that girls could be boys recognises this biology, but I am glad that in this respect it does. However, that means some of the participants will be primary school-aged children with the merest form of puberty. How can they possibly meet the eligibility criteria, which includes
“sufficient understanding of the treatment advantages and disadvantages, including discussion of fertility preservation”?
How can a child of 11 understand what it means to lose sexual function, to be unable to have children when they are older, to have difficulties in thinking and to have weak bones? Remember that this Government think that 14-year-olds are not old enough to watch social media, but they think 11-year-olds are capable of understanding this.
Jim Shannon (Strangford) (DUP)
I just say this to the hon. Lady and, perhaps more importantly, to the Secretary of State, who is very genuine, personable and easy to speak to. In Northern Ireland, the Assembly and the Minister there have taken a decision not to pursue this. Would the hon. Lady agree that, when the Government pursue something here that may set a precedent for somewhere that has not agreed to it at the time, there could be an influence, with an adverse impact on the regional Administrations—the Northern Ireland Assembly where we are, and elsewhere—and it is important that the Government here do not take a decision that could influence areas they do not control?
Dr Johnson
I thank the hon. Gentleman for his intervention on devolution, and I am sure the Secretary of State was listening and considering what he has said.
To go back to the age of the young people, I am reminded of the judgment in Bell v. Tavistock, which says:
“We do not think that the answer to this case is simply to give the child more, and more detailed, information. The issue in our view is that in many cases, however much information the child is given as to long-term consequences, s/he will not be able to weigh up the implications of the treatment to a sufficient degree.”
I draw right hon. and hon. Members’ attention to the next part of the quote:
“There is no age appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years.”
Yet, as Secretary of State confirmed yesterday, the children must consent or assent to being in this trial. Another question that he did not answer yesterday is why the Government did not heed the MHRA recommendation for a minimum of 14 years. Having established that the Government are going to put a group of physically healthy children with a self-resolving condition at a risk they may not fully understand, the remaining question is why they would they want to do this.
The trial itself has an interesting design. We are told that it is a randomised controlled trial—as a doctor, I am familiar with that term—but in this case it is a bit of a fudge. Yes, this Government-sponsored trial will randomise which children get the drugs now and which get them in a year’s time, but the comparison group that does not receive puberty blockers—300 children from the Horizon Intensive trial, with whom the trial will seek to compare—may not be considered a reliable comparison, because the group is a different group with different eligibility criteria. When the results of this trial are published, this fact is bound to be used by people who dispute or disagree with the findings. The Secretary of State said this trial will resolve the dispute over the issue, but that is one of the reasons why I think it will not.
I want to discuss sexual function, because yesterday the Secretary of State said that the trial would involve the completion of a number of questionnaires, and one of my hon. Friends raised the question about what happens to children’s sexual function in the long term. What is sexual function? It is desire, arousal and orgasm. The trial organisers are clearly concerned about this, because they put into the trial the ALSPAC—Avon longitudinal study of parents and children—romantic relationships questionnaire. I read the questionnaire on the Health Research Authority website, and children from the age of 12 and over will be asked these questions, one of which is:
“In the last year have you had oral sex with another person? (This is when they put their mouth or tongue on your penis/vagina or you put your mouth or tongue on their penis/vagina)”.
Let us be clear: if that is happening to a 12-year-old, that is sexual abuse and the police should be called. Is the Secretary of State content for the Government to be asking these questions of such young children? Can he believe that they will be paid £20 for completing their questionnaires, alongside £30 for completing the assessment of cognitive ability and £15 for completing physical and height assessments, in addition to travel expenses?
There will be lots of talk this week about the Prime Minister’s legacy. Putting children as young as 11 on puberty blockers, with irreversible life-changing consequences, would be the most disturbing final chapter in what has been a troubled book of leadership. Today, right hon. and hon. Members will be asked to vote to consider their approval or disapproval of the trial. I urge them to look at their conscience, read the trial protocol—it is online—and remember that these are vulnerable children who deserve the best care. One day, the children caught in the middle of this debate will be adults. It is our responsibility to ensure that when they look back on their one childhood, their one adolescence and their one chance to enjoy growing up, they must know that every decision was made with the utmost care, caution and respect for their future. The power to make that happen is in our hands today. I urge hon. Members to protect children’s futures.
Spinal Muscular Atrophy: Newborn Screening Test
Jim Shannon Excerpts(3 months, 4 weeks ago)
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Lewis Atkinson (Sunderland Central) (Lab)
I beg to move,
That this House has considered e-petition 755980 relating to spinal muscular atrophy and the newborn screening test.
It is a pleasure to serve with you in the Chair, Mr Mundell, and a privilege to open the debate as a member of the Petitions Committee. I want to begin with two little girls. In May last year, twin daughters were born prematurely to the petitioner, Jesy Nelson, who is a constituent of the hon. Member for Broxbourne (Lewis Cocking). Several months later, they were diagnosed with spinal muscular atrophy type 1, which is the most severe form. Their mother was told that they would, in her words, “probably never walk”.
In January of this year, Jesy chose to share that diagnosis publicly, saying that it would be
“selfish to keep this to myself and not potentially save a child’s life.”
This petition is the result, and I pay tribute to her for the way that she has courageously told her story, using her own unique reach. As a result, the petition was signed by 149,692 people, including 225 of my constituents in Sunderland Central. I was grateful to meet Jesy earlier in Westminster Hall, and I thank her and every family who has turned the hardest experience imaginable into a campaign for other people’s children.
In preparing for this debate, I also met Giles Lomax of SMA UK, Muscular Dystrophy UK, and Professor Francesco Muntoni of the Neuromuscular Centre at Great Ormond Street. I thank all of them for their time, and I also thank the Petitions Committee staff for their help as I prepared for this debate.
SMA is a rare genetic condition that attacks the motor neurones, causing progressive muscle weakness. Around 1,500 people in the UK live with it and about 48 babies are born with it each year—roughly one a week. With type 1 SMA, symptoms appear within the first six months and the effects are profound. Children cannot hold up their heads or sit unsupported; they may be tube-fed and need help to breathe. Until recently, up to 90% of untreated babies either died before the age of two or required permanent ventilation.
I used the past tense there deliberately and happily, because the important fact in this debate is that SMA is no longer untreatable. There are now three disease-modifying therapies in this country, including a one-time gene therapy that did not exist a decade ago. They are approved by the National Institute for Health and Care Excellence, and funded by the NHS. A condition that was too often a death sentence for babies is now one that we can treat.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for, as he often does, leading this debate on a petition that has generated a lot of interest. I understand that the one of the life-altering gene therapies for SMA, Zolgensma—I hope that I have pronounced it correctly—is available on the NHS, but such gene therapies only work if they are administered before irreversible nerve damage and muscle wasting occur. My hon. Friend the Member for Upper Bann (Carla Lockhart) has been at the forefront on this issue. Does the hon. Gentleman agree that perhaps what we really need is a UK-wide purchasing power for these heel-prick testing kits to be fully extended to all local health trusts without delay? That would make sure that those who have SMA are caught in time.
Lewis Atkinson
The hon. Gentleman is absolutely right and I will come on to talk about screening in just a minute.
Lewis Atkinson
My hon. Friend is absolutely right, and I will come on to talk about the potential postcode lottery. I do not believe it is a decision for individual ICBs to make, but a national decision that includes the UK National Screening Committee, which I will come on to.
The screening that I have described is already in place in dozens of countries. Across Europe, 75% of children are screened at birth and since 2024, every newborn in the United States and Canada has been screened. Ukraine managed to begin newborn screening for SMA in the midst of a full-scale Russian invasion. Given that, the petitioners simply ask, “Why is this screening not in place universally here too?”
Jim Shannon
On 23 March, Scotland rightly introduced routine screening. In October, babies born in England will benefit from the in-service evaluation framework. Yet families in Northern Ireland do not qualify whatsoever. Does the hon. Member agree that the Government must commit to working across jurisdictions with the Northern Ireland Department of Health to ensure that the evaluation framework is immediately extended to Northern Ireland so that a child’s chances of walking, breathing and surviving are not dictated by the part of the United Kingdom that they are from?
Lewis Atkinson
I thank the hon. Member for making one of his excellent interventions. Clearly health is a devolved matter in Northern Ireland and Wales, where screening is also not available, but the hon. Member is absolutely right. It would be difficult to explain to parents anywhere in the UK why this screening is increasingly standard practice internationally but is not available in every nation of the United Kingdom.
The petitioners are clear that all the conditions necessary to begin screening have been met. The test exists, the treatments exist and the evidence tells us that screening would save both lives and money. In the UK, screening is overseen by the independent UK National Screening Committee, which gives recommendations to Ministers. I was unable to meet with the committee in preparation for the debate, but I am sure that the Minister has had the benefit of its advice.
I recognise, as we all must, that the committee’s independence matters. However, its decision making and the way in which it balances risk, evidence and benefit must be subject to ministerial oversight. In this case in particular, there are questions about how those three elements have been balanced, and specifically about how far the committee seemingly required NHS-specific evidence when significant international evidence already exists.
When the National Screening Committee reviewed SMA for potential inclusion in the screening programme in 2018, the committee did not recommend screening, but campaigners like SMA UK did not walk away; they kept on doing the work. New cost-effectiveness modelling commissioned by the screening committee and published last year finds that screening for SMA is likely to be lifesaving and cost-effective.
Mental Health: Parity of Esteem
Jim Shannon Excerpts(4 months ago)
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Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for securing the debate, and she is absolutely right to address this issue. In Northern Ireland, we have extreme mental health issues; indeed, the figure is 25% higher than it is here on the mainland. The Government have made a commitment to address the nation’s physical health. Does the hon. Lady agree that they must now treat the nation’s mental health equally? In doing so, they will address the emotional issues among the people we represent here.
Access to Dental Services: West Sussex
Jim Shannon Excerpts(4 months ago)
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Jess Brown-Fuller (Chichester) (LD)
I beg to move,
That this House has considered access to dental services in West Sussex.
It is a pleasure to serve under your chairmanship, Sir Desmond, to have secured this debate—on Sussex Day, no less; I am confident that the Minister will have some excellent responses on behalf of all constituents in Sussex—and to have the opportunity to lay out the impact of the historic failings within the dental contract before the Minister.
The state of access to NHS dental services across the country is utterly disgraceful. In Sussex, 63% of adults had not seen a dentist in the two years prior to June 2025. Similarly, four in 10 children had not seen a dentist during that time. Fourteen million people were unable to access NHS dental care in early 2025 across the UK. The result of people locked out of NHS dental services has been a rise in cases of DIY dentistry, with a survey earlier this year suggesting that 7% of UK adults had attempted some form of DIY dentistry.
All that contributes to an alarming increase in hospital admissions for tooth-related issues. Tooth decay is now the most common reason for hospital admission among children aged between six and 10, with more than 100,000 children admitted to hospital with rotting teeth between 2018 and 2024. Those figures outline a dire situation that is only getting worse. Improvements in oral health are being wiped out, and tooth decay rates are at levels not seen since the 1990s.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady on bringing this forward. She is absolutely right that there is a dental crisis not just in West Sussex, but across the whole United Kingdom. Some 14 million people cannot get an NHS dentist. Whenever I look back—and I am old enough to look back, at my age—I think that perhaps we should move back to the situation I can well remember in the past, when there were full-time NHS dental surgeries in community hospitals. They never let us down. Those positions must pay enough for dentists to be comfortable. Is that perhaps where we are going?
Jess Brown-Fuller
I thank the hon. Gentleman for his passionate advocacy for NHS dentistry in West Sussex. I am grateful to him for caring about access to NHS dentistry across the whole country. He is a fierce advocate for Strangford and makes the important point that the situation we are in is a damning indictment of the failure of the previous Government—a failure that the Prime Minister himself referred to regularly in the run-up to the general election. It was a stick that he used to beat the Conservative Government with in every televised debate, when he spoke about rotting teeth falling out of children’s mouths.
We are still going backwards, dealing with problems on a scale not seen for generations, all at a time when the British Dental Association has warned that NHS dentistry is facing an existential threat. Parliament often hears the term “postcode lottery”, but I cannot think of a more applicable example than NHS dental services for residents in Chichester and West Sussex.
Last week I had the opportunity to conduct a little bit of research with a staff member who has recently moved to London and needs to register with an NHS dentist. Within two miles of his new postcode in London, 10 surgeries were accepting NHS patients. Entering the postcode of my constituency office in Chichester into the NHS search tool produced a very different result: zero surgeries accepting new adult NHS patients within a 12-mile radius. There were none within the city itself, and only one surgery was accepting new patients under the age of 17. That means that residents not registered locally have to travel to other towns and cities. At the time of looking, the closest surgery was in Littlehampton in the constituency of the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths). That is not close to the city of Chichester.
I ask the Minister what his solution would be for people attempting to register locally, people living in the area already and people moving to it after years of increased mandated development in my constituency. I would like to share with the Minister a few examples of what this means for my constituents in Chichester, who very kindly got in touch with me to share their stories. Kathryn moved with her family to the area four years ago. She still travels to Three Bridges for dental care. Christine still returns to the Isle of Wight for treatment. Marina and Denise moved to Bracklesham in 2011—15 years ago—and have never been able to register for an NHS dentist locally. Jim contacted me to say that he undertakes a 140-mile round trip just to receive routine dental care.
Community Hospitals
Jim Shannon Excerpts(4 months ago)
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Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for securing this important debate. I apologise to her and to you, Sir Jeremy, for not being able to stay; unfortunately, I have to be somewhere at 10 o’clock that is about 10 miles away. Like the hon. Lady, I wish to shine a light on the quiet heroes of our health service: our community hospitals. Places like Ards community hospital in my constituency are not just buildings but the bedrock of local care. They are the vital bridge between the high-tech intensity of a major acute hospital and the sanctuary of a patient’s own home. I support the hon. Lady in making the case for community hospitals, because my community hospital does all the things she wants community hospitals to do across this great United Kingdom of Great Britain and Northern Ireland.
Dr Savage
I thank the hon. Gentleman for his perceptive intervention. Community hospitals often do feel more like a home from home. They are more accessible for a patient’s friends and family to visit, and they deliver better outcomes for patients and clinicians alike.
In the south-west, ambulance handovers at acute hospitals took more than 30 minutes in more than half of cases in January 2025—nearly 30% above the England average. A few months ago, I had the privilege to ride in an ambulance for a day. In what ended up being a 13-hour shift we attended only three call-outs. Maybe it was a quiet day—I am definitely not saying I wish there had been more grief out there—but we spent much of the day on the road and/or waiting outside hospitals, which did not seem the best use of a highly qualified ambulance crew and an expensive resource.
It will not be news to anybody in this room that our NHS is under pressure, yet, against the odds, community hospitals continue to perform. The Care Quality Commission reports that between 75% and 92% of community hospitals are rated good or outstanding, which is remarkable given that the number of district nurses working in them fell by around 55% between 2009 and 2024, with underinvestment and the loss of EU staff after Brexit cited as key causes.
Secondary Breast Cancer
Jim Shannon Excerpts(4 months, 1 week ago)
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Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairship, Mr Betts. I thank the hon. Members for Wokingham (Clive Jones) and for City of Durham (Mary Kelly Foy) for calling attention to this disease, and I thank the hon. Member for West Lancashire (Ashley Dalton) for her spirit and courage; it always touches me and makes me quite proud of her. I wanted to put that on the record.
The hon. Member for Fermanagh and South Tyrone (Pat Cullen), some local ladies, Tristan Loraine and I had a meeting with Health Minister Mike Nesbitt in Northern Ireland some four or five weeks ago to discuss the issue of lobular cancer. It was an important meeting because those ladies around the table were ladies like the hon. Lady for West Lancashire; they were ladies who had cancer, were living with it and were trying to deal with it. Their personal stories really touched me because almost every one of those ladies had children. One lady had four young children, and I was moved by her contribution and very touched by the life that she was leading with four young children.
Each month in the UK, around 1,000 people die from secondary breast cancer, which equates to one life every 45 minutes. That stat paints a harrowing picture of the devastating impact that secondary breast cancer has on many individuals and their families. Although the cancer is not curable, as it has metastasised, it is treatable and can often be managed. On average, patients can survive two or three years or more after diagnosis. Symptoms can be relieved, and patients’ quality of life can be maintained, with many leading a “normal life”.
In 2024, secondary breast cancer was deemed “moderately severe”, meaning that funding would not be granted in Wales, England and Northern Ireland. My request is that we have access to the licensed Enhertu drug, which is used to slow the cancer’s progression and maintain quality of life for patients. It is incredibly difficult to justify a system in which patients in Scotland and more than 20 other European countries can access this treatment, while eligible patients in England, Wales and Northern Ireland cannot. It just does not make sense. Mental health support should also be invested in across the United Kingdom to ensure that patients and their families receive emotional support to help them cope.
Despite secondary breast cancer being the leading cause of death for women under 60 in the United Kingdom of Great Britain and Northern Ireland, over 40% of British adults have not heard of the disease. There is a lack of awareness. It was quite amazing to know that some of the ladies I met that day with the Minister in Northern Ireland thought that they were cured but found out that they were not, because the full diagnosis had not been done. The hon. Member for Horsham (John Milne) is very knowledgeable about the Lobular Moon Shot Project; he spoke about how more needs to be done, and I want to speak about that as well. It is estimated that some 36% of people cannot name any signs or symptoms of the cancer.
Those figures show that there is much work to be done to ensure that individuals are informed, and that they rapidly access treatment as a result of early diagnosis. We can, however, inform the public only of what we know. Advancements must be made to invest in further research to deepen healthcare professionals’ understanding of the disease and change its prognosis from being a death sentence. Charities such as Breast Cancer Now have already awarded some £300,000 to researchers at Queen’s University Belfast to support an investigation into the inequalities among people living with this disease.
I am very pleased to see the Minister in her place. She encourages us with her interest and compassion for this subject, and I know that she will give us some idea of what has been done at Queen’s University Belfast and the trials that are taking place. We are not that far from finding the cure, and from raising awareness to the level it should be at to save lives and give people hope for the future, long beyond the times that have been allocated. Has the Minister’s Department had an opportunity to talk to Queen’s University Belfast to see what it is doing? Has she had a chance to talk to Mike Nesbitt, the Minister of Health in the Northern Ireland Assembly, to support the investigation into the inequalities among people living with this disease?
The study will consider factors including education, income, disability and mental health—we always say this, because it is the truth: it is not just the ladies who suffer; the families, the children and their in-laws suffer too, because they are all very aware of what is happening—to determine how inequalities influence patients’ access to care, their treatment outcomes and their overall quality of life. Would the Government consider supporting this research at Queen’s University Belfast so that everyone living with the disease across the United Kingdom is given a fair chance to access effective care?
Speaking as my party’s health spokesperson and as a representative from Northern Ireland, I draw attention to the long wait times for cancer referrals in comparison with the rest of the United Kingdom. From July to September 2025, urgent breast cancer referrals in particular saw long delays, with just 6.8% seen within the 14-day target. Over the same time, the Health and Social Care Trust received more than 6,000 referrals for suspected breast cancer, 86% of which were marked as urgent—86%, and no response. With approximately 1,000 living with the disease in Northern Ireland, I must draw attention to the increased risk of women in Northern Ireland experiencing delays in diagnosis and access to treatment.
Cancer treatment should not be a postcode lottery. Advances in treatment mean that more people can now live longer and maintain a good quality of life with secondary breast cancer. While the disease remains incurable, everyone across the United Kingdom of Great Britain and Northern Ireland should have equal access to the treatment and support that they need. I join Members—those who have spoken and those who will speak shortly—in looking to the Minister and simply asking for more: more screening, more funding and more saving of lives.
Compassionate Use Medicine Schemes: VAT
Jim Shannon Excerpts(4 months, 1 week ago)
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Karin Smyth
The hon. Gentleman’s last comment reveals exactly why he is raising this issue.
Jim Shannon (Strangford) (DUP)
Hon. Members have raised concerns for compassionate reasons and on behalf of their constituents who feel the pain. Compassionate access schemes are a critical lifeline for terminally ill patients, often stepping in when the NHS has exhausted all standard funding avenues. Any move by HMRC to levy, to barter or to impose deemed supply VAT on free clinical treatment places an unacceptable risk on voluntary patient provision. I say this kindly, but will the Minister ensure that the Treasury works collaboratively with the devolved health Executive to create a permanent and water-tight VAT exemption, so that no patient, regardless of their postcode, is left behind and compassion is a UK-wide attribute, not a postcode lottery?
Karin Smyth
The hon. Gentleman works very hard in this area. He is right to use the word “compassion”, because that is exactly how we must approach the issue for patients who have an unmet clinical need and are desperate for innovation. That is why we are putting our collaboration and work with the life sciences sector front and centre and working closely with HMRC. My hon. Friend the Exchequer Secretary to the Treasury is on the Treasury Bench listening attentively to the issues and we will continue to work together. They are long-standing rules. As the hon. Gentleman would acknowledge, we have made huge progress in this area for patients in this category, particularly with our revision of the National Institute for Health and Care Excellence threshold, and we will continue to do so, on behalf of the patients we all want to help.
Maternity Nurses, Nannies and the Infant Sleep Industry
Jim Shannon Excerpts(4 months, 1 week ago)
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Mr Connor Rand (Altrincham and Sale West) (Lab)
Being a parent is the one of the greatest joys we can have in life, but let me be clear, it is also one of the hardest things we ever do. I remember the first year of my son’s life and the happiness those precious early moments brought me and my partner, but I also remember the less precious moments, with the daily battle every new parent has with their own anxieties as they ask themselves, “Why are they crying? Why are not they sleeping? Am I doing something wrong?” Those questions swirl around our heads at a time when we are sleep deprived, emotionally drained and totally unsure of ourselves—in other words, we are vulnerable.
What do we do in that situation? We seek out help, expertise and people we think we can trust. In the majority of circumstances, that is absolutely the right thing to do—health visitors and the vast majority of nannies who provide responsible care give parents vital support that helps them get by—but what if, when we turned for help, the person who responded was not someone we could trust? What if they were not the expert they claimed or seemed to be? What if they had no qualifications, no training and no accountability? When that happens, we run the risk of unimaginable tragedy.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for bringing forward this really good debate; I spoke to him about it last week. He will be aware that, as it stands today across the United Kingdom of Great Britain and Northern Ireland, anyone can buy a website domain, call themselves an infant sleep expert or a maternity nurse and charge vulnerable, sleep-deprived parents hundreds of pounds for unregulated, untested and potentially unsafe advice. Does he agree that sleep-deprived and vulnerable parents need to have security that the advice they are taking comes from a solid foundation, and that qualifications—or lack of qualifications—must be clear when advice is offered?
Mr Rand
I thank the hon. Member. The vulnerability that parents feel in that moment is one of the reasons why it is so important that we ensure adequate regulation in this area. At the moment, we run the risk of unimaginable tragedies day after day, and it is happening more and more as the support we used to provide for new parents has shrunk. In the gaps that has created, the infant sleep industry has boomed. The industry is currently a wild west where, as the hon. Member said, anyone can pose as an expert and give parents advice that puts their child’s life at risk. Sometimes, these people call themselves maternity nurses, practitioners or consultants. Sometimes they call themselves sleep trainers or specialists. Sometimes they provide care in the home. Sometimes they share their advice to vast and growing audiences on social media. In all cases, there is no requirement for them to have any medical training or qualifications to justify their title. In addition, there is also no legal accountability for advice provided and no recognised standard for support provided.