Adult Autism Strategy

Debate between Jim Shannon and Kate Green

Wednesday 5th March 2014 Westminster Hall

[Jim Shannon]

I thank my hon. Friend and colleague for clearly setting out the issue for the bodies responsible for helping parents. The parents I mentioned came to me about parenting skills, and they got the help, by the way, which was good. They told me what a blessing these classes were. That is why I am happy to stand with my colleagues today and highlight the needs of sufferers of autism and their families.

I am familiar with the care of one autistic young man. Many hon. and right hon. Members here have personal knowledge of such situations, and I hope that some of them will have a chance to contribute to this debate. That young man’s parents do everything for him: they dress him, cook for and feed him, clean, bathe and toilet him, amuse him, and hug, kiss and love him. He depends on his parents entirely for his every need. When he is at his day classes, they do the washing, ironing, cleaning, and shopping and try to find time to work to pay the bills at the same time.

The pressure on the parents and on the family unit is greater because of the problems and behavioural issues related to the autism of their child. They love their son—that is never in dispute—but love is not enough to get the family through the sheer exhaustion and the emotional and mental strain. Sometimes help is needed on matters outside of parental skills—through social services, for example, giving a bit of respite. Difficulties in the benefits system are practical issues for parents and those with adult autism; they relate to how parents can help their child through the school years and into the early years of adult life. It is up to the community and us as elected representatives to step up to the plate and help that boy and his parents. We can do that by supporting them and offering them the best that our society can do to ensure that they do not reach the point of no return.

We can all relate to the story of Susan Boyle, who has Asperger’s syndrome, which is also autism. She found out that she had it later in life. After she was diagnosed, she said that she almost felt relieved to know, after all those years, what was wrong and why she was different. That is a practical example of how someone the nation knows has been affected. She said what she said because she felt it was important that other people knew that autism cannot and will not hold people back, but they need help to get along. That is the thrust of this debate.

[Kate Green]

Does the hon. Gentleman agree that we need to raise awareness across society of the circumstances of adults with autism? For example, a young man in my constituency, looked after by his parents in the way that the hon. Gentleman describes, got severely into debt because he did not understand what financial services companies were saying when they were pushing credit cards and loans on him. Does he agree that educating the business community, neighbours and community groups, and everyone in society, about how adults with autism respond and cope would protect people and prevent those things from happening?

[Jim Shannon]

I thank the hon. Lady for her valuable contribution. Yes, I agree; I think all hon. and right hon. Members would. Churches have intervened to help in a number of complex cases in my constituency. What is not complex for us is complex for people with autism. There is a clear role to be played in that regard. Only 15% of adults with autism are in full-time employment; again, that results from some of the issues that they suffer from, including epilepsy, sleep disturbance and mental health problems. Many out there are trying to help and assist.

I ought to give a Northern Ireland perspective, because we have done good, helpful work there, health being a devolved matter. The Minister is aware of that good work because he has visited a number of times. Perhaps he might comment on that in his response.

The Northern Ireland Assembly put in place the Autism Act (Northern Ireland) 2011, which is the most comprehensive autism and single disability legislation in the whole of Europe. The need to do something was recognised at an early stage, as was the fact that the power was there to do it within the devolved Administration, and that was done. It is the first legislation in Northern Ireland requiring by law all Departments to plan and work together on the delivery of the strategy. The cross-governmental attitude that the right hon. Member for Chesham and Amersham requested is there. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Stretford and Urmston (Kate Green), who both intervened on me, have confirmed that that should happen. Departments worked together on the delivery of a strategy. No cross-Department barriers are allowed at all. When we say “comprehensive”, we mean it. I am delighted that the debate is calling for such a strategy.

Autism Northern Ireland was at the centre of the campaign for the Autism Act (Northern Ireland) with its grass-roots campaign. There was no money or external lobby company—just hard work, and determination to make it happen and to gain support from all parties, which was forthcoming. It had autism ambassadors—health and education party spokespersons—to build up expertise on issues of concern. It also formed a partnership with Autism Cymru, which was already working with the Welsh Government on implementing a Wales autism strategy. That was the foundation of the Celtic Nations Autism Partnership—Celtic as in “keltic”, and certainly not “seltic”. No offence to any Celtic supporters who might be here, of course. That is a partnership with the autism societies of Scotland and the Republic of Ireland, which has led to initiatives in the USA. The CNAP and Members of the Legislative Assembly visited the US Congress and the European Parliament.

When we say that the approach is comprehensive, we are talking about looking across Europe and the world; examples were considered and discussions took place. That led to the Autism Act (Northern Ireland). A partnership was initiated with Autism-Europe and MEPs to develop a comprehensive and well-thought-out European autism strategy.

In 2012, I highlighted the difference between the Autism Act (Northern Ireland) and the English Autism Act 2009: the Northern Ireland Act is equality-driven and lifelong-focused. Perhaps the Minister will indicate whether the Government are trying to achieve in England the equality and lifelong focus that we have in Northern Ireland through the Autism Act (Northern Ireland) 2011. That Act amends our disability discrimination legislation, too, to include those with social communication disabilities such as autism. That supersedes the Great Britain Equality Acts, which only give recognition and guidance in primary legislation. That is significantly different from how we did it back home, where we have attempted to address adult autism.

I again thank the right hon. Member for Chesham and Amersham for securing the debate. She, like me and everyone else in the Chamber, sees the gaps in the strategy and the need to enhance provision by including an adult strategy. I have raised today the cases of a young girl and a young adult male. The strain on families grows greater with time as the child becomes an adult and more difficult to handle. The legislation should be amended to provide more state help.

Organ Transplants

Debate between Jim Shannon and Kate Green

Wednesday 17th July 2013 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

Last week was national transplant week, and the NHS highlighted an important campaign to increase organ donation. Donor rates have, pleasingly, increased by 50% since 2008, but although almost every one of us would accept a donated organ if we needed a transplant, only 57% of relatives agree to organs being retrieved. However, that proportion rockets to 95% if the deceased has discussed his or her wishes in advance with family members. Some 19.7 million of us are on the organ donor register, but three people still die each day while waiting for a transplant, so I wholeheartedly support the efforts of NHS Blood and Transplant to increase the number of organs donated. I add my voice to those who advocate an opt-out scheme.

Having met and talked to transplant survivors, I can testify to the immense gratitude that they feel to donors who have literally given them a new lease of life, but donation is only half the story. Although the selection and allocation of organs for transplant is much less widely discussed, it is also a complex and controversial issue.

A few weeks ago, I met my constituent, 18-year-old Natalie McCusker, who had been on the waiting list for a lung transplant for 19 months. She described to me what it is like to live in a state of limbo waiting for a suitable transplant. She has been too unwell to go to school, although her school arranged for her to participate in classes via Skype. She wanted to study sciences, but could not because oxygen cylinders and science experiments do not mix. As a young girl, she had enjoyed and been very good at sport, but that has become impossible since she became too ill. The effects on her family have also been profound; for example, her mum has taken a five-year career break.

Natalie was first told that she would need a transplant when she was 15. She initially hoped it would be carried out at Great Ormond Street children’s hospital, but people transfer to the adult register at the age of 16, so she was advised to delay transplant surgery until she moved to the adult list.

When Natalie first moved on to the adult system, she was able to access treatments that are deemed unsuitable for children. At first her condition improved, but seven weeks after taking her GCSEs, she became much more unwell. She was eventually listed for a transplant in November 2011. I completely accept that there are different clinical demands when treating children and adults, and that there is a need for separate systems. However, from the patient’s point of view, it seems that the transition may lengthen waiting times, and it also means that a new relationship of trust and confidence must be built up between the patient and new teams of clinicians.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the hon. Lady for bringing the matter to the House. I have a particular interest in organ transplants and donation because I have carried a card since I have been able to do so. In Northern Ireland, we carried out about eight transplant operations in 2008, but now in 2013 we carry out more than 50 a year—almost one a week. That has happened not only because those who carry the card pass on their organs when they die, but because we have the largest number of live donors in the whole of the United Kingdom—far above the average for England and Wales. If more effort was made on live donors, it could help to address the problem faced by the hon. Lady’s constituent. The evidence from Northern Ireland indicates that the longer one is on a donor list, the less one’s health deteriorates, so perhaps the Minister will address that point when she responds to the debate.

[Kate Green]

I note with interest what the hon. Gentleman says and I am sure that the Minister will want to respond to that point. Obviously, we would want to explore all methods of increasing the number of donor organs available. We should bear it in mind that one person may donate up to nine organs following their death.

I was talking about the crucial importance of a sense of trust and confidence between patients and clinicians. For a course of treatment as massive and life-changing as transplant surgery, that is certainly no trivial matter. I cannot suggest any easy answer to that, but my first point to the Minister is to ask her to consider ways in which the disruption of the transition process between childhood treatment and the adult list could be minimised, with a particular interest in ensuring that waiting times are not extended unnecessarily.

There are other concerns relating to the allocation of organs for those on the waiting list. The current process for allocating hearts and lungs for transplant is based on dividing the country into a number of zones. That means that if someone lives in one zone and a suitable organ becomes available in another, they might not receive it simply because they are on the wrong waiting list. In following a rigid zonal approach, important considerations of equity across the country could be neglected. A patient can be registered on only one list, and the result can be a postcode lottery for treatment.

Patients in my region, the north-west—it is your region, too, Mr Deputy Speaker—wait the longest in the country for lung transplants: over 400 days in Manchester, compared with under 200 in Cambridge. According to a written answer I received from the Minister on 15 May, between April 2008 and March 2011 62.2% of patients in the north-west waited more than six months for a lung transplant, compared with an England average of 47.3%, and 23.2% of patients in the north-west waited more than 18 months for such a transplant, compared with an England average of 15.8%. The north-west also has among the highest death rates for those on the waiting list for a lung transplant—between 20% and 30%.

I believe that we need to look again at the operation of the zonal system so as to get the balance right between the underlying issues of urgency, geographical proximity between donors and recipients, and waiting times. The most urgent cases should clearly take priority. One approach could be to treat urgent cases on a national basis and, if no urgent case exists, to allocate on a zonal basis. If that approach were adopted, zones would need to be more dynamic. In other words, if the waiting list grew the zone would also expand to give access to more organs.

More radically, we could move to a fully national allocation system, whereby patients could be matched with suitable organs across the country. I recognise that geographical considerations are of course important, not least if the ischemia time, the time between organ retrieval and transplant, is integral to the success of the operation. For heart transplants, in particular, it very often is, and the system for heart transplants in fact appears to work effectively. That seems to be much less true for lung transplants. Equity is also a consideration. It is of course important to have regard to the interests of those who have been on the waiting list the longest, and that really should not be dependent on where someone lives and which list they are on.

I understand that the NHS is now considering whether to move to a national registration system, which would be fairer to patients in regions such as ours. In the US and much of Europe this approach has already been adopted or is being considered. The evidence suggests that it could achieve greater equity without any increase in mortality rates, or indeed cost.

So what is the block? Inertia and convenience undoubtedly play a part. I acknowledge that there is already better sharing of organs between zones when a suitable match cannot be achieved within a zone, but it seems that some transplant centres might be more interested in building up the scale of their own activities rather than progressing the idea of a national scheme that could deliver greater equity for all patients. Progress towards delivering a national list scheme in this country is proving painfully slow.

What steps are being taken to make progress towards a more equitable national scheme of allocation, and what is the Minister’s attitude to the development of such a scheme? What work, if any, is being done to develop a national approach, and over what time scale might progress be expected? How best can we make use of technology and the sharing of data to facilitate the allocation of organs between zones? What learning and best practice can be adopted from other countries? What incentives would encourage a more equitable system of allocation between transplant centres and protect or improve outcomes for patients?

I am very pleased to report that Natalie had a successful lung transplant two weeks ago. She is growing stronger every day and it is hoped that she will be well enough to return home next week. She and her family are of course absolutely delighted and hugely appreciative of the treatment she received from the transplant team at Wythenshawe hospital. However, for 19 months, while waiting for her transplant, her life was put on hold. Perhaps that wait could have been shorter if she had not been restricted to a single zonal waiting list. Yesterday she wrote to me to say how pleased she is that this debate is taking place in Parliament, which she says she hopes will help “to achieve something that will in future benefit the thousands of people that will need life saving transplants.”

I hope that the Minister will be prepared to commit tonight to working towards a national system of organ allocation that offers equity of access to organs for transplantation and rapid progress towards achieving this. I am very grateful for the opportunity to raise this matter and look forward to her response.

Marriage (Same Sex Couples) Bill

Debate between Jim Shannon and Kate Green

Tuesday 21st May 2013 Commons Chamber

[Kate Green]

I am disappointed in that question. Secular and humanist are not the same. I am not a humanist. I would want a purely secular ceremony were I to be marrying, but others want a ceremony that reflects their beliefs. Humanism is recognised as a strand of belief. A ceremony to accommodate that deep-held feeling has to be organised and provided if we are to meet the legitimate desires of our humanist friends and neighbours.

[Jim Shannon (Strangford) (DUP)]

The hon. Lady will be well aware of my opinions and views on this matter. In Committee evidence, there was among the Churches and other religious organisations an overwhelming majority opposed to humanist weddings. Is she saying we should ignore that vast strand of public opinion—the many millions of people who oppose this—in favour of a small minority?

[Kate Green]

With the greatest respect, I do not think the hon. Gentleman has any evidence whatever that millions of people are opposed to this proposal.

[Jim Shannon]

Will the hon. Lady give way?

[Kate Green]

No, not until I have dealt with the question fully. I do not believe the hon. Gentleman has evidence of millions of Church members opposing this proposal. I fully accept that there is quite likely to be a lack of enthusiasm among those at the top of the Church hierarchy, but I would not necessarily take even that for granted in all cases. Many people, including people of faith, attend humanist weddings, and value and celebrate their participation in them, either as family or friends.

Induced Abortion

Debate between Jim Shannon and Kate Green

Wednesday 31st October 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Mid Bedfordshire (Nadine Dorries) on securing the debate. I am pleased to speak in this debate, and my position will become very clear. I believe in human rights. I believe in the most basic of human rights, the right to life, so I am against abortion. I believe that the strong have a duty to protect the weak and the vulnerable. It is that protection that I seek to uphold, and that is why I am here to speak on this matter.

I begin by stating clearly that I am against abortion, except in the extreme case in which it is done to save the life of the mother. Statistics show that Northern Ireland, which has a restrictive abortion law, has the lowest maternal death rate in the whole of the United Kingdom. That is backed up by the fact that the Republic of Ireland has almost the lowest maternal death rate in Europe, and has no legislation that allows abortion. The UK mainland, with its more liberal abortion law, has a higher rate of maternal deaths. That speaks volumes, and it is clear that restricted abortion to save the mother’s life, which we have in Northern Ireland, works well to save both mother and child.

If there was the option of bringing in Northern Ireland’s abortion laws, I would be pleading with everyone in this House to do just that. I have been contacted by the Christian Medical Fellowship, which states things clearly. Today’s debate is calling for a small reduction in the upper time limit for legal abortions. That will affect approximately 2,000 abortions that are carried out for social reasons—I use the phrase “social reasons”, because that is why they are happening—out of a total of nearly 200,000 abortions per year. It will not prevent the abortion of babies with foetal abnormality up to term.

This issue is emotive. A large number of people have contacted me and asked me to watch the scans of a 20-week-old baby to remind me of the humanity behind our decisions. When I look at a baby at 20 weeks’ gestation sucking its thumb, having the hiccups, crying and blinking, it is beyond me how anyone in good conscience, in this House or outside, could say that it is fine to rip away life at this stage. It is not fine. It is never going to be fine. A 2008 study by University college London found that survival rates were more than 70% for babies born between 22 and 25 weeks when high-quality care was available.

[Kate Green]

It is really important that we are accurate about these figures. At 24 and 25 weeks, survival rates improve a lot, but at 20 to 24 weeks, survival rates are very low: zero at 20 weeks; 1% at 22 weeks; and 11% at 23 weeks. It is wrong to imply that at under 24 weeks, we have survival rates of 75%.

[Jim Shannon]

I thank the hon. Lady for her intervention, but life is life as far as I am concerned; that is where I am coming from.

The survival of more than 70% of babies born between 22 and 25 weeks when high-quality care is available blows away the argument that a baby can be aborted until it is viable at 24 weeks. Recently, in America, a baby of 21 weeks responded to stimulus, crying and smiling, so there is evidence that shows clearly that it can happen. All the things that we associate with life are in evidence before the time of so-called viability.

I will give the example of a young girl from my constituency. A friend of mine had a grandchild who, they were warned, would not survive as she was so premature. The family prayed hard, and asked for all possible treatment to sustain the baby’s life. Today, Zoe-Lee is 13 years of age and is the light of her parents’ life. It is scary to think that if an abortion had been allowed at that time, that young girl would not be here today.

The question that has been posed to me by members of the medical fraternity is: how much longer can we justify doctors desperately—the hon. Member for Mid Bedfordshire referred to this as well—trying to save premature babies born at 23 weeks, while down the corridor in the same hospital, another doctor is aborting a 23-week baby, which is perfectly healthy, for social reasons?

A 24-week upper limit in the UK is outdated and out of line with other EU countries. In 2008, our 24-week upper limit was double the 12-week limit for most EU countries. Some 16 out of 27 other European countries had a gestational limit of 12 weeks or less, so if we want to be in line with other countries that have high standards, then let us do that.

Ask any woman who has miscarried a baby in early term—at, say, at 12 weeks—and she will tell you that she saw its perfectly formed fingers and toes, its spine and head, and that wee face. For me, it is almost unimaginable to take it from the womb at this stage, never mind any later, and to ask any general practitioner to do this is grossly unfair. I am no man’s judge, and I feel for those women who have felt that they had no other option than to take this step.

Rickets

Debate between Jim Shannon and Kate Green

Tuesday 4th September 2012 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

I am very pleased to have been given the opportunity of and time for this debate and to introduce it with you in the Chair, Mr Hollobone. I start by acknowledging two Manchester GPs, Dr Hans-Christian Raabe and Dr Avril Danczak, who came to see me some months ago to draw my attention to the shocking rise in the incidence of rickets in this country over the past 15 years. A written answer that I received on 9 November 2011 contained figures showing that the number of reported cases of rickets had risen from 183 in 1995-96 to 762 in 2010-11. Earlier this year, it was reported that the chief medical officers of the UK had contacted health professionals to highlight the need for vitamin D supplements for at-risk groups. Therefore, the issue is clearly one of concern. I welcome the steps that the Government have taken so far to deal with it, but more needs to be done.

Rickets is a disease that affects the growing of bone in children and is associated with moderate vitamin D insufficiency. It is mainly characterised by deformed bones, bone pain, convulsions and delayed development, particularly in relation to height rather than weight. Current Government guidance is that most people can get all the vitamin D that they need by eating a healthy balanced diet and getting some sun. However, it is not at all clear that that advice is adequate. The national diet and nutrition survey found that 90% of people in the UK do not get enough vitamin D from their diets, and there is widespread confusion in the public mind about what constitutes an appropriate amount of exposure to sunshine.

Certain groups have particularly high levels of vitamin D deficiency. They include pregnant and breastfeeding women and their babies, young children, elderly people, those who are not exposed to much sun—perhaps because they cannot get out of the house or because they cover up their skin for cultural reasons—and people with darker skin pigmentations, such as those of African, African-Caribbean or Asian origin. Levels of air pollution may also have an impact on sunshine exposure levels, and there is certainly a gradient of rising incidence of vitamin D deficiency as we move north across the UK, so it is clearly a concern in the north-west region, where my constituency is located. When one member of a family has a vitamin D deficiency, it is also likely to be replicated among siblings and children.

It is therefore clear that steps need to be taken to deal with vitamin D deficiency in quite large sections of the population. I am pleased that the Scientific Advisory Committee on Nutrition is examining the issue, but it is not due to report until 2014, and it is likely that any recommendations made by the committee could take time to implement in any event. However, there are things that can and should be done now, not least in terms of informing and educating the public and health professionals.

A recent study by the clinical effectiveness unit at Stockport NHS Foundation Trust highlighted a quite surprising lack of awareness among health professionals about vitamin D. That study, across eight acute and six primary care trusts in the north-west, found quite poor knowledge among midwives and health visitors surveyed. Only 24% of health visitors and just 11% of midwives reported having had training in vitamin D supplementation. As a result, they felt less confident in discussing vitamin D with pregnant women and mothers, vitamin D was poorly promoted at the booking of appointments and 90% of the women were not provided with information about vitamin D. However, the study found that where trusts had good policies or expert personnel in place, staff reported greater confidence in discussing vitamin D and more women received verbal and written advice.

Last year, my hon. Friend the Member for Bolton South East (Yasmin Qureshi) hosted an event in Parliament, in conjunction with the Proprietary Association of Great Britain—the UK trade association for manufacturers of over-the-counter medicines and food supplements—at which it was suggested that doctors, nurses and pharmacists receive very little nutritional training at undergraduate level and that there is no obligation for health professionals to undertake such training once in practice. Therefore, I would like first to ask the Minister to comment on the steps that the Government are taking or planning to improve training, awareness and knowledge among health care professionals. I would also like to ask what steps are being taken to raise awareness among the wider pool of professionals working with families and children, and what discussions the Minister and colleagues in the Department may have had with Ministers in the Department for Education to ensure that staff in schools, Sure Start workers, child care professionals and so on are aware of the importance of vitamin D.

There are also concerns about financial incentives. I have looked at the quality and outcomes framework for GPs, and there is a lack of a clear financial incentive for GPs to address their patients’ nutritional needs. Will the Minister say what steps are being taken to develop the quality and outcomes framework to focus more GP attention on nutrition and vitamin D intake, and how she expects that that framework will be kept under review?

I come now to the question of vitamin supplements, which the Department of Health recommends for at-risk groups—the groups I mentioned in my opening remarks—and which are available free of charge to certain low-income families via the Healthy Start programme. However, that targeted approach has resulted in only very limited uptake, which unpublished PCT data suggest could be as low as 2% to 4%. Clearly, many at-risk families are missing out on the recommended vitamin D supplements; and although some families may obtain supplements, from over-the-counter sources, that can be expensive and the dosage may be inappropriate. I would be interested in the Government’s attitude to allowing food supplement manufacturers greater freedom to develop and market a wider range of vitamin D products, targeted at different population groups. I would also welcome the Minister’s view on how the European Food Safety Authority might make it easier for manufacturers to make legitimate claims about the role of vitamin D in good bone health.

I particularly hope that the Minister will consider a report published online, on 21 August, by the British Medical Journal that considers an initiative by the Heart of Birmingham PCT to provide universal vitamin D supplementation to all children from the age of two weeks to five years and to all pregnant and breastfeeding women. That provision of supplements was supported by a programme of continuing professional education of health staff, including GPs, health visitors, midwives, pharmacists, paediatricians and obstetricians and by a public communications campaign. In that initiative, uptake of vitamin D supplements rose year on year to reach 17% among children and pregnant women. That was still low, but considerably higher than the 2% to 4% achieved under Healthy Start. Public awareness of vitamin D also rose from just over 60% to nearly 90%, and a 59% fall was recorded in the number of cases of vitamin D deficiency.

Clearly, there are some important lessons to be learned from the Birmingham initiative. Although some problems were experienced with distribution through the NHS supply chain, limited opening hours at pharmacies and so on, and with the availability of trained staff, the initiative was very successful overall in reaching a considerable number of families who might be at particular risk of vitamin D deficiency by virtue of ethnicity, skin pigmentation or lifestyle, but would not be eligible for free supplements.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall today. I am of an age group, and others in the House may be of a similar age, that can remember that when we went out to play at school lunchtime, the milk was on the table when we came in. Is there a role for the Department of Health in the education of children to ensure that children’s health is better monitored and supervised?

[Kate Green]

I absolutely agree with the hon. Gentleman. Health professionals, and other professionals from across different disciplines, have pointed to the absence of a holistic approach that draws different practitioners and professionals together to ensure that the message is promoted and the education of children and families is pursued coherently.

The absence of trained staff was certainly seen as a factor that limited the effectiveness of the Birmingham initiative, but overall it was very successful in improving vitamin D uptake in families who would have been at risk. I am keen to invite the Minister to look carefully at the Birmingham experience. Is she willing to analyse the costs and benefits of a universal approach based on the study’s findings?

On food fortification, relatively few foods are naturally rich in vitamin D, and consumption of many of those that are, such as full-fat dairy products, eggs and oily fish, has fallen in recent years. Yet in the UK, we fortify relatively few foods, such as margarine, some processed cheeses and breakfast cereals. We do not fortify milk, which has been fortified in Canada and the US for many years. Finland, Jordan and the Irish Republic have all taken recent steps to introduce food fortification. Will the Minister indicate the Government’s attitude to statutory food fortification? There seems to be scope for a more robust approach. Can she confirm whether the work of the Scientific Advisory Committee on Nutrition will look at the experience of other countries? Will the committee’s report reflect an analysis of the effectiveness of food fortification measures in those countries?

Finally, there appears to be scope to make greater use of the public health outcomes framework, to focus attention on vitamin D. I looked at the framework, and, with the exception of some quite vague indicators on diet and hip fractures, there appears to be nothing specific to highlight the need for action to tackle vitamin D deficiency and its consequences, including the risk of rickets. I welcome the Government’s focus on public health, but we must ensure that the framework and the new health structures being put in place more widely achieve the best possible outcomes.

This is a crucial and, I have to say, challenging time of transition. We are settling into the new public health infrastructure against a backdrop of far-reaching changes in the NHS more widely. Although I appreciate that the public health outcomes framework will be kept under regular review, I would like very specific and early attention to be given to the issue in the framework and by the new health and wellbeing boards. I would welcome the Minister’s comments on that.

[Jim Shannon]

I thank the hon. Lady for giving way again. She is being very gracious. Is she aware of the statistics and figures that show a greater problem in the United Kingdom—England, Wales, Scotland and Northern Ireland—with not only rickets, but osteoporosis, from the lack of vitamin D? Is there a need not only for a pilot programme, such as the one she mentioned in Birmingham, but for a programme for the whole UK, working with all the regions?

[Kate Green]

The hon. Gentleman is quite right. The impact of vitamin D deficiency is felt in not only rickets and diseases in children, but osteoporosis and other diseases. Vitamin D deficiency inhibits the absorption of calcium, for example, which is important for bone health and growth.

Professionals have identified the lack of joined-up advice—for example, telling a woman recovering from a cancer operation and having chemotherapy that there could be an impact on her bone health and the steps that she could take to address it. It is right that professionals have expressed an interest in the development of a strategic approach, both geographically and across health conditions. Perhaps the Minister will comment on how the Government might react to that.

Rickets is a largely preventable disease that many of us thought had been left firmly in the past. Its resurgence is not in question, yet the distress and pain it causes are preventable, and we know what steps we need to take. What is more, the solutions are mainly systemic—within the control of public policy and health care practice. Although I acknowledge that some gaps in the evidence remain, the importance of vitamin D for at-risk groups—children, pregnant women and mothers—has been understood for many decades, as has the need for effective supplementation where intake is inadequate. There is therefore no need to delay working on and developing appropriate systems and a programme of public and professional education to maximise vitamin D intake. I hope that today’s debate raises public and professional awareness of the issue.

Disability Hate Crime

Debate between Jim Shannon and Kate Green

Wednesday 23rd November 2011 Westminster Hall

[Kate Green]

That is an important point and I am sure that it is one that the police will also take note of. Too often there is an attitude that nothing can be done because the victim is disabled and there is scepticism about what disabled victims say. One shocking case, quoted in Katharine Quarmby’s book “Scapegoat”, was that of a blind woman who had been sexually assaulted, but the response of the police was that it was not possible to proceed with the case because, of course, she had not seen her attacker.

In its report, “Hidden in plain sight”, the EHRC has proposed a number of important measures to help to improve the situation. First, there must be leadership and ownership of the issue across all public bodies. This is not an issue simply for one arm of government. It cuts across central Government Departments, local government, the criminal justice system, the education system, health, housing, care, transport, employment and so on. Therefore, a signal from the Minister today of the seriousness with which the Government regard the issue will be important. However, warm words will not be enough. Disabled people want to know how Ministers will ensure that the issue remains a priority for ministerial attention across Government; what structures exist within Whitehall to focus attention and drive action; what accountability mechanisms will be put in place; how public institutions that fail to take action will be compelled to do so; and how Ministers will work with local government to ensure ownership of the issue at local level.

Secondly, such an approach must be informed and supported by the systematic gathering and monitoring of data that spell out the scale and severity of the problem, and by analysis of that data to support and direct policy makers’ attention to where action is needed. We know that there is significant under-reporting of harassment and abuse of disabled people, and there is a need to improve the recording and reporting of disability hate crime.

Radar has responded to that problem through its “Stop Disability Hate Crime” project, which is working with disabled people’s organisations and the authorities to develop a national independent disability hate crime reporting centre, which will provide minimum standards for other such centres, and raise awareness of disability hate crime and incidents and how to report them. The project also maps the disability hate crime third-party reporting sites that already exist or are being established. Also, a survey has been undertaken to find out why disabled people do not want to report disability hate crime and what would make them more confident to do so.

The Radar project is an important initiative and I hope that the Government will look carefully at the lessons that emerge from it, and at ways of strengthening the capacity of third-party hate crime reporting centres as a valuable way of increasing the incidence of reporting. Of course, it will be important that such centres follow minimum standards, but I know that all right hon. and hon. Members will welcome Radar’s work in that area and look forward to its report, which is due to be published early next year.

Thirdly, practice at the front line is, of course, vital to ensure that action is taken swiftly to respond to and prevent harassment or criminal attacks on disabled people. That requires the engagement, attention and effort of a range of public institutions. Crucially, those public institutions must work in partnership with each other and with disabled people to develop and to implement the right strategies to tackle disability hate crime. That partnership working can enable early identification of the patterns of behaviour that we have been discussing today, which is essential if problems are not to escalate. Today those patterns are too often missed, or cases are dealt with in isolation. As a result, the response of the authorities can be fragmented, inadequate or too slow.

In its 2009 report on the security of disabled people, the EHRC pointed out that a range of public authorities were not playing any preventive role: housing associations, social care providers, health care providers, the voluntary and community sector and local authorities. Too often, there is an inadequate response to incidents even when they are reported. That must change. Although there has been some progress in the response of the criminal justice agencies, action across the piece is needed and it is in that context that the Government’s action plan will be so important.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate and bringing this matter to the Chamber today. Society is always measured by how it treats those who are less well-off, and that is true of individuals as well as of society as a whole. She has discussed a campaign that she hopes the Government will support. Does she feel that that campaign should not only be an England and Wales campaign but a campaign that goes to Scotland and Northern Ireland, too? If so, perhaps the catalyst to make that happen will come from this Chamber today. I ask the Minister to consider that point too in her response to the debate.

[Kate Green]

That is also an important point, and if there is good practice from which we can learn we will want to learn it in every part of the United Kingdom.

The Government’s action plan will need to include action on developing a better understanding of the motivations of perpetrators of disability hate crime, and of the interventions that are effective in changing such behaviour. It must be a priority to develop appropriate interventions that can be made in schools, which have already been mentioned, in the criminal justice system, through family and community programmes, and in other settings. I hope that the Minister will be able to tell us what analysis and action the Government are considering with regard to those interventions.

The action plan must also address the need for proper training of front-line professionals who may be required to recognise and respond to issues of disability-related harassment. Such training must include training in communication skills and understanding and recognising signals of abuse. I hope that the Minister will be specific today about the steps that the Government are taking to make progress on those matters and I look forward to hearing her response.

Before I conclude, I want to highlight one especially vulnerable group of victims—those people with learning disabilities who have experienced sexual violence or abuse. All too often in those cases, the perpetrator is a partner, a family member or a carer, so the attack is compounded by an abuse of intimacy and a breach of the victim’s trust.

A shockingly high proportion of women with learning disabilities have experienced sexual abuse. The problems that other victims of disability hate crime experience are magnified for these women by their not being believed, by professionals not knowing how to address the issue, and by abuse continuing and escalating over a long period, which happens all too often.

During the summer, I attended a conference with a group of learning disabled women to discuss the measures that are needed to address that form of abuse. The conference was jointly organised by the rape crisis centre in my own borough of Trafford, Salford university and Change, an organisation that is run by and for learning disabled people.

The learning disabled women present at the conference, who themselves were victims of sexual abuse, were absolutely clear about the action that is needed. I should say that they were also prepared to acknowledge that there have been improvements in parts of the criminal justice system, including better awareness among the police, greater understanding of their circumstances and their needs by the Crown Prosecution Service, and greater responsiveness from the courts. However, they also highlighted the need for specialist advice and support to be much more widely available. They spoke about a lack of access to health services and other support services, which happened for a number of reasons: sometimes because of discrimination, sometimes because of a lack of communication skills, and sometimes because they and other learning disabled women were not empowered to express their needs. They repeated that there was a need for training for front-line professionals, which they strongly suggested should be delivered by learning disabled women themselves. They identified an additional barrier that they faced, which was dealing with workers who did not have the confidence to deal with them as learning disabled women.

Women often want to use mainstream services where they can, but feel that the staff are often not equipped to support them. In her role as Minister with responsibility for disabled people, I hope that the hon. Lady takes these points up urgently with colleagues in the relevant Departments, and urges them to engage directly with learning disabled women in formulating Government policy.

I want to put on record my gratitude to the disabled people and their families who have taken the time to describe to me the deeply distressing, shocking and vicious attacks they have experienced, and how the system has sometimes let them down. I also want to thank the families of Keith Philpott and Gary Skelly, members of the Disability Hate Crime Network, Simon Green and Stephen Brookes, and the women I met at Change. Their stories of abuse, violence and in some cases death, have brought home to me that there remains a dark and primitive side to our attitudes to disabled people, which still too often manifests itself in harassment and criminal behaviour that simply cannot be tolerated in any civilised society. I am pleased that we are debating the issue this morning. It must not remain hidden in plain sight.

Disabled Young People (Support)

Debate between Jim Shannon and Kate Green

Wednesday 7th September 2011 Westminster Hall

[Kate Green]

My hon. Friend is absolutely right. As I say, many children’s conditions vary, progress and retreat much more suddenly and rapidly than those of adults. Crucially, children’s educational and social development is also taking place as they grow into young adulthood. If there are concerns about the financial support for children with medical conditions, that will also have wider developmental implications for them.

There is continuing uncertainty about children and young people in residential settings. I am particularly interested in young adults, some of whom are quite likely to want to look at residential colleges for their further education. The Minister wants to remove any duplication in funding in relation to the mobility component that people receive as part of DLA. I would be grateful if she could tell us how she expects to assess whether there is actually any duplication, because I have so far been unable to uncover much evidence of it. What assessment has she made of the implications for young people over the age of 16 in residential colleges, and particularly for their ability to participate as fully as possible in not only educational life but wider social life?

I echo the comments of the hon. Member for Eastbourne on housing benefit. I also want to highlight the concern that constituents have raised with me about the substantial costs of adapting housing and about the implications for them if the housing benefit changes and the housing benefit cap force them to move. It seems quite ridiculous that, as a result of other policies, we should disrupt families who might have had to make substantial investments to adapt their home accommodation. I hope that the Minister will indicate that there will be flexibility in the system to ensure that families of young disabled people, in particular, are not subject to great instability and do not have to move as a result of housing benefit changes. That is particularly important for the young people we are talking about, because such instability disrupts not only their social and educational networks but their medical and care networks in many cases.

[Jim Shannon]

On that point, which the hon. Lady has clearly illustrated, does she feel that the Government need a concerted policy to address housing benefit for young disabled people, considering that 10% of them will be homeless in a short period?

[Kate Green]

Clearly, that is an incredibly serious concern, which the Minister will want to take seriously. Like the hon. Gentleman, I very much look forward to hearing her reply to his suggestion.

I want to say something about employment and education. I echo other hon. Members’ comments about the need to encourage employers to be more willing to take on disabled people and to recognise the extensive capacity that many of them can bring to the workplace. However, I want to raise a few points with the Minister about the education and training environment in which young people prepare for employment.

Following the loss of the education maintenance allowance, what assessment is being made of the extent to which young disabled people in financial need can access other sources of financial support, including those provided by colleges and schools to enable people to continue and complete their education? With the loss of Connexions next year, how will the new predominantly web-based information and advice service for careers be tailored and adapted to meet the needs of young disabled people? How will the structure of integrated budgets, which are meant for young people’s living needs, be protected, so that people are not forced to dip into them to pay for their education, including transport to educational settings, books and equipment? Like other hon. Members, I am interested to hear what further steps the Minister thinks she can take in government to encourage employers to become more willing to employ young disabled people.

I am pleased to have had the opportunity to contribute to the debate. There are many more issues that I would like to raise and which I am sure colleagues would like to raise. I am pleased that the Minister is here to listen to the debate, and I look forward to her response.

Finance Bill

Debate between Jim Shannon and Kate Green

Tuesday 28th June 2011 Commons Chamber

[Kate Green]

Does the hon. Gentleman not accept that the reason why children from married relationships so often do better is that their parents come from higher socio-economic backgrounds, not the fact of marriage itself?

[Jim Shannon]

The evidence from the constituency that I represent would indicate that that is not necessarily the case. Those who are perhaps worse off financially are in stable relationships as well. The reason I am speaking on this issue tonight is that I am reflecting not only my personal views, but—I believe—those of a large majority of the people whom I represent. I am here as the MP for Strangford to put that on the record and ensure that that opinion is well heard this evening. Many people might not like what I have to say, but hon. Members will have to accept that it is my opinion.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Member for his contribution and for providing a bit of focus to this debate.

Given that the agreement pertains to a full Parliament, one ordinarily would not be concerned at the failure to action a commitment in just over a year. What we need is for legislative change to be approved by the coalition Government, to move forward and perhaps see this legislation coming through in two years. The latest publication of the international tax comparison, CARE’s “The Taxation of Families 2009-10” puts things in a very different light. It demonstrates that we are now headed to a place where the tax burden on a married family with children with one earner on an average wage is growing so much that it will soon be more than 50% greater than the OECD average. That breaks new ground, taking us into territory that not even new Labour dreamt of occupying.

Some will no doubt respond by saying that this is a result of the tax burden having to increase on everyone in the context of the debt crisis. I understand that, but it is not exactly the case. Let me quote a director of an influential think-tank, who said:

“Given that it will take some time between changing the law and implementing the actual recognition of marriage in the tax system, it is important that the Government makes this a priority, takes swift action. The change, or at least a recognition of it, should be made”.

I very much hope that that report can be taken seriously, that the Government can look further at the issue and perhaps bring it forward in future legislation.

[Kate Green]

I just want to ask the hon. Gentleman which report he is referring to and which think-tank?

[Jim Shannon]

The think-tank is ResPublica.

As the hon. Member for Gainsborough (Mr Leigh) said earlier, the tax burden on single people with no dependants on the same wage has been falling and far from being 50% above the OECD average, it is now actually below it. That is reflected in the fact that the tax burden on a one-earner married couple on an average wage with two children is projected to rise from 73% to 80% of that of a single person on the same wage by 2012-13, while the equivalent average burden among OECD nations is 52%.

In this context, it is strange that the Government have started investing what will probably end up being almost £12 billion on increasing individual allowances to £10,000. There is a cost factor there and an agreement within the coalition on how that is going to happen. That will cost us all. It is a measure that will have a disproportionately positive effect on single people, yet the Government will not have brought forward a much cheaper transferable allowance policy.

I do not believe that the current situation is sustainable. It is now urgent that the Government introduce legislation to give effect to the transferable allowance. I hope that the Minister will be able to provide robust assurances on this point and a commitment to ensure that as the tax burden increases in the context of the current financial difficulties, it is allocated in a way that is fair, sensitive to family responsibilities and recognises the real strengths that marriage brings to society. I also trust that the Minister will address the important points raised by other hon. Members, including the need urgently to address the IT implications of recognising marriage in the tax system. There are changes to be made, there are costs and a system will need to be set up.

I urge Members to support new clause 5. I believe it is worthy of support. I understand that there are differences of opinion. This is probably the first time that I have disagreed with many colleagues on the Opposition Benches, but I believe in my heart that this is an issue of some importance.