Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman is right, which is why we have ensured that we are putting more money into the NHS and more money into primary care, with £4.5 billion in real terms on primary medical care and community health services. It is why we commissioned Baroness Dido Harding to produce the “Interim NHS People Plan”, which she has done, and why we are working on ensuring that we have the health service workers to provide excellent care for all people in the community.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

13. What assessment he has made of the effect of public health services on reducing health inequalities.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The Government recognise the importance of reducing inequalities and have included a commitment to that in the NHS long-term plan. We know that public health services, such as immunisation, screening programmes, smoking cessation services and many other initiatives, can significantly improve health outcomes to combat some of the inequalities faced by ethnic minorities and those living in less affluent areas.

[Mr Sharma]

I thank the Minister for her response. After nine years of Tory austerity, advances in life expectancy, which steadily increased for 100 years, have now ground to a halt and have even gone backwards in some of the poorest areas. How does the Minister plan to reverse that damning trend?

[Jackie Doyle-Price]

Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

Genetic Haemochromatosis

Virendra Sharma Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Ben Lake (Ceredigion) (PC)]

Diolch, Mr Sharma. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Rugby (Mark Pawsey) on securing this important debate and I pay tribute to Haemochromatosis UK for its work supporting both the sufferers of the genetic condition and the all-party parliamentary group. If I may, I particularly thank Lisa Flude, who first brought the condition to my attention and has been an invaluable source of information and advice to me in recent months.

As we have already heard this afternoon, genetic haemochromatosis is the most common genetic disorder in the UK and yet it remains largely unknown or unfamiliar. Too often it is poorly diagnosed and managed. Approximately 10% of individuals of white European descent in the UK—as my hon. Friend the Member for West Dunbartonshire (Martin Docherty-Hughes) pointed out, this particularly affects those of Celtic descent—or some 5 million people are believed to be genetic carriers of the mutated copy of the haemochromatosis or HFE gene, as the hon. Member for Rugby mentioned. Perhaps 100,000 or 200,000 people might have two mutated copies of the HFE gene and are then at the risk of iron toxicity or overload and the subsequent diseases and conditions that can emerge from that. Yet—this is the nub of the debate in my opinion—for every patient diagnosed with the condition, between eight to 10 are left undiagnosed and unaware of the risk to their health. It is some risk, too: although genetic haemochromatosis is easy to diagnose and to treat, if left untreated it has serious consequences.

The hon. Member for Heywood and Middleton (Liz McInnes) referred to the two recent studies led by groups from the Universities of Exeter and Connecticut. They have shown that the condition quadruples the risk of liver disease and doubles the risk of arthritis and that individuals with the condition are at higher risk of diabetes and chronic pain. In addition to those serious health complications of iron overload, individuals with genetic haemochromatosis can suffer from fatigue, muscle weakness and joint pains. Unfortunately, those symptoms are often mistaken for the signs of ageing or tiredness, but together they can still prove debilitating. Yet genetic haemochromatosis can be diagnosed and treated effectively when detected. The treatment, as we have already heard, entails venesection. I will not go into that any further, but it is a safe process that should be widely available across the UK.

Given the pervasiveness of genetic haemochromatosis and the serious impact that iron toxicity has on an individual’s health and wellbeing, the case for ensuring consistent and effective diagnosis of the condition across the UK is clear. It is not a condition for which there is no treatment or diagnosis. The problem that we face is the lack of consistency, or standardisation, as the hon. Member for Rugby put it, in the application of clinical guidelines.

A survey of health boards across the country showed that even where protocols are in place they are often non-mandatory and differ between boards. Sometimes they are discipline-specific, which can be problematic in itself when we consider that haemochromatosis is often treated by a range of specialists, including hepatologists, haematologists and gastroenterologists.

Introducing standardised guidelines, and ensuring their consistent application, has the potential to increase diagnosis rates tenfold. Early diagnosis prevents so much unnecessary pain and suffering. I hope that the Minister can explore the introduction of more standardised guidelines or patient pathways for the diagnosis of this condition, as it would vastly improve treatment and management of the condition.

If further persuasion were needed, improved diagnosis and earlier treatment of genetic haemochromatosis has the potential to save the NHS considerable resources in the long term, as other Members have mentioned. Iron overload can cause a range of cancers, heart failure, diabetes, and joint disease. Researchers have found that, for men, 1.6% of all hip replacements and 5.8% of all liver cancers occurred in those with two HFE genes. The treatment of those conditions exerts incredible pressure on both primary and hospital care, without considering the impact that multiple appointments over years by patients with non-specific chronic conditions have on primary care.

I am conscious that you want me to finish, Mr Sharma, so to conclude, addressing the current lack of national or standardised guidelines and thus improving the rate of diagnosis of genetic haemochromatosis could reduce the unnecessary suffering of thousands of individuals, while saving the NHS much-needed resources. As somebody more eloquent than I put it, it is a no-brainer.

[Mr Virendra Sharma (in the Chair)]

I am sorry, I was conscious of the time—I want the Minister and the Opposition spokesperson to respond as well. I call Gavin Newlands.

NHS: North-West London

Virendra Sharma Excerpts

Wednesday 24th April 2019 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Hammersmith (Andy Slaughter) and congratulate him on securing this important debate.

North-west London has been a guinea pig—unloved and uncared for in the testing of a failed experiment. It has taken our local NHS trust and the Secretary of State all this time to recognise what we have been saying for years. When I say “us”, I mean not just Members of this House, but doctors, nurses, clinicians and, most importantly, patients and the local community. The “Shaping a healthier future” programme was not fit for purpose. It did not work, and it did not deliver for those who needed it most.

Two weeks ago, I attended a party in Ealing—my hon. Friend mentioned that he had one in Hammersmith—celebrating the end of “Shaping a healthier future”. My constituents were ecstatic. I have rarely seen more strongly held convictions than those they had that lives were being put at risk by the scheme. The cancellation of the programme is the greatest gift that we could have been given. It was almost an Easter miracle. Ealing Hospital, Charing Cross Hospital and others in the area can now rise from the dead and continue to serve our constituents.

However, those hospitals remain broken—not yet whole again. Ealing Hospital has lost full A&E services, which we badly need. We have lost our maternity ward and in-patient paediatric care. I remember, only a few years ago, spending time with volunteers in that area helping to raise funds for a publicly paid-for refurbishment of that children’s ward. It now lies empty. The garden we built is un-played in, and the swings are still. Its closure was a slap in the face to hospital users and the patients’ group. Parents felt un-consulted—a theme that runs throughout the “Shaping a healthier future” programme. It always seemed to be a top-down programme: a project put on local people and led by Whitehall that was not what patients needed.

Thankfully, the scheme is now only a failed experiment, not an ongoing disaster, but the clearing and cleaning up still need time and effort. Local residents want to feel listened to. They want to feel that their needs are being placed at the centre of their care, not treated as a peripheral concern. I hope that the Minister can commit to restoring services to all our hospitals in north-west London, but—I would say, selfishly—particularly to Ealing Hospital, which is in my constituency.

The London Borough of Ealing has a very high number of young people, but suffers from one of the highest levels of lifestyle-led premature death. The widely reported Mansfield commission into the programme roundly condemned the “Shaping a healthier future” plans, and found that cuts were falling disproportionately on the poorest in society. Minister, please reverse the cuts and give my worst-off constituents a fair chance at healthy and full lives, unblighted by ill health.

Health and Social Care Committee

Virendra Sharma Excerpts

Thursday 28th February 2019 Westminster Hall

[Mr Virendra Sharma (in the Chair)]

We begin with the Select Committee statement. Dr Paul Williams will speak on the publication of the thirteenth report of the Health and Social Care Committee, “First 1,000 days of life”, for up to 10 minutes, during which no interventions may be taken. At the conclusion of his statement, I will call hon. Members to put questions on the subject of the statement and call Dr Williams to respond to these in turn. Members can expect to be called only once and their questions should be brief.

[Dr Paul Williams (Stockton South) (Lab)]

Thank you, Mr Sharma, for inviting me to address this Chamber, so that I can present the Health and Social Care Committee’s report into the first 1,000 days of life.

I have been studying and working in health for the past 27 years and I have concluded that if our society wants the most effective interventions to improve health, we must act in the period from conception to the age of two. That is because the seeds of health inequalities are sown during that time. Good social, emotional, physical and language development during that time is crucial to building healthy brains and children, and having a healthy society.

This week our report set out an ambition challenge to the Government and all our colleagues in the House. We want to kick-start the second revolution in early years services, as recommended by the Marmot review in 2010, so that our country can become the best place in the world for a child to be born. Building that kind of society drives me, not only as an MP, but as a father and doctor.

I thank the hon. Member for Totnes (Dr Wollaston) for letting me take the Chair of the Committee for this inquiry. It is typical of her generosity of spirit that she seeks to give opportunities to others. I hope that I have done justice to the chance she gave me. I thank my Committee colleagues—of all parties and of none—for their support and guidance during our inquiry. I thank our Health and Social Care Committee staff team, particularly Lewis Pickett, Dr Joe Freer and Huw Yardley, who played a crucial role in helping us to make this report a reality.

Almost all research into this subject demonstrates that our path in life is set during the crucial first 1,000 days from conception to the age of two. Healthy social and emotional development during that time lays the foundations for lifelong good physical and mental health. Yet, our current political system invests a fortune in reacting to problems much later in life, leaving a gaping void where we should be warriors for a fairer and healthier society.

During the first 1,000 days of life, more than 1 million new brain connections are made every single second, and babies’ brains are shaped by the way in which they interact with others. However, more than 8,000 babies under the age of one in England currently live in households where domestic violence, alcohol or drug dependency and severe mental illness are all present. Over 200,000 children under the age of one live with an adult who has experienced domestic violence or abuse. Two million children under the age of five live with an adult with a mental health problem.

We know that many children who experience such adversity become happy and healthy adults, but adversity in childhood is strongly linked to almost all health problems and many social problems. Children exposed to adverse childhood experiences are much more likely to get heart disease, cancer and mental health problems than those who are not. Children exposed to four or more ACEs are 30 times more likely to attempt suicide at some point in their life, 11 times more likely to end up in prison and three times more likely to smoke as adults than those exposed to no ACEs. Our politics is currently failing some of these babies and other children who are born into families where poverty strongly affects their chance of achieving good health.

As part of this inquiry, our Committee read 90 submissions of written evidence and held three focus groups with stakeholders. I thank those who made superb contributions to our three oral evidence sessions. I particularly thank David Munday from Unison, Sally Hogg from Parent Infant Partnership and Viv Bennett from Public Health England for their guidance to me.

Our Committee was keen to reach outside Westminster for evidence. We hosted an online forum on Mumsnet, where we heard 80 stories from parents telling us about their experiences of pregnancy and early childhood, as well as their views on services. We visited the Blackpool Better Start project, run by the National Society for the Prevention of Cruelty to Children and funded by the Big Lottery Fund. We held focus groups with representatives from councils, clinical commissioning groups and charities from across the country.

We all know how austerity has affected our councils and the NHS over the last nine years, but we saw how a relatively small Big Lottery Fund investment had helped local authorities to redesign their services. Staff were able to take time to reflect. The extra money brought added capacity and outside expertise. We saw joined-up, effective collaboration between the council, NHS commissioners and providers, the voluntary sector and the police.

We also saw the importance of investing in long-term goals and service transformation, rather than just using money to firefight short-term challenges. We heard how having a one-stop shop for families helped to provide better support, and helped professionals to have better relationships with each other and to share information. We visited community spaces across Blackpool, including a library and a local park, which had been transformed by members of the local community, to make them more suitable for families with young children. We heard about the importance of a father in a young child’s life. Some fathers say that they lack parenting skills and other fathers felt that the system excluded them.

I firmly believe that we need to devote much more attention and protection to resources for this crucial period of life. There are many people across the political divide who share that belief. This is an area where politicians should be working together. It was very encouraging to hear that the Early Years Family Support Ministerial Group, led by the Leader of the House, was announced shortly after the start of our inquiry. That has the potential to take forward some of our Committee’s recommendations. I will soon be meeting with the Leader of the House to hear about the group’s progress.

Our inquiry has identified the need for a long-term, cross-Government strategy for the first 1,000 days of life, setting demanding goals to reduce ACEs, improve school readiness, and reduce infant mortality and child poverty. Our report recommends that the Minister for the Cabinet Office should be given specific Cabinet-level responsibility for the oversight of this national strategy.

We want communities, the NHS and voluntary groups to be led by local authorities, to develop their plans to bring this Government strategy to life, inspiring improved support for children, parents and families in their area. We think that a Government transformation fund should be established to encourage these different groups to come together, to pool their resources and deliver shared, agreed actions. We also think that a single nominated individual in each area should be accountable to the Government for progress.

Our report also calls for the existing, and actually very good, healthy child programme to be improved and be given greater impetus. It should be expanded to focus more on the whole family rather than just the child, begin before conception, deliver more continuity of care for families—something we found families really valued—and extend health visitor engagement beyond the age of two and a half, to ensure that all children become school-ready.

We heard from Scotland, Wales, Northern Ireland and parts of the United Kingdom that had enhanced the healthy child programme. However, we also heard from too many areas where some of the contact with health visitors was just a letter, and we were told that 65% of families do not even see a health visitor at all after the six to eight-week check. That clearly is not good enough. Our report recommends that information sharing needs to be significantly improved. Information needs to be better shared between organisations so care can be better co-ordinated and the long-term impact of an intervention can be tracked and assessed.

Alongside that, we need a workforce strategy to address the reduction in health visitors. That does not seem to have been a deliberate strategy, but happened because local authorities were given the funds for the healthy child programme at the same time as they had their budgets cut. We also want the strategy to make sure that knowledge and skills are improved, especially knowledge of ACEs and the importance of using motivational interviewing techniques.

If we get this crucial 1,000 days of life right, it will have huge benefits for everyone in our society. As politicians, we should try to get it right not just because it makes financial sense, but because every single one of us in Parliament has a moral responsibility to our country’s children. Every child deserves the best start in life.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Ind)]

I pay tribute to the hon. Gentleman for his effective chairing of the inquiry, and for his powerful speech. I also pay tribute to the other Committee members and the wider Committee team for the excellent report. It is fantastic that it sets out effectively the importance of early intervention in the first 1,000 days if we are to make the greatest difference and have the greatest impact on reducing inequalities.

Will the hon. Gentleman join me in paying tribute to a group in my constituency, the Dartmouth Nurslings, for its work to support breastfeeding mothers through peer-to-peer support? Will he touch on the evidence about the important of breastfeeding in the first 1,000 days of life, and how effective it can be? Will he also join me in hoping that we can reduce some of the fragmentation that means there is not a consistent level of support across the country? I hope that such groups will receive the support they deserve.

[Mr Virendra Sharma (in the Chair)]

Order. Hon. Members should keep their questions short.

[Dr Paul Williams]

I absolutely join the hon. Lady in commending the breastfeeding peer support workers in Totnes, and those in many other parts of the country—I have met some in my constituency, too. There is a common theme: when services are reconfigured and new services are put out to tender, the people who have devoted a lot of time and effort as volunteers can find themselves excluded. That is partly because of the nature of commissioning and tendering.

The Royal College of Paediatrics and Child Health gave us compelling evidence about breastfeeding. In the United Kingdom, we have some of the lowest breastfeeding rates in the whole of Europe, and there are wide socioeconomic disparities. Investment in breastfeeding support is crucial.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

May I, too, thank the Committee for its excellent report?

As Members are aware, tackling inequalities is part of my brief and, frankly, there is no more obvious place to start than in the very early years. If we can get all children a good start, we will not only be well on the way to making life better for them, but will, as the hon. Member for Stockton South (Dr Williams) has observed, make savings for the taxpayer, too. I encourage him to continue pushing this work. As he is aware, prevention is very much at the heart of this Secretary of State’s agenda, and what we can do in the first 1,000 days is clearly a big part of prevention.

I note that the hon. Gentleman will meet the Leader of the House very shortly. He will find that she is very enthusiastic about and receptive to a lot of the themes that are discussed in this report, so my message—indeed, my plea—to him is this: please carry on with this work.

[Mr Virendra Sharma (in the Chair)]

It is the end of the time for the statement and questions about it. Thank you all very much. We move on to the next debate.

Organ Donation (Deemed Consent) Bill

Virendra Sharma Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Madam Deputy Speaker, for giving me the opportunity to speak in this very important debate. I congratulate my hon. Friend the Member for Coventry North West (Mr Robinson) on bringing this Bill forward in the Chamber and on raising our awareness of the issue. I also thank and congratulate my colleague, my hon. Friend the Member for Sunderland Central (Julie Elliott), on her very emotional, personal and courageous contribution to the debate. I am quite confident that the public and Members will have taken note of it.

Others have spoken at length about the importance of raising donation rates. I have my own personal reasons for supporting the move: my younger brother has been waiting for more than five years for somebody, somewhere, to donate a kidney. He has dialysis four times a week. Another very close personal friend is also going through the same difficult times. Therefore, I have those reasons for supporting the Bill, as well as my own personal views, and a moral commitment to the cause.

As many colleagues have said, more than 6,000 people are still actively waiting for a transplant in the UK. Three people die every day because they cannot get the transplant that they need, ruining family lives across the country. Over the past 10 years, the number of donors has increased by 75%, which is fantastic and has saved countless lives, but there is still a great shortage both in the UK and—as we are a global community—internationally as well. If we go to any country, we are asked, “What are you doing in this field?” I am glad that, once again, Britain is leading in this field, so that the rest of the world can learn and pick up its ideas from here.

Only a third of eventual donors are registered to donate at the time of their death, and this number is even lower among the black, Asian and minority ethnic communities. BAME patients fare far worse than other patients. They will, on average, wait six months longer for a transplant than a white patient. I do apologise if my language is not politically correct, but for convenience, I will use black and white in this case. BAME people face the struggle of comparatively rare blood and tissue types and compatible organs. Although the overall number of donors has increased by 75%, BAME donations have only increased by less than 7%—a fraction of the rate for white people—and that has translated directly into deaths.

There is still a problem with public education and awareness. The families of minority populations are also less likely to consent to organ donation when asked after death: 64% of BAME families refuse permission for donation compared with only 43% for the rest of the population. An opt-out system rather than an opt-in system will increase the likelihood that donors of the same blood and tissue types are available to members of the BAME community. Increasing the number of compatible organs on the transplant list could save thousands of lives each year.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the hon. Gentleman for giving way. He is making some extremely important points in his speech, and they are ones that I am particularly conscious of and really want to tackle. Let me amplify some of his points: of the 6,400 people on the waiting list, more than a 1,000 are from Asian backgrounds and 800 are black. I just wish to endorse his point that, in terms of racial fairness, we really need to increase donation from those parts of the community.

[Mr Sharma]

I am glad and thankful for the Minister’s very positive intervention and for the information that she has provided to Members in the Chamber. Activist groups and campaigners, such as the National BAME Transplant Alliance, support the move to an opt-out system, because it will ultimately save more lives across our diverse country.

[Kelvin Hopkins (Luton North) (Ind)]

I support everything that my hon. Friend has said. Like him, I represent a constituency with a very high proportion of people from BAME communities. There are not just fewer people consenting to donate their organs, but considerably higher rates of heart disease among these communities. Therefore, particularly for heart transplants, it is very important that we get as many people from BAME communities on to the list in future.

[Mr Sharma]

I thank my hon. Friend for that intervention. I was going to raise that matter myself, so I am thankful that he both highlighted and supported it.

Issues such as diabetes, high blood pressure and hepatitis are more common in BAME communities, making their members more likely to need transplant organs. BAME patients make up a third of the kidney transplant waiting list and wait an average of a year longer for a transplant than their white counterparts. Just one person can save or improve up to nine lives. One tragic death can give life to so many through organ donation and even more if they donate tissues as well.

Although ethnic minorities constitute only 11% of the UK population, they make up nearly a quarter of transplant waiting lists, and only six out of every 100 people signed up to the NHS organ donor register are from BAME communities. Opt-out can and will save lives. It respects religious differences and takes away no freedom of expression or belief. Countless constituents of mine have written to urge me to come to the House today to support the Bill, and I am proud to do so and to lend my support to my hon. Friend the Member for Coventry North West.

--- Later in debate ---

[Mr Virendra Sharma]

I am sorry to interrupt my hon. Friend while she is making such a strong point. One of my constituents rang me after my speech to suggest first that Members of Parliament could run roadshows, along with members of their local voluntary sectors, to raise awareness and to encourage people to register as donors and secondly that we could encourage the local education system to enable schools and parents’ associations to run awareness sessions. Would that not be the best way of both raising awareness and engaging with communities?

[Mrs Hodgson]

Absolutely. I think that schools are an ideal forum for a number of public health awareness messages on a host of issues to be delivered to young people.

Perhaps the solution to all these concerns has been developed in the two countries where the opt-out system is working well, Wales and Spain. In Wales, the system came into force in 2015. The law sets out that those who live and die there will be deemed to have given consent for their organs to be used unless they have explicitly said otherwise. Before that change in the law came into effect, a public awareness campaign alone resulted in an increase in the number of organs transplanted from 120 to 160. That was not huge, but it was a definite start. NHS organ donation statistics show an 11.8% increase between 2014-15 and 2016-17 in the number of people in Wales opting to donate their organs. That was the highest increase among England, Wales and Scotland. Although there has not been a notable change since the law came into effect, it is worth remembering that—as we heard earlier—Spain took almost 10 years to increase organ donation rates significantly.

Spain has had a soft opt-out system for 39 years. It is considered to be the world leader in organ donation and currently has the highest organ donation rates in the world. In Spain, consent is presumed in the absence of any known objection by the deceased, but family consent is still sought, as it would be here, we hope. In the immediate aftermath of this change in law, there was only a small increase in the number of organ donations and transplants, but there was a dramatic increase after 1989, when the Spanish Government made a big push to reorganise organ donation, as a result of which there was a medically trained transplant co-ordinator in every hospital by 1999.

It is unlikely that we here in the UK will have an identical opt-out system to Spain’s, but these are just two examples showing how an opt-out system can work and improve the lives of thousands of people waiting for an organ transplant. This also gives us the opportunity to learn from past experiences, to ensure we get it right in this country, which I am sure we all seek to do. I know the Government will be working to ensure that that is what happens, and the Opposition are passionate about world-class health services, but, as the NHS Blood and Transplant service made clear, we

“will never have a world-class donation and transplantation service if more than 4 out of every 10 families say no to donation.”

Some 90% of people surveyed by the British Heart Foundation say they support organ donation, but just 33% of those surveyed are on the NHS organ donor register. It is clear from what we have heard today that more people need to be on the organ donor register, and these difficult conversations must be encouraged, so that more lives can be saved.