Diabetes: Tailored Prevention Messaging

Paul Girvan Excerpts

Thursday 24th October 2019 Westminster Hall

[Jim Shannon]

I know the Minister will reply to that, because that is one of the questions that I had hoped to get an answer on.

On the Monday before last, we had a diabetes event in the House. Before I came over, some of my constituents said, “Will you go along to this event about diabetes? It is really important, because some great things are being done in some parts of England and we would like to know about them.” When I got there, the people were most helpful and informed me that Northern Ireland has one of the better type 1 diabetes schemes, which is reaching out to 70% of people. As we often do in Northern Ireland, in this case we have a scheme in place that is almost voluntary. We have an un-functioning Assembly, which is disappointing, but we have a system whereby that scheme is working. Some of the things that we are doing, we are doing quite well.

There are 4.7 million people living with diabetes across the UK, each of whom should be treated as an individual. In Northern Ireland, we have 100,000 people with diabetes in that 17-plus bracket, but obviously it is more than that when it is all added up. Every day across the United Kingdom of Great Britain and Northern Ireland, 700 people are diagnosed with diabetes; that is one person every two minutes.

I had a good friend—he is not in this world any more, but that is not because of diabetes—who was a type 1 diabetic. He ate whatever he wanted and I always said to him, “You cannot eat all those things.” He said, “Oh, I can. All I do is take an extra shot of insulin.” I said, “That’s not how it works!” I do not know how many times I told him that. My three hon. Friends—my hon. Friends the Members for East Londonderry (Mr Campbell), for South Antrim (Paul Girvan) and for Upper Bann (David Simpson)—will know who it is, so I will not mention his name. He was very flippant about the control of his diabetes, but it seemed to work for him. I could never get my head around the idea that an extra shot of insulin seemed to cure the problem.

[Paul Girvan (South Antrim) (DUP)]

I thank my hon. Friend for bringing this important debate to the Chamber. My wife is a type 1 diabetic who is insulin-dependent. She has already—she is a bit younger than me—lost a kidney, because of lack of control, which can cause problems. That needs to be identified: control is vital, and it is important for people to monitor regularly. New technology is available that can actually give readings constantly, as people go. It is important that people start to use the available technology, so they do not have to take more insulin than they need, but can take it only when it is needed.

[Jim Shannon]

Like my hon. Friend, my wife is younger than me. It must be a Northern Ireland DUP MP thing—we look for younger wives to keep us young. I am not sure if that is right or wrong, or if it is politically correct to say that, but my wife is nine years younger than me. She understands the issue of me and diabetes.

Some 10% of people with diabetes have type 1 and 90% have type 2. I will refer to both throughout my speech, and I encourage hon. Members to do the same and to acknowledge the different factors at play with each. We can manage type 2 with medication, provided we control what we eat and what we put in our bodies. Of those living with diabetes, we have the broadest cross-section of society. The condition affects all genders, ages, ethnicities and financial situations. However, too often I see that policy makers and clinicians fall into the trap of treating people with type 1 or type 2 diabetes as homogenous groups that will respond to the same approach and message, but they respond in different ways.

During this debate I want to focus on four things: the primary prevention of type 2 diabetes; the need to offer different messaging to ensure that the support is appropriate for each individual living with diabetes; the necessity of preventing the complications of all forms of diabetes; and innovations in technology—there is marvellous technology —and patient pathways that can improve outcomes for people living both type 1 and type 2 diabetes. I wish that I had known 12 months before I was diagnosed that the way I was living—the lifestyle, the stress—was putting me at risk. We all need a bit of stress; it is good and keeps us sharp, but high stress levels with the wrong eating and living habits is harmful. I do not drink fizzy lemonade any more because it was one of the things pushing me over the edge. That was probably why I lost most of the weight fairly quickly.

Let us talk about prevention. Today more than 12 million people are at increased risk of type 2 diabetes across the UK. More than half of all cases of type 2 diabetes could be prevented or delayed. If I had known a year before my diagnosis, I could have stopped the downward trend in my health, but I did not know, and I wish that I had done. Many in this House offer leadership on type 2 diabetes prevention; the right hon. Member for Leicester East is certainly one of them. England is a world leader on this front, having recently committed to doubling its national diabetes prevention programme.

I was pleased to attend a roundtable discussion last summer, chaired by the hon. Member for Enfield, Southgate (Bambos Charalambous), at which we considered the link between obesity and diabetes and the importance of tailored messaging for the different subsets of the population. During the discussion I met the inimitable Professor Valabhji, the national clinical director for obesity and diabetes at NHS England, whose leadership in this space should be celebrated. I put that on the record because his knowledge and help for those around him, and his research into and development of how we deal with diabetes, are incredible.

For people with type 2 diabetes, there is the additional aspiration of achieving remission. I echo colleagues’ congratulations to the deputy leader of the Labour party, the hon. Member for West Bromwich East (Tom Watson). We watched him almost shrink. One day I stopped him and said, “Tom, is everything all right?” He was losing so much weight, but it was his choice to diet as he did. He is an inspiration for many people because of what he has done, and I commend him for it. The concept of remission can be alienating, however, because it is not possible for every person with type 2 diabetes.

Central to the effectiveness of all types of support for the individual and the wider population is the messaging used, which is what this debate is about. Tailored messaging should be developed for the sub-groups most at risk of type 2 diabetes. For example, those in the most deprived areas of the country are nearly 50% more likely to be obese and have type 2 diabetes than those in the most affluent areas: there is type 2 diabetes in areas where people do not have the same standard of living.

Obesity is responsible for around 85% of someone’s risk of developing type 2 diabetes. Additionally, south Asians are six times more likely to develop type 2 diabetes than Europeans are. It is a well-known cliché that men are not so open or proactive—I can say this is true—about their health needs, and men are 26% more likely than women to develop type 2 diabetes. I am willing to speculate, as one who fell into that category, that that is in part due to messaging not being in a format that reaches men. I did not know what it was, did not know what it meant, did not know what the symptoms were, but it was happening.

We need to focus some of the messaging on the importance of prevention and the risk of type 2 diabetes for men. Will the Minister commit to ensuring that all messaging to support those with type 1 and type 2 diabetes, as well as for type 2 diabetes prevention, is tailored to the relevant sections of our society?

I have to manage my diabetes every day. I take my tablets in the morning and at night. I am careful about what I eat. By and large, I manage it. I check my sugar levels every morning. The doctor tells me to check and I do it every day so that I know where I am. I am a creature of habit; I do it all the time so that I know exactly where I am. Some days it is out of kilter, probably because I transgressed and had a cream bun when I knew it was the wrong thing to have. None the less, we do such things.

On self-management, the average person with diabetes will spend just three hours a year with a healthcare professional. That means that they will spend most of their time managing the condition themselves and will need appropriate education. The right hon. Member for Leicester East chairs the all-party parliamentary group on diabetes. He organised a seminar where we looked at healthcare professionals and how people manage their own condition and therefore need appropriate education. The current delivery of structured education does not reflect the varying needs of each individual living with diabetes. We are all different.

The best efforts of healthcare professionals and those who provide education often focus on perfect self-management or no self-management at all. In reality, the daily struggle of living with a long-term condition means that every marginal improvement should be seen as a true achievement. We have to manage it and encourage ourselves as we move forward. We have to make sure that by moving a step forward we can then move forward again. There has been an admirable drive to increase the uptake of education, but education alone will not help an individual manage the ups and downs of living with the condition. They need the tools and confidence, as well as the education, necessary to manage their condition.

When I speak to people in my constituency who live with diabetes, they often highlight the feeling of isolation. I am sure we can all agree today that there is a need to provide each of those individuals with the support they need to take away the isolation. Being a diabetic can be lonely if someone does not know how to manage it. They might think they are doing the right thing when they are not. Issues have been highlighted to me about the delivery and format of education programmes. Digital solutions and coaching services should be explored. The Minister referred to that in a conversation that we had prior to this debate. I look forward to her response. We always get something positive from her, and we will certainly get something positive today.

Will the Minister commit to ensuring that the delivery, format and content of structured education programmes is improved through the use of digital solutions, and that national guidelines are adapted to accommodate that? Health apps could also be used to refine and augment diabetes training programmes by enabling clinicians to learn from patients about what motivates them and therefore what support to provide.

I want to congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on her leadership on how health apps can be used to improve care and patient self-management. Many MPs in this House are diabetic or have an interest in diabetes. That is why we are here today. We are either diabetic or interested in the matter and here to make a contribution. I commend and thank right hon. and hon. Members for their commitment.

Will the Minister commit to undertaking an extensive public engagement and education programme, using digital platforms where appropriate, to showcase effective and evidence-based health apps and encourage their wider usage? Support needs to be tailored to individuals’ particular needs, in recognition that no single solution works in self-management for everyone. Everybody’s needs are different. I was the first diabetic in my family. When the doctor diagnosed me as a diabetic he asked me about my mum and dad and my wife’s mum and dad, and whether there was anybody in my family tree with the condition, but there was no one there. Unfortunately, my condition was caused by my diet and my lifestyle, so I created the problem. It was not hereditary, but it is how we deal with such things and tailor our responses that matters.

I have recently been convinced that health coaches—the Minister will comment on this—can play a key role in this space. Coaches can bring a distinct non-clinical skillset that poses questions for patients to help them devise the solutions that work for them, to help build their self-confidence and self-motivation—in stark contrast to the more prescriptive approach taken in clinical settings. Coaching needs to be clearly defined, and the full range of support that coaches can provide to support tailored prevention messaging needs to be identified. I look to the Minister’s response, because I believe it will have some positivity in relation to what we seek and what will happen.

It has been brought to my attention that the health service may ultimately need to decide whether to adopt a population-based approach to support improved outcomes across the entire population, or a more targeted approach aimed at those facing the greatest barriers to effective self-management. Will the Minister ensure that the health system explores the full range of ways in which health coaches can support people living with long-term health conditions, as well as carers and family members, through the development of an NHS definition of health coaching? Does she agree with me—and I hope with others in the House—that the UK has an opportunity to be an exemplar in the use of health coaches? It is an excellent opportunity and I hope that through the Minister we can make those changes.

I want finally to discuss the potential of innovations and technology in addressing issues related to self-management. That is what I do—I self-manage my diabetes. A flexible approach to the provision of structured education is vital to support self-management. Once equipped with the information and skills necessary to self-manage, people must have access to, and choice from, a range of proven technologies to help them manage their condition in everyday life. There has been a big investment in technology recently in the NHS.

We welcome the Government’s commitment to the extra spend on health, which we talk about regularly. All us in the House are particularly appreciative of the Government commitment. People with type 2 diabetes are now provided with glucose monitors; my hon. Friend the Member for South Antrim (Paul Girvan) referred to those in an intervention. However, people are offered little education on how to use them appropriately. There may be something more that we can do about that. It is good to have the technology, and to be taking steps forward, but it is also good for people to understand how to use it appropriately for management.

The level of investment in innovative hardware for people with type 1 diabetes is substantial and should be commended. However, individuals can be left lost if timely support is not available to help them to interpret and utilise those tools as a means of preventing complications. Many people with type 1 diabetes choose not to access the technologies now available to them. Why is that? I do not know the reason, but it is a question we must ask. I believe that it is partly because of a lack of individual awareness. In the case of my diabetes, that would be right. It could, potentially, be linked to a lack of information. If information is not being provided, I should hope that something could be done about that.

Later in the month an event is being held in Parliament, chaired by the right hon. Member for Knowsley (Sir George Howarth). The event, held in partnership with the type 1 diabetes charity JDRF, is to do with the development of a new report on access to technology for people with type 1 diabetes, “Pathway to Choice”. I look forward to reading the report when it is published, and I know the Minister will be keen to read it.

All of us with an interest in diabetes—and that is why Members are here for the debate—will be interested to read it. Can the Minister inform colleagues here today what measure will be introduced to ensure that all people living with either type 1 or type 2 diabetes can access the latest proven technologies that are right for their situation?

--- Later in debate ---

[Liz McInnes]

My right hon. Friend is absolutely right. There is an unfortunate blame culture and children can be quite cruel to each other at times; we, as adults, must be careful about the language that we use about diabetes. If I achieve one thing in this place, I would like to get people to understand the difference between type 1 and type 2 diabetes—then I would feel as though I had achieved something.

Despite the growing public pressures associated with both type 1 and type 2 diabetes, a person living with diabetes only spends, on average, three hours a year with a clinician. People with diabetes are often put under a great deal of stress, because of the challenges and complexity in managing the condition and the multiple day-to-day decisions they have to make. In order to allow them to develop the necessary skills to manage their own condition, further support is required—including, but by no means limited to, weight management support.

This debate is very timely and follows a meeting we held in parliament in June of this year, which was attended by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley (Sir George Howarth), among other MPs. The meeting was about realising the potential of health coaches in diabetes care, which the hon. Member for Strangford has already mentioned, and it was supported by Roche Diabetes Care—although of course I have to say that other diagnostic companies are available.

The meeting heard from health coaches about how they support participants in a lifestyle management programme, using their professional expertise as qualified nutritionists to support people to better manage their weight.

[Paul Girvan]

Does the hon. Lady agree that sometimes GPs do not give the right advice to patients? Perhaps a patient who presents with a bad infection is put on antibiotics, which can have an impact on their absorption of insulin, and as a result they can go into a hypo or take a low. That can cause major problems unless they have someone who knows them well, who can watch the signs and knows how to deal with them. Some GPs do not relay that information to patients when prescribing.

[Liz McInnes]

The hon. Gentleman makes a very important point, which I will come to later in my speech, about the need for all health professionals to be aware of diabetes and the complications that can arise, particularly in the situation he describes, where a GP may prescribe something without asking how it will impact on other conditions. The hon. Gentleman highlights the need for more and better training for health professionals around the whole condition of diabetes.

The meeting held in Parliament in June had three main themes. The first theme was relieving workforce pressures in diabetes care by providing non-clinical advice where there are gaps in clinical capacity, which refers back to the point that the average diabetic does not spend a lot of time every year with a clinician. The second theme—it is very pertinent to this debate—was about helping people to find their own tailored solutions to immediate health challenges such as weight management, as well as changing the way they think about their situation. The third theme, which the hon. Member for Strangford mentioned, was digital solutions to deliver 24/7 services to users. The health coaches explained to us how, through apps and other devices, users can message them at any time of day or night. The health coaches will get back to the individual, talk to them and help to address the issue.

Health coaching should be seen as a complement to clinical work and not as a tangent to it. It does not necessarily have to be done by discrete health coaches and could be incorporated into the day-to-day work of NHS staff; that relates to the point made by the hon. Member for South Antrim (Paul Girvan) on GP coaching. It should be incorporated into the day-to-day practice of all staff who work with people with diabetes. That is a point that NHS England and Health Education England should be considering.

Some would say that coaching on lifestyle and weight management is a role that should be fulfilled by the diabetes specialist nurse. I am interested to hear the Minister’s comments on the decline in the numbers of those who perform that very important specialist role. The National Diabetes Inpatient Audit reported that more than a quarter of hospital sites do not have a dedicated in-patient specialist nurse—there is a real gap that we need to examine. The specialist nurse is recognised by most diabetics as their go-to person, so it is quite shocking to hear that they are no longer available in a quarter of our hospitals.

I agree with the basic premise of the hon. Member for Strangford on tailored solutions and prevention messaging for diabetes. I hope the Government will follow the issue up, as well as ensuring that provision is equitable and that variations in uptake are addressed.

Of course, underpinning the whole issue is the need for better public health funding. It is no coincidence that just yesterday in this very Chamber in a debate on the declining numbers of health visitors, I quoted the figures for the national reduction in public health funding and the local reduction in my own borough of Rochdale. Nationally, there has been a reduction of £531 million on public health spending. In my local borough, there has been a cumulative reduction of £8 million over the last four years.

We cannot provide important services on an ever-decreasing budget. It was short-sighted of the Government to try to cut costs by reducing public health funding, and the chickens are now coming home to roost on this ill-thought-out decision. Given the emphasis on prevention in the NHS long-term plan, I will be interested to hear what the Minister has to say about how the cuts to public health funding will be reversed, and how quickly.

Finally, I understand that a National Audit Office report on health inequalities will come out at midnight tonight. I suspect that that report will lay bare the health impacts of cuts to public health services. I will certainly read it with great interest, and I hope the Minister will too.

--- Later in debate ---

[Keith Vaz]

I say yes to the hon. Gentleman on all those points—I agree with them all. I will come to the sugar tax later, but I can take a chunk out of my speech by saying that I agree with all those six points. His shopping list is fine with me, and I will happily copy it.

However, campaigns are extremely important. Very soon, we will have World Diabetes Day. Diabetes UK writes to everyone, asking them to turn buildings in their constituency blue. That is in just 26 days’ time. As chair of the APPG, I have written to mayors across the country, asking them to turn their landmark buildings blue. I ask the Minister to turn the Department of Health and Social Care blue on the outside—it may well be blue on the inside—on World Diabetes Day. I say to the hon. Member for Strangford that he should turn the Castle Ward or the statue of St Patrick blue in his constituency to raise awareness. Of course, one day we will have a statue to the hon. Gentleman himself in Strangford, next to the one of Jamie Vardy, and we will turn them both blue.

We in the all-party parliamentary group, of which we have so many members here—one could call them the usual suspects, but I call them the all-stars—meet every month. We produce reports, one of the most important of which is on mental health and diabetes, something that diabetics are simply not aware of when they get diabetes. I certainly was not aware of it. Support for mental health and wellbeing is critically important to people who have type 2 diabetes. It is an ongoing thing; people do not know why they have depression or why their lifestyle has changed, but it is to do with diabetes. I pay tribute to Diabetes UK, to Chris Askew, and to Nycolle Diniz for the work she does for the APPG.

It is not only specialist nurses who can help us, but other professionals, such as pharmacists. Everyone knows that pharmacies and pharmacists have great expertise in diabetes. My mum—I go back to talking about my mum—could spend more time with her pharmacist in Evington in Leicester talking about her condition than she ever did with her doctor. Maybe the Government should run the awareness campaigns through the pharmacies. That would mean reducing the money going to the doctors a little, and they will quaff around and complain—but if we fund pharmacies to do the testing, we will save so much money in the end. Pharmacists such as our APPG ambassador, Jimmy Desai in Ilford, have done an amazing job. Let us empower them to do things.

The third pillar is prevention, which we have all talked about, and reversal if possible. The hon. Member for Strangford has changed in terms of his weight; we have heard from people such as Dr David Unwin, another of our ambassadors at the all-party parliamentary group, that around 60% of cases of type 2 diabetes can be delayed or prevented by making those lifestyle changes and having a healthy, balanced diet.

At the Health Hub in Doha, which I recommend the Minister visits—although obviously not if there is a crucial vote, as the Government will need her here; I am happy to pair with her and we can go together—if a doctor says, “You are borderline diabetic,” they do not give the patient tablets. Rather, they say, “Here is a prescription to go to the gym downstairs. Start doing your gym work, and don’t see me again until you get your lifestyle sorted out,” because lifestyle makes a great deal of difference. Some of us have our watches connected to our phones—I do not know whether my right hon. Friend the Member for Knowsley (Sir George Howarth) does—so we know about our steps. I very rarely hit 10,000, but at least there is a willingness to try to do more exercise, and walking round the Palace is a way to make sure we do that.

As we have heard, obesity is a killer. Obesity-related conditions cost the NHS—cost the Minister—£6.1 billion a year. I adopt as my own the shopping list of the hon. Member for Strangford: the six things he has asked for, from the watershed to multiple offers in supermarkets. We should all do that and say, “Let’s do it.” The private sector has done its bit. Kellogg’s has put traffic light labelling on most of its cereal packs sold in the United Kingdom since 2018—well done to it!

[Paul Girvan]

On food and how manufacturers can help, does the right hon. Gentleman agree that much of the focus is on sugar, and little is on carbs, which normally convert to sugar in the body? With the Dose Adjustment For Normal Eating—DAFNE—programme, instead of counting sugar, people count carbs. It is really only for type 1 diabetics, but it helps them administer their insulin according to the carbs they have eaten during the day.

[Keith Vaz]

That is extremely important. I support the DAFNE programme and the work being done on the conversion to sugar. That brings me on to the sugar tax—a great achievement of the previous Government. All praise to George Osborne for introducing it.

Baby Loss Awareness Week

Paul Girvan Excerpts

Tuesday 8th October 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), in her absence, for moving the motion. It is always a pleasure to follow the hon. Member for Rotherham (Sarah Champion).

We have heard some marvellous speeches today about personal experiences, and every one of them has been very poignant and has encapsulated what this is all about. I have spoken to previous motions on baby loss, and I am happy to continue doing so in remembrance of those little lives lost.

The fact of the matter is that, since last year, more hearts have been broken, more arms have been left empty and more grief has entered homes throughout the United Kingdom of Great Britain and Northern Ireland. That deserves recognition in the House this year and every year, as the hon. Member for Banbury (Victoria Prentis) said.

This does not take away from anyone else who has contributed to the debate, but I would particularly like to mention the hon. Members for Thirsk and Malton (Kevin Hollinrake), for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). In our debates in this House they have told us their personal stories and have helped us to understand exactly what it means to lose a child. One thing that came out of those Adjournment debates and those contributions in this House was the need to have a separate room in hospital where people can grieve and have privacy, and the hon. Member for Brigg and Goole (Andrew Percy) talked about the one in his constituency. [Interruption.] I hope Members excuse me; I have a bit of a chest infection and am trying to keep it off if I can.

I mentioned the next thing to the hon. Member for Colchester and he can probably remember it: the importance of having faith involved, as people can use that to help get to the other side of the grieving process. Where there are rooms where people can have privacy, it is important that they can call upon someone of faith to come to give support. The hon. Member for Rotherham spoke about how important it is to have someone to speak to, relate to and understand.

Most miscarriages happen in the first 12 weeks, which is known as “early pregnancy”, and an estimated one in four pregnancies ends in miscarriage—it is one in five if we only count women who realise and report the miscarriage. About 11 in 1,000 pregnancies are ectopic. About one in 100 women in the UK experience recurrent miscarriages—three or more in a row—and more than six in 10 women who have a recurrent miscarriage go on to have a successful pregnancy. The risk of miscarriage greatly reduces in the second trimester—miscarriages then are called “late miscarriage”. My mother miscarried on three occasions, and seven in our family have had this happen; my sister also miscarried on three occasions. The girl who is, in effect, my Parliamentary Private Secretary and writes my speeches in this House—she is a very busy girl, as people would understand, given the contributions that are made—has also had two miscarriages.

[Paul Girvan (South Antrim) (DUP)]

On the number of people who have had difficulties, the problem we have perhaps relates to the level of focus on care, aftercare and counselling. I am not saying this is inevitable and will always be the case, but we do not have the necessary focus on counselling for the individuals and families who have gone through this traumatic experience. Unfortunately the fear of what they have been through sometimes means that they do not want to have another child and go through this again, so they are denied the opportunity to have a family because of what they have experienced; a lack of counselling means that that can sometimes be a fear.

[Jim Shannon]

I thank my hon. Friend for that intervention and I can relate it to my constituency and the people I have spoken to. The thing that sustained my sister, my mother and my PPS was their faith, which is why I come back to the importance of having faith, as I said to the hon. Member for Colchester. In the past year, I have known of two women in my constituency who knew that their baby would not live for more than a couple of hours after the birth yet they carried their baby to its full nine months and enjoyed those few hours together. I am a member of many organisations, one of which is the Royal Black Preceptory. We helped the father of a young child who was lost with a charity event at the bowling club in Ballywater to raise money for this issue, and we raised some £1,000.

I wanted to say all that because it is important, as everyone deals with things in their own way. About one to two in 100 women have a miscarriage in the second trimester. According to one study, once a pregnancy gets past six to seven weeks and there is a heartbeat, the risk of having a miscarriage drops to about 10%. Those are the facts and they are worthy of noting, but they cannot begin to deal with the process of grief that is suffered. It may sound comforting for people to understand that one in four pregnancies ends in a loss and so they are not alone, but, as one lady said, “I don’t want to be the one in four, I want to be the three who live their life as normal and don’t have this emptiness inside.”

It is important to note the facts, but it is more important to acknowledge the grief and the right to grieve. Long gone are the days of, “Just don’t talk about your loss.” We have learned that for those who wish to express themselves it is healing to do so. Some people need to talk about it, but some decide that they may not. Of course many women will never talk of their loss, and that too is part of their process and is to be respected. For others, the symbolism of a balloon release or the lighting of a candle is a way of acknowledging a life that did not blossom but was most definitely there.

We do not understand why many miscarriages take place, but with an NHS under such pressure—I say that really gently, because we have a wonderful NHS that does great work—we do not investigate until the third miscarriage. That in itself is incredibly difficult. I know of one lady whose parents, after encouragement by the midwife after her second miscarriage, paid for private care and for private tests and all the rest, to learn that taking baby aspirin would increase her chance of keeping the next little one. A baby aspirin once a day saw her have a beautiful baby girl. There could well have been another miscarriage had she not been able to seek private advice. When it comes to that example of how that lady dealt with a miscarriage and then had a child, I wonder whether the necessary advice is there in the system and throughout the process. I have said it before and I shall say it again: three miscarriages but no investigation is too much. I sincerely urge change in the NHS procedure. Perhaps the Minister will be able to respond to that point or give me some idea of where we are.

This debate cannot solve the issue of baby loss and grief, but it can validate the fact that a miscarriage was a loss. It happened and should be remembered, and we as a nation should mourn. The fact that a death certificate cannot be issued until 24 weeks must be reviewed. I find that quite incredible. It does not mean that it is not widely understood that someone has suffered through a death. And it is not simply the mother who suffers, but the father and the would-be grandparents, too. The hon. Member for Eddisbury referred to it, and although the hon. Member for Colchester has not spoken today, I remember his previous contributions. The wider family suffer as well. It is like throwing a stone into a pond: the ripples go right to the edge—they touch everyone in the family circle and all the friends. Everyone should remember that.

We must do more to recognise and support those who suffer from a miscarriage. A pamphlet in a cold, sterile procedure room is not enough. I read a little quote that touched my heart. This lady said:

“I carried you for every second of your life—and I will love you for every second of mine…Let sweet Jesus hold you until mummy and daddy can hold you”—[Interruption.]

NHS Workforce: England

Paul Girvan Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas]

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

[Paul Girvan (South Antrim) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

[Paul Girvan]

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

[Derek Thomas]

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.

NHS Whistleblowers

Paul Girvan Excerpts

Wednesday 18th July 2018 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank my hon. Friend the Member for Central Ayrshire (Dr Whitford) for bringing forward this important debate. I think we all agree that when malpractice and failure in our NHS threaten the public interest, and when concerned staff do not have the confidence to speak up and share their concerns, our public services are threatened across the board. Of course, that does not apply just to the NHS—we know it has happened in other sectors.

My hon. Friend, who focused on the NHS, pointed to recent examples that underline the need for staff who raise concerns to be protected. Indeed, almost all the official reports and the inquiries that have followed have shown that co-workers had seen the dangers but had been too afraid to raise the alarm, or had raised it with the wrong person or in the wrong way. We need only cast our minds back to the Clapham rail disaster, the Zeebrugge ferry disaster and the empire of Robert Maxwell—in all those cases and others, people already had concerns, but they were either unable or unwilling to come forward, for whatever reason.

[Paul Girvan (South Antrim) (DUP)]

Numerous NHS staff have indicated to me their unwillingness to come forward because they believe there is a culture of bullying in the NHS. If they make a complaint, they are targeted. Even though complainants want to remain totally anonymous, that does not seem to happen. I know one doctor, in particular, who raised an issue and who feels he has been sidelined from promotion and everything else because of the stance he took against his peers.

[Patricia Gibson]

Sadly, we have heard that point several times during the debate. We hear it far too often. The culture must change.

We have focused on the NHS, which we all understand is an important public service. If the public cannot trust and have faith in the NHS, we are in a sorry state indeed. I am sure my hon. Friend the Member for Central Ayrshire would tell us that the reason we need to ensure there are robust mechanisms in place to protect whistleblowers is that, ultimately, whistleblowing is about saving lives.

We will never know whether safer whistleblowing, with protection for those who raised concerns, would have halted the activities of Ian Paterson in the NHS and the private sector, given that concerns about his surgical procedures and his desire to carry out harmful and unnecessary mastectomies had apparently been circulating since 2003. Professor Ian Kennedy, who reviewed Paterson’s practice, put it like this:

“Whistleblowers do not fare well in the NHS. This is one of the major indictments of management in the NHS: that it is inwards-looking, over-defensive, and prone to destroy, by a variety of means, those who suggest that the Emperor has no clothes…It is a blight on the NHS and is one of the principal areas where lessons must be learned.”

As the hon. Member for Stirling (Stephen Kerr) reminded us, where provisions to further protect whistleblowers are required, they should be put in place.

It has been reported that up to 10 doctors who worked with Paterson are under investigation by the GMC, apparently for failing to act on concerns. I make no comment about that, but one has to ask how it is possible that there is a culture in which fellow medics can even be suspected of failing to act on such concerns. How on earth could such an ethos ever develop and, apparently, thrive? That monster has lurked in the NHS, and that culture has to be changed. As the hon. Member for Hartlepool (Mike Hill) said, it is changing, but not as quickly as we would like.

As my hon. Friend the Member for Central Ayrshire outlined, the Scottish Government have implemented a number of measures to help protect whistleblowers and ensure they feel confident to speak out. Extra legal protections are now in place for student doctors and other postgraduate trainees who speak up if they are unfairly treated by their training body. However, as she pointed out, those are—and must be—quite separate from standard employment issues.

Importantly, the Scottish Government have committed to the function of the independent national whistleblowing officer for NHS Scotland being held by the Scottish public services ombudsman, creating a mechanism for independent external review where an individual has a concern about the handling of their whistleblowing case. That will be in place by the end of 2018. Importantly, the intention is to ensure that whistleblowing cases are concluded in a reasonable timescale. We heard from the hon. Member for Stirling about a case that dragged on for many years, which is far too long. That is simply not acceptable.

As my hon. Friend the Member for Central Ayrshire pointed out, we are building a consistent approach in Scotland. Staff will have access to an independent external body that can review their case and bring it to a clear, final and fair conclusion. I urge the Minister to study the improvements in Scotland carefully to ensure that the system in England is as robust as it can be and as supportive as possible to whistleblowers who raise genuine concerns. Of course, that is not to suggest that Scotland has nothing left to learn. We all must continue to be very vigilant, as the hon. Member for Stirling pointed out.

Gagging clauses have been used to suppress, or potentially suppress, information about patient care, which can lead to failings being repeated. I think we would all agree that that is completely unacceptable. My hon. Friend gave us a timely reminder—if we needed reminding —about the tragedy of Mid Staffordshire, which led to the deaths of as many as 1,200 patients. That must not be allowed to happen again.

Such malpractice and failings can thrive only in a culture where people are afraid to speak out and where fear and secrecy reign, as the hon. Member for Hartlepool reminded us. We have learned from Mid Staffordshire, but we must go on learning from it. I urge the Minister to be ever vigilant and watchful. Of course, genuine concerns have to be raised responsibly, but they must be raised. The NHS as an institution must encourage that, as the hon. Members for Stirling and for Hartlepool set out.

A whistleblower must be seen not as a problem but as someone who genuinely seeks to improve how things are done. Every Member who spoke alluded to that. That requires a culture change in the many corridors and management offices of our health system, which will take time. We are getting there, but we are not there yet. We must never be complacent. Openness and transparency are key to ongoing learning and improvement, and such a culture will give patients the confidence they need. I am keen to hear the Minister’s response to those concerns.

Access to Orkambi

Paul Girvan Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

Of course I agree entirely. It must be very frustrating for Holly and her family to find themselves in this situation. There really is no excuse for delaying the beginning of a review. Members know full well how long these reviews can take, so let us get on with it. I think we are united in a belief that this is absolutely essential as part of the lessons that we need to learn from this situation.

[Paul Girvan (South Antrim) (DUP)]

The hon. Gentleman alluded to having spoken to families of people who were on a large cocktail of drugs and the costs associated with that. Let us not say that it is just down to costs; I appreciate that NICE might well be using the wrong process. This cocktail of drugs adds up to a significant cost, and there can be a dramatic saving if they can come off some of those drugs, as well as losing the side-effects that come with them.

[Mr Lewis]

I agree entirely. We sometimes spend vast amounts of public money reacting to a problem, and the rhetoric is all about prevention and early intervention, but we end up doing the opposite. This is a very good example of that.

Fortified Flour

Paul Girvan Excerpts

Wednesday 16th May 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the hon. Member for Pontypridd (Owen Smith) on bringing this debate to Westminster Hall. I congratulate him on presenting his case so well, as he did at the awareness day that some of us were able to get down to. As the Democratic Unionist party spokesperson for health, I am aware of this issue and very supportive of the fortification of flour.

All the speeches we have heard were tremendous. I commend my right hon. Friend the Member for Belfast North (Nigel Dodds) for telling a very personal story. Personal stories in these debates always carry substantial weight. His was a story that he and his wife have walked, and although we might have known something about this issue, we have heard a whole lot more. I commend him on that and assure him of our support. He knows that it has always been there for him, but on days when we tell personal stories we feel it a bit more.

When my parliamentary aide was pregnant, we got a surprise. In the mornings when she was under a little pressure, instead of shouts of “coffee” coming from her desk she would ask for water. By the time of her second baby, we all knew what “no coffee” meant—baby on board. You can imagine the apprehension I felt, Mr Hanson, on a Friday morning when I said to the staff in the office, “Girls, who’s for coffee?” If they said no, I knew they did not want coffee, but was there anything they wanted to tell me? That, however, is by the way. Why did my aide do that? It is simple: she told me, “Coffee makes the baby’s heart beat faster, so I need to stay away from it.” I wanted to make a contribution to the debate because she has lived through this.

Almost every mother I have ever known, as soon as they have that pregnancy test, has made changes to their lifestyle. They do it automatically, and in many cases right away, for the sake of the baby. They stop having alcohol and start on vitamins, reduce caffeine and increase their fruit and veg. By doing that, they naturally create—to use an Ulsterism—a better wee home for their child, which is what the mother is trying to achieve.

This is a personal story from my aide. They are told by the doctor to take folic acid, and of course they do, because it is important, but the problem is that ladies who have been on contraceptive pills find their folic acid store completely depleted. If they have not taken folic acid before pregnancy, it may be too late. With approximately 40% of UK pregnancies estimated to be unplanned, that is certainly an issue, so we look to the Minister for a good response. I mean this respectfully: larger ladies who have a higher body mass index should be taking more folic acid than the usual pregnancy dose. That is not talked about widely, but it is important to put on record how important folic acid is for anyone who is pregnant, and perhaps those showing signs more than others.

I read an excerpt from the NHS Choices website regarding flour and folic acid that made things very clear to me. It describes how a randomised controlled trial from 1991 first indicated that taking 4 mg of folic acid during pregnancy—10 times the current recommended dose—could prevent about 80% of neural tube defects. On the basis of that trial, it was concluded that such defects are due to a vitamin deficiency that needs correcting before pregnancy. However, it said that, despite campaigns, a study of nearly half a million women in England showed that less than a third took folic acid supplements before pregnancy. That tells me clearly that action is needed, and it is needed now.

[Paul Girvan (South Antrim) (DUP)]

On adding folic acid to flour, we have potentially been putting fluoride into water, and that has virtually no health benefits. That has only dental benefits, which are about lifestyle choice, and that is different from those suffering because they are not getting folic acid through their diet. It is great that this issue has been brought forward, and we should look to put folic acid into flour and ensure that everyone gets it, because there are no negative sides to that.

[Jim Shannon]

I wholeheartedly agree with my hon. Friend. We are already putting additives into many products we eat, to our benefit, and that is what we should be doing.

To return to taking folic acid supplements before pregnancy, of the half a million women in England surveyed, less than a third did so. The figures varied by age, with the highest use in women aged 35 to 39, of whom 38% took it before pregnancy, compared with only 13% of those aged 20 to 24 and 7% of those under 20. There was also a marked ethnic variation, with 35% of white women taking it compared with 20% of south Asian women and 18% of Afro-Caribbean women.

Just under two thirds of all women took supplements in early pregnancy, but the researchers say that that is already too late. The current strategy of encouraging women to take folic acid before pregnancy is inadequate and, in particular, putting younger women and minority groups at a disadvantage. People always talk about stats, but the fact of the matter is that they tell a story—and these stats tell a clear story. When women take folic acid before and during pregnancy, it makes a difference. However, there is clearly either no knowledge or not enough information about it. We look to the Minister and the Government to step forward and do what is right.

I would also like to mention that whenever people come to my office for benefit claims and I see what medication they are on, as we need to do—it must be the same for everybody’s offices—I find it surprising how many are, for different reasons, in receipt of folic acid. That is because folic acid helps to get their bodies back into kilter. That is important: folic acid has benefits not just for those who are pregnant but for those who are in ill health.

While I understand the Government’s reluctance to become a nanny state who enforce rather than guide, we should remember that flour fortification is not new. To white flour, the UK adds calcium, iron, thiamine and niacin to replace the nutrients stripped and discarded when the bran and germ are removed from the wheat grain. That was introduced after world war two to help improve the nation’s heath. We did it then for that purpose, so why in 2018 can we not do it for the purposes we are presenting to the House today? I do not agree with the nanny state argument. Sometimes, Governments have to take the initiative and do things that are important.

Today, milling is even more efficient at stripping the nourishing layers from the endosperm, which means that even less natural folate is left in white flour than there was when replacing other lost B vitamins was deemed necessary. There is, therefore, a greater need today for folic acid than there was in the past—even after world war two, when that was seen to be important.

I will conclude, because I am conscious of the timescale you gave us, Mr Hanson. The Government must consider this issue. I give my full support to the hon. Member for Pontypridd for bringing the debate forward, and to my right hon. Friend the Member for Belfast North and other speakers. We have all come here with the same message, in an attempt to highlight this issue to the Government. Anything we can do to bring healthy babies into this world should be done without any delay. This seems to be a cost-effective way of helping mothers and their babies from the earliest opportunity. I am fond of the Minister, and he knows that. I look to him for a substantial response—no pressure whatsoever—on what we have proposed, with reasons.

Cancer Targets

Paul Girvan Excerpts

Tuesday 1st May 2018 Westminster Hall

[Mr Baron]

I completely agree. Our inquiry into cancer inequalities in 2009 found that the NHS is as good as any other healthcare system internationally, if not better, at treating cancer once it is detected; the problem is that we do not detect it early enough and we never catch up. The line of international averages compared with UK averages shows that we are always behind, and there is little evidence that we are catching up. We get behind at that early one-year point, because we are not diagnosing as early as other healthcare systems, and no matter how good our treatment, we do not catch up. That is how we are losing those tens of thousands of lives, because we are not matching the European averages for survival rates.

[Paul Girvan (South Antrim) (DUP)]

Having been through treatment in the past, I appreciate that early diagnosis can, if dealt with correctly, save an absolute fortune. Everyone has heard the saying, “A stitch in time saves nine.” Unfortunately, leaving it too late, rather than intervening early, and having to treat the symptoms as they progress costs the health system a lot more money.

[Mr Baron]

I completely agree. I have not mentioned that aspect, because I have been focusing on patients, but the hon. Gentleman is absolutely right. If we were to diagnose earlier, the NHS could save a lot of money. We all know that, by and large, the more invasive the treatment, the more costly. Given how large the NHS is, too few health economists are trying to quantify this. When I ask my local CCG or cancer alliance, they do not know the cost savings associated with earlier diagnosis. That is a great shame.

 Orkambi and Cystic Fibrosis

Paul Girvan Excerpts

Monday 19th March 2018 Westminster Hall

[Paul Scully]

One thing I will say in favour of Vertex in this case is that, although the amount of people who suffer from this condition is fortunately restricted, the research and development still has to go in. It is not like developing the next ibuprofen or cancer drug, which will go out to millions of people; this would go out to 70,000 people in the world. In order to build that research and development budget in, Vertex needs to charge reasonable costs for the drug. None the less, those costs do need to be reasonable. That is why the negotiation needs to be absolutely above board, transparent and sensible for the sake of the sufferers, who, frankly, do not have time to wait for a prolonged negotiation.

[Paul Girvan (South Antrim) (DUP)]

So much emphasis is put on the cost of treatment, yet if we add together the costs of the cocktail of drugs that many sufferers are currently on, there probably would not be a big difference from the cost of the new drug.

[Paul Scully]

I will come back to that important point in just one second. We were talking about the campaign being brought together, and I want to pay tribute to the hon. Member for Dudley North (Ian Austin), who has done a fantastic job in raising the profile of cystic fibrosis. I am sorry that I was not able to be at the roundtable that he hosted—I was out of the country—but 41 Members were there who were keen to learn more about this. That is because of his efforts and the efforts of the petitioners, and that is absolutely to be welcomed.

--- Later in debate ---

[Paul Masterton]

My hon. Friend powerfully sums up why Vertex, the SMC, NHS Scotland, NHS England and NICE need to work together to find a way to make Orkambi available on the NHS as soon as possible, not just in Scotland but right across the United Kingdom. I understand that confidential talks are ongoing and I very much hope that there will be a positive conclusion; there is no reason to assume that an agreement cannot be reached. We have seen things happening right across Europe, and in the Netherlands a deal was struck fairly recently to allow the drug to be made available.

[Paul Girvan]

Big pharma has a strong lobby and there are those within the industry who would lose out if a drug such as this were to be licensed and used in the UK. They would fight tooth and nail to ensure that it did not get across the line. I ask the Minister: whenever a new drug is assessed, is consideration given to the fact that there are those who will not want it to see the light of day?

[Paul Masterton]

I suspect that the Minister has listened carefully to that intervention. I, too, will be interested to hear his response.

I finish by extending my hope that we are able to get the drug licensed for more children—the current license is for those aged 12 and over. In January, the European Commission extended the marketing authorisation for Orkambi to include children aged between six and 11 —just like those young people whose desperate grandparents took the time to contact me—and, just days ago, the Republic of Ireland became one of the first EU countries to make Orkambi available to children aged six and over. I hope, therefore, that Orkambi will not only become available on the NHS in the near future, but that Vertex will make a further submission to the SMC so that it can also be available to six to 11-year-olds.

Cystic fibrosis is a serious, life-limiting condition, and Orkambi can help to give people with the condition as long and healthy a life as possible. Both in Scotland and across the UK, there should be no unnecessary delay in extending access to it, either because of age or because of its availability on the NHS.