Prescription Charges: Long-term Health Conditions

Christina Rees Excerpts

Monday 11th March 2024 Westminster Hall

[Christina Rees (Neath) (Lab/Co-op)]

I beg to move,

That this House has considered e-petition 608237 relating to prescription charges for people with chronic or long-term health conditions.

It is always a pleasure to serve under your chairpersonship, Dame Maria. I am honoured to deputise for my hon. Friend the Member for Gower (Tonia Antoniazzi) by reciting her excellent speech to open the debate. She was scheduled to move the motion on behalf of the Petitions Committee, but has duties elsewhere. To use a rugby analogy, as my hon. Friend is a rugby player, I have come off the substitutes bench to replace her. But that is all I will say about rugby, having spent the train journey to Paddington this morning with lots of very happy French rugby fans who got on the train at Cardiff still celebrating their victory over my beloved Wales yesterday.

On 6 March last year, my hon. Friend the Member for Gower opened a debate on e-petition 594390, relating to prescription charges for people aged 60 or over. Many of the issues covered then are also applicable in this debate. I pay tribute to Mia, the petition’s creator, who spoke to the Committee recently about her motivations behind starting it. Only in her 20s, Mia is already feeling the impact of prescription charges for the medication that she needs to alleviate the symptoms of her multiple sclerosis. Having been diagnosed so young, and with the situation as it currently is, she faces paying for her medication for decades.

Following her diagnosis, Mia has become part of an extensive online community of people with long-term and chronic health conditions. The common feeling of exasperation at paying for medication inspired her to create the petition. Based on the conversations she has had, Mia listed in her petition a number of conditions that are not exempt from prescription charges, including MS, endometriosis, inflammatory bowel disease, postural orthostatic tachycardia syndrome, depression, anxiety and Ehlers-Danlos syndrome. Other conditions that are not exempt and have been the subject of their own e-petitions include cystic fibrosis, sickle cell anaemia, Crohn’s and colitis, along with—this is not a specific condition but a group of people—those who have undergone organ transplantation.

For many of the conditions included in Mia’s non-exhaustive list, there is no gold-standard medication that alleviates symptoms completely. Mia spoke to me about having to try new medications, often knowing full well that they may not work but still having to pay for the pleasure. Perhaps to rub salt in the wound, Mia was told that a potential side effect of her chemotherapy treatment for MS could be that she developed hyperthyroidism. Should that happen, the hyperthyroidism would make her exempt from prescription charges.

I also thank Dan, who the Committee spoke to about his petition on behalf of organ transplant patients. Dan had a liver transplant after having relied on medication since the age of 13 and spent years paying for the medication that kept him alive. Now, he has to take medication to prevent his body from rejecting the new liver and allow him to go back to work, and he still faces paying for prescriptions.

The crux of the issue lies in the criteria for the medical exemption certificate. I find it astonishing that the list of exempt conditions has not been reviewed since 1968, apart from the inclusion of cancer patients in 2009. Treatments have come on in leaps and bounds since the 1960s, as has our knowledge of medical conditions that were once unknown or not spoken about. That the exemption list has not moved with the times is frankly baffling.

The question that came up time and again in conversations about the petition was, “Why were the conditions on the exemption list chosen over others?” That is not to say that the conditions on the list do not belong there, and nobody the Committee spoke to suggested that x condition deserved to be there over y condition; rather, it is to ask on what basis conditions were chosen for the list. What was the evidence for inclusion and for exclusion? I would really appreciate any light that the Minister can shed on that.

Perhaps the list was based on survivability, which has, thanks to decades of improved research, improved by leaps and bounds. To give an example, in 1968 children with cystic fibrosis were not expected to live into adulthood. With medication and physiotherapy, the prognosis now is much different from what it was nearly 60 years ago. However, cystic fibrosis remains life-threatening, and those living with it still face having to pay for the medication that keeps them alive. Over the decades, research has improved our understanding of chronic and long-term health conditions and in turn improved the length and quality of life for so many people. Surely it is only right that the exemption list grows with this knowledge.

The UK Government need to rethink their approach to prescription charges, because their consequences can be dire. Recently, Donna Smitheman has been campaigning for free asthma inhalers, following the tragic death of her 25-year-old son Jordan. Jordan was not able to afford his inhalers, and questioned why he had to, given that he had not asked to have asthma. Donna has taken action because she believes that access to life-saving medication such as inhalers should be a right and not a privilege.

Research published in 2023 by the Prescription Charges Coalition found that almost one in 10 respondents had skipped their medication as a result of the cost. As a result, 30% of those people said that they now suffer with other physical health problems. The Committee spoke to Lindsey Fairbrother, a pharmacist who had conversations with people who were not taking the medication they needed because of its cost. A similar observation was made by Ellen Schafheutle, who has done qualitative research into the subject. She said that her one wish for this debate was that we stress the negative impact of people forgoing medicine because of the cost.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is doing a great job of setting out some of the challenges that people with long-term conditions face. Does she share my concern that this situation has a damaging impact not only on people’s health—she rightly says that people have a right to receive prescriptions and improve their health—but potentially on the national health service, because if people skip their medication because they cannot afford it, they will end up making more trips to a GP or to accident and emergency, and potentially have more hospital stays, which would be extremely expensive for the health service and would, of course, have a damaging impact on them and their families?

[Christina Rees]

I thank my hon. Friend for her important intervention. I completely agree with her and will come to that issue later in my speech. I will pass on her support to my hon. Friend the Member for Gower, who I am sure will appreciate it. The UK Government have stated that the revenue raised from prescription charges goes back into the NHS. However, given the cost of enforcing the list of exemptions, as well as the longer-term financial impact on the NHS of people forgoing medication, that argument seems to be a false economy.

Parkinson’s UK has long campaigned for a change to prescription charges for the people it represents, and research published in 2018 found that scrapping the charge for people living with Parkinson’s would save the NHS money. The UK Government’s written response to the petition stated that those with long-term conditions could save money by utilising the prescription prepayment certificate. Although that is a good option for many, it is still too much for some in a cost of living crisis when people are living pay cheque to pay cheque.

We should not forget that it is somewhat of a postcode lottery, as England is the only UK nation where prescriptions are not free. When the Welsh Government abolished prescription charges in 2007, they cited evidence that some people with serious chronic conditions could not afford their prescriptions and were choosing to have only part of them dispensed to reduce the cost. It was seen as a long-term investment in people’s health, with the added bonus of being cost-effective because it prevented further complications arising from people not taking vital medications, which would increase costs to the NHS.

According to the Government, 95% of items dispensed in 2023 were exempt from prescription charges, but that proportion is entirely useless given that exemptions do not apply to medicines. It tells us absolutely nothing about who is exempt. Perhaps the Minister could enlighten us with some statistics on that. Mia stated that although the UK Government’s response did not surprise her, she was still gutted by it. She did not feel that it answered any of her concerns, and I must agree with her.

Of course, if we lived in an ideal world, England would catch up with Northern Ireland, Scotland and Wales. Exemption lists are inherently unfair. Expanding the medical exemption list is not a perfect solution to the cost of prescriptions, but we need to start somewhere. I urge the Minister and the UK Government to listen to the thousands who have signed petitions relating to prescription charges. The NHS is under immense pressure, but people’s lives are truly on the line. I give you my sincere thanks, Dame Maria, on behalf of my hon. Friend the Member for Gower.

--- Later in debate ---

[Christina Rees]

On behalf of my hon. Friend the Member for Gower (Tonia Antoniazzi), I thank my hon. Friend the Member for Nottingham South (Lilian Greenwood) for her important intervention; my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), the spokesperson for the official Opposition; and the Minister. I am sure that my hon. Friend the Member for Gower will read the debate in Hansard with great interest. Finally, I thank you, Dame Maria.

Question put and agreed to.

Resolved,

That this House has considered e-petition 608237 relating to prescription charges for people with chronic or long-term health conditions.

Healthy Start Scheme

Christina Rees Excerpts

Wednesday 7th September 2022 Westminster Hall

[Christina Rees (in the Chair)]

I will call Kate Green to move the motion, and then the Minister to respond. There will not be an opportunity for the Member in charge of the debate to wind up, as is the convention in 30-minute debates.

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

I beg to move,

That this House has considered access to the Healthy Start scheme.

It is a pleasure to introduce the debate and to see you in the Chair, Ms Rees. I start by praising Healthy Start. The scheme provides support to expectant mothers who are more than 10 weeks pregnant, and to parents and care-givers who are responsible for at least one child under the age of four. Healthy Start vouchers, which have a value of up to £4.25 a week, or £8.50 a week for those with a child under one, entitle parents in receipt of certain social security benefits to fruit and vegetables, cows’ milk, infant formula and pulses. The vouchers also enable mothers to access vitamins from pregnancy until their child reaches the age of one, and enable children to access them from birth until the age of four. Originally, the scheme used paper vouchers, but since September 2021, families who were already enrolled on the Healthy Start scheme have been moved on to prepaid cards. Since the end of March 2022, prepaid cards have entirely replaced the paper vouchers.

Healthy Start has an important role to play in helping to ensure that mothers and young children have a nutritious diet. It is effective: research has found that participating families increase their spend on fruit and vegetables. The Minister will understand how crucial a healthy diet is for pregnant and new mothers, babies and young children. The British Medical Association has highlighted the effects of poor nutrition during pregnancy: adverse health and social outcomes, premature birth, low birth weight, shorter life expectancy and a higher risk of death in the first year of a child’s life.

NHS PPE Supply Chains: Forced Labour

Christina Rees Excerpts

Thursday 14th July 2022 Westminster Hall

[Maria Caulfield]

I am very happy to do that. While I have been able to highlight what the NHS is doing, some good cross-departmental work is also being done on procurement and on identifying where slavery is happening both globally and domestically. I highlighted the evidence from Mo Farah this week. We must not take it for granted that slavery is not happening in this country. I am happy to write to the shadow Minister and those who have taken part in the debate to highlight the work that is happening across the Government. It has to be a cross-Government initiative to make sure that we are all working together to root this out. Much remains to be done to ensure that we deliver the message that modern day slavery is completely unacceptable. I look forward to working with MPs across the House to make sure that we all do our bit.

[Christina Rees (in the Chair)]

Jim Shannon, would you like a couple of minutes to wind up?

Healthcare: Carshalton and Wallington

Christina Rees Excerpts

Wednesday 30th March 2022 Westminster Hall

[Christina Rees (in the Chair)]

I will call Elliot Colburn to move the motion, and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Elliot Colburn (Carshalton and Wallington) (Con)]

I beg to move,

That this House has considered healthcare outcomes in Carshalton and Wallington.

It is a pleasure to serve under your chairmanship, Ms Rees. It is also a pleasure to be here, because it is just over two years since I made my maiden speech in the Commons Chamber, when the House was debating the health and social care element of the Queen’s Speech, and I made it abundantly clear that afternoon that health and social care outcomes in Carshalton and Wallington would be a top priority for me, as they were for my constituents.

I want to read out some statistics that demonstrate why the issue is so important. I am particularly concerned about four areas of health, beginning with cancer. One in two, or 50%, of us will receive a cancer diagnosis in our lifetime. The London Borough of Sutton is very lucky to be home to the Surrey branch of the Royal Marsden and the Institute of Cancer Research. The plans for the London cancer hub will be truly groundbreaking in the UK and will deliver better cancer outcomes for all patients.

Dementia is another issue I am concerned about, after having my own family experience with it. There will be a predicted 25% increase in the number of people diagnosed with dementia in Carshalton and Wallington by 2030, which presents a huge challenge for health and social care services.

My third concern is obesity, which has got progressively worse—I have had my own struggles with obesity, having once been as heavy as 21 stone—so we need a decent obesity strategy to tackle the problem from a young age. My fourth concern is mental health. Throughout lockdown we saw how the rates of mental health cases spiked as people struggled to cope with isolation.

I am sure the House will be aware of my many contributions on health and social care issues, and one of the topics I raise most—unashamedly—is my local hospital, St Helier. I offer no apology for doing that, and it should come as no surprise that St Helier will feature as a major part of my speech today.

I was born at St Helier, as were most of my family. The hospital and the staff have supported my family and me through some of our darkest days and have saved the lives of people I know. They also saved my life at Christmas. It is difficult to articulate just how grateful I am, and the residents of Carshalton and Wallington are, for that local hospital and all the amazing work it does.

St Helier opened its doors in 1941, during the second world war. Despite a few bombings—and the birth of a former Prime Minister—the building has barely changed. At the time of construction it was considered a modern 1930s design, but almost a century later the way that we practise medicine has developed and improved, and the buildings are now anything but modern. Over recent years, particularly throughout the last two years of the pandemic, the limitations of that old building have become glaringly obvious. For example—this is one of the worst examples—some of the lifts are too small to fit a modern-day hospital bed, so money has to be spent on transferring patients from the back of the building to the front via ambulances.

When I made my maiden speech in the Chamber and spoke about St Helier, I never imagined that I would be serving as an MP during a global health pandemic. St Helier was hit hard by covid-19, as were all our hospitals across the country. I thank the staff for their tireless efforts and their uphill battle with the limitations of older facilities in trying to tackle the pandemic. There was a very worrying moment in the winter of 2020 when oxygen supplies nearly ran out, but thanks to the innovation and enthusiasm of the team there the situation was quickly resolved.

Over the 20th century, St Helier helped to raise our local care and health services to a much higher plane, but it is now time to take that care even higher. That is why I am incredibly grateful that the Government are using the nation’s resources to do just that by investing £500 million—half a billion pounds—in the NHS in Carshalton and Wallington. That does two things: it protects St Helier and Epsom hospitals, allowing them to make the improvements needed to become more modern medical facilities, and it allows us to have a third brand-new, state-of-the-art and built-from-scratch acute care hospital in Sutton. That record level of investment will do wonders to improve healthcare outcomes for local residents, so I am incredibly grateful to the NHS and colleagues at the Department of Health and Social Care who developed the plan and allowed the funding for it to come forward.

I want to make it clear that, for the first time, the plan was developed by our local NHS services. We have heard so many times in this place about reorganisations of the NHS or plans for the NHS coming from politicians and bureaucrats, but this was an NHS-led initiative. The NHS came to the Government and asked for the funding, and I am so pleased that the Government listened.

It is therefore disappointing that my Lib Dem opposition in Carshalton and Wallington have turned their backs on St Helier and refused to support the £500 million investment. I would like to read out a statement I received only yesterday from a Lib Dem councillor, who does not want to be named but who is retiring and not re-contesting their seat at the elections in May:

“Hi Elliot, I wanted to pass this onto you as I think you’ve actually done a great job since taking over as the MP, but please don’t tell anyone I sent you this.

As you may know, I am standing down as a Lib Dem councillor. I was promised a lot by the party when I agreed to stand. I was told it would be easy and I’d be well paid, but it’s been hell frankly and the party’s been no help at all. I can’t keep asking my family to go through this.

I also cannot support my party’s u-turn on St Helier. We were all so excited when we heard the £500m was being announced for St Helier, but we were told we had to campaign against it as St Helier is one of the only reasons people used to vote Lib Dem.

This experience has not been what I was led to believe. I feel betrayed, let down and hurt.

Again, please don’t pass this onto anyone—they can be very angry and vindictive, anyone who raises any issue get shouted down, but keep up the good work, you have my support!”

That is a very striking and brave statement for someone to make, particularly to a member of an opposing party, and it demonstrates why it is so important to invest in St Helier Hospital.

I want to talk about the positives of the investment and why it is such good news. The new specialist emergency care hospital will treat the sickest 15% of patients in my constituency—those normally arriving by ambulance—and the specialist team will be available 24 hours a day to diagnose patients more rapidly, start the best treatment faster and help patients recover more quickly. St Helier and Epsom will also remain open 24/7, with updated and improved facilities. This will be absolutely ground-breaking for health and social care outcomes in Carshalton and Wallington. I cannot say how long we have waited for investment to come into St Helier. Time and again I have seen the threat of closure and loss of services, such as A&E and maternity going to St George’s, Tooting or Croydon, but they are now staying in the London borough of Sutton and can treat local patients, which is absolutely incredible news.

To reiterate, the purpose of the plans is to improve local health outcomes, which all my local residents want to see. Our priority has always been the outcomes for people’s health. Since the covid-19 pandemic hit, the NHS has slightly amended its plans for the project. It has learned from the pandemic to future-proof health and social care against future shocks. The new hospital ward designs will increase ventilation, and single room occupancy rates have gone up, which will help to reduce the risk of disease transmission.

In terms of timelines for the new project, a planning application is due to be submitted later this year. Over the next three years, some of the planned improvements will begin to be implemented at St Helier, including the building of a new pathology centre and a nursery. From 2025 onwards, the plan is to build a new main entrance to St Helier, to improve accessibility, and a new multi-storey car park, as well as to make major internal changes to A and D blocks and other improvements. As things stand, the new specialist hospital is due to open in 2026.

I have a number of quotes from local NHS professionals on why these changes are so important. When the independent reconfiguration panel last year backed the proposals for a new hospital and upgrades to Epsom and St Helier, it emphasised the need to expedite the project, stating:

“The problems facing the Epsom and St Helier University Hospitals NHS Trust are real and require urgent attention…The Panel understands the heightened sense of uncertainty created by Covid-19 but does not believe the interests of local health services will be served by pausing—rather work should proceed on the basis that there may well be benefits should another pandemic arise in the future.”

Commenting on the confirmation of the investment, Arlene Wellman, the chief nurse at Epsom and St Helier said:

“What covid-19 has shown the NHS is that for all our communities survival rates are higher if specialist hospital staff work together in one team, in one place to care for the sickest patients around the clock”.

Dr Andrew Murray, a GP and clinical chair of NHS South West London clinical commissioning group commented:

“Covid-19 has shown that there’s no time like the present to invest in our hospitals. Now more than ever we need to ensure the right healthcare services for local people”.

Finally, Surrey Downs integrated care partnership clinical chair and GP, Russell Hills, said:

“This pandemic shows we cannot afford to delay improving and modernising our local health services for the benefit of both patients and staff—and the independent analysis of feedback shows there is clear support for this vital investment.”

It is clear that the £500 million investment in our local healthcare system is much needed and very much welcomed by the NHS.

I hope the Minister will be able to provide an update on work on the project, which should be expedited and delivered as soon as possible. As always, I am more than happy to meet her and her departmental colleagues to discuss the issue, alongside my hon. Friends the Members for Wimbledon (Stephen Hammond), for Sutton and Cheam (Paul Scully) and for Reigate (Crispin Blunt), who have been fighting for this project longer than I have been in the House.

Unfortunately, attempts to frustrate the delivery of this record investment will no doubt continue for reasons of political point scoring. Nevertheless, I am not deterred, and I hope the Government will not be deterred. I am proud of what we are trying to achieve—prioritising health outcomes above everything else—so let us get on with the job and raise the plane of health and social care delivery, which has been almost a century in the making.

Smoke-free England

Christina Rees Excerpts

Tuesday 29th March 2022 Westminster Hall

[Christina Rees (in the Chair)]

I will call Sir Charles Walker to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Sir Charles Walker (Broxbourne) (Con)]

I beg to move,

That this House has considered progress towards a smoke-free England.

I will start by reading a couple of paragraphs from an excellent Government document published in July 2017, entitled “Towards a smoke-free generation”. I will not detain the Chair too long, but there are a few sentences that I want to read into the record. The document says:

“Over 200 deaths every day are still caused by smoking…Smoking rates have remained stubbornly higher amongst those in our society who already suffer from poorer health and other disadvantages. Smoking rates are almost three times higher amongst the lowest earners, compared to the highest earners…Smoking accounts for approximately half the difference in life expectancy between the richest and poorest in society. This injustice in the variation in smoking prevalence can be seen across England; from places where adult smoking is as low as 5% to others where smoking remains above 25%. The prevalence remains even higher in people with mental health conditions, where more than 40% of adults with a serious mental illness smoke. We want to address this. Our vision is nothing less than to create a smokefree generation…the government will provide leadership and guidance on the most effective interventions.”

There we have it: a bold statement of intent. So what does a smoke-free 2030 look like? First, it is not smoke-free. When we talk about a smoke-free 2030, we are actually talking about 5% or less of the adult population smoking—that is recognised by The Lancet. Currently, more than 14% of the adult population smoke, and it could actually be higher than 14%, because lockdown may have increased the prevalence of smoking as people turned to cigarettes as a way of releasing and relieving stress. Cancer Research UK is not optimistic about the 2030 date, which will not come as a surprise to anyone here. Its best guess is that 2037 is when we will achieve 5% or less, and I am afraid the general view is that 2037 now looks optimistic.

To put it in context, what is 200 deaths a day? That is 75,000 deaths a year and, on top of that, 500,000 admissions to hospital every year for smoking-related illnesses. Over 10 years, 750,000 people will die from smoking. That is approximately the population of Birmingham every 10 years, and 5 million people will be admitted to hospital.

The Government touch on the huge disparities in smoking between richer and less well-off areas. In some of the most deprived wards in seaside towns in the north-west, smoking rates are above 22%. In the leafy parts of Surrey, they are less than 5%—in essence, parts of Surrey have achieved smoke-free status. What does 22% versus 5% look like? That translates into about an eight-year differential in life expectancy. Of course, not all that eight-year differential will be linked to smoking but, as the Government identified in their report in 2017, about 50%—four years—of that differential will be linked to the fact that more people smoke in more deprived areas than wealthier ones.

Look, the Government have made great strides. I will not be churlish with the Minister—I would not be churlish with her, because she is a very nice woman and she is very committed to this cause, which is more important than being nice.

I understand that a pack of cigarettes now costs more than £10, although that is not something I have bought for 17 years. Some might be pushing £14, so this is becoming an expensive habit. Even at that price, 14% or more of the population are smoking. We are down to some really tough nuts to crack, if we want to reach that 5%. I remind the Government of the part of the report entitled, “Backing evidence-based innovation”:

“Despite the availability of effective medicines and treatments to support quit attempts, the majority of smokers choose to quit unassisted, by going ‘cold turkey’. This has proved to be the least effective method…The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The Government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.”

Surgical Fires in the NHS

Christina Rees Excerpts

Thursday 16th December 2021 Westminster Hall

[Christina Rees (in the Chair)]

I remind Members that they are expected to wear face coverings when not speaking in the debate. That is in line with Government and House of Commons Commission guidance. I also remind Members that they are asked by the House of Commons to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre on the estate or at home. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of preventing surgical fires in the NHS.

It is a joy to see you in the Chair, Ms Rees, for the third time this week, and to be here myself to make a contribution to the debate. I am pleased that other hon. Members are present: the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar); the shadow Minister, the hon. Member for Ilford North (Wes Streeting); and the Minister. It is no secret that I am very fond of the Minister. She and I have worked together in the House on many health issues, and I very much look forward to her response. This topic is of significant importance, so I am glad to see other Members in the Chamber to make what I am convinced will be significant contributions.

As Members are aware, health has been my portfolio in this House for quite some time—almost 10 years—which means I have been exposed to some of the more challenging issues to face the healthcare system across the United Kingdom. Today’s discussion is about one of those: surgical fires in operating theatres. It is certainly one of the most concerning issues that I have come across in my time in this House. Did I know much about it? I probably did not, but once it was brought to my attention in this place and back home in Northern Ireland, where it is a devolved matter and the responsibility of a Minister in the Assembly, I became aware of it.

I spoke to the Minister present before the debate, and she has some of the questions in my speech from my staff and others. I very much look forward to her response to the questions that I will pose today. First, however, I pay tribute to the work of the expert working group on the prevention of surgical fires, who brought the matter to my attention and whose report on the prevention and management of surgical fires I recommend to the Minister and all Members of the House. It is a thorough and detailed report, which encapsulates the issues that we will discuss in the debate and gives the Minister and her Department the opportunity to respond, I hope in a positive way.

I had the pleasure of chairing the parliamentary launch of the working group’s report in November last year. I am sure that their report and campaign will feed into much of the debate—it certainly will through my comments, and I am pretty sure it will through those of other hon. Members as well.

I want to underline what we mean by surgical fires and the serious dangers they pose to patients and clinicians alike. A surgical fire is a self-descriptive name: it is a fire that occurs during surgery in an operating theatre. In order for a surgical fire to occur, three elements must be present: the ignition source, the fuel and the oxidiser. Ignition sources include electrosurgical units, fibre-optic light sources and lasers. The fuels regularly include alcohol-based skin prepping agents that have been used in excess or applied inappropriately. The oxidiser is simply an oxygen-rich environment in which nitrous oxide is present, alongside the oxygen. Those are the three ingredients, or the three elements that are the reason for surgical fires. I do not believe that it is impossible to address the issue, through the Department and the Minister’s response, so that we can ensure that such fires do not happen.

The statistics, which the people working in the background have gained from across the whole United Kingdom, highlight just how worrying this matter is. The report states:

“Injuries caused by a surgical fire most commonly occur on the head, face, neck and upper chest.”

By and large, that is where operations focus on, and a fire can leave victims with debilitating pain and lifelong physical and psychological scarring—I will later give the example of someone whom I met in this House at a presentation that we did some time ago. A surgical fire can also cause harm to operating theatre staff, who are exposed to similar risks. It can affect not just the patient on the table who is having the operation, but the staff, so there is a dual responsibility for safety—obviously for the patient, but also for the staff.

Like so many members of the public and those of us present for the debate, I had absolutely no idea that surgical fires posed a threat to patients across the United Kingdom, and I was unaware of the extent of the injuries that they can cause, so I am extremely pleased that this subject is being debated, even though we are in the graveyard slot. We are going into recess after today, so most Members have probably left. That is unfortunate, because others had wished to participate but could not stay. The omicron variant has also been part of the problem, and that is perhaps the case for the shadow Minister who was originally going to participate in the debate but could not do so. We are ever mindful that although we may be small in number, the debate is none the less important, and we want to put that on the record.

Today’s debate is about raising awareness about the seriousness of surgical fires and pushing for the next steps to ensure that they no longer happen. Ultimately, that is the goal of the debate—to ensure that precautions are taken so that surgical fires do not happen. What I will outline in my contribution will helpfully enable the Minister and her Department to take the necessary action.

I am sure that many Members will be asking the same question that I did when this issue was first brought to my attention: how common are surgical fires? That is a question that many of us ask. The reality is that nobody knows entirely, but the expert working group sent out a freedom of information request to trusts, health boards and relevant bodies across the United Kingdom. Although there were significant discrepancies across all organisations, the NHS England acute trusts and Welsh health boards stated that they recorded some 96 surgical fires between 2010 and 2018. The report states:

“A search of the National Reporting and Learning System (NRLS) data from between 2004 and 2011 identified just 13 reported surgical fires.”

The important point is that, by comparison,

“NHS Resolution claim to have been notified of 631 clinical negligence claims relating to surgical burns to patients”

between 2009 and 2019. NHS Resolution also claims to have paid out £13.9 million

“in damages and legal costs on behalf of NHS organisations.”

The data that some of the trusts and health boards hold as their evidential base indicate to me that the issue is bigger than many people thought. The fact that some £13.9 million has been paid out in damages and legal costs emphasises that point with a strong evidential base. I am sure that the figure is still a stark underestimate of the scale of the problem, and not all incidents will have been recorded. I suspect the number of claims could be bigger than 631, and that does not even account for all the near-misses that may have occurred in operating theatres across the United Kingdom.

According to a survey by the Association for Perioperative Practice, which is one of the largest membership organisations for operating theatre staff, almost half of its members have personally witnessed a surgical fire—again, an evidential base to prove that this issue is like picking at a scab, because the evidential base and examples are far-reaching and quantitative. There is no question but that there is a clear and obvious discrepancy in how surgical fires are reported, which raises questions about the true number of such incidents.

One of the key questions is what reason is behind the large discrepancy in reporting and why the number of surgical fire incidents that occur each year cannot be accurately quantified. The answer is quite simple: it is not mandatory for trusts to report these events when they take place. I am astounded that that is the case. There is evidence to show that £13.9 million was spent in pay outs for damages and legal costs, and that there were 631 fires. How can it be possible that it is not mandatory to report when someone is set alight during surgery? It is bound to be a fairly dramatic situation. These figures do not even cover the near-misses that must occur on a regular basis.

As the Minister may know, over the past year I have tabled a few parliamentary questions, asking the Government to provide an answer about the number of surgical fires that occur every year, but each time they have been unable to do that. I find it concerning that the Government accept that surgical fires are an issue within the NHS but they still do not know the true scale of the problem. Such is the magnitude and severity of this issue that I would have thought the Government might respond. I say that very respectfully, which is my way of doing things, Ms Rees; when I ask questions, I ask them both to get the answer and to improve the situation. That is probably why I always see the glass as half full, rather half empty. I look to the Minister for a response on that.

The Government are still not monitoring or reporting issues that threaten the safety of patients in the UK. This is also a structural problem that requires proper education and training, and puts in place the necessary protocols to mitigate and reduce the risk as much as possible. One would assume that trusts across the country all have protocols in place to prevent such fires from occurring, but I am sad to report that that is not the case.

According to research by the expert working group, which examined specific protocols and training programmes addressing surgical fires in local NHS trusts, only a limited number of trusts across the UK actually have surgical fire protocols. I think it is vital that they should have them, but many rely on general fire safety guidelines, where there is often no mention of surgical fire risk and prevention processes. Again, I look forward to the Minister’s response about what protocols and safety measures can be put in place.

According to a survey by the Association for Perioperative Practice, over half the respondents reported not having surgical fire protocols to date, while almost two thirds reported that their organisation did not provide training courses or education for operating theatre healthcare professionals on preventing surgical fires. Again, there has to be a clear change of focus among healthcare professionals to ensure that this issue is addressed.

A third of respondents reported receiving training and education, and that training included both high-risk management courses and more generic fire safety training, which was more reactive than preventative. I am a great believer in early diagnosis and preventative measures, rather than reactive measures, so I hope that as a result of this debate we will have measures put in place to address those issues. The training is clearly not adequate for the seriousness of the danger at the moment. The lack of prevention and management protocol is completely unacceptable and represents a clear and present danger to all patients who undergo surgery in the NHS.

It is truly astonishing that surgical fires are already recognised as a safety concern in other countries. I will give examples of those, because if other countries can see the risk, difficulty, impact and severity of this, then I know that our NHS, which we all treasure and love, can deal with the issue equally well, if not better. Yet there is insufficient guidance about how to prevent and manage surgical fires in the UK.

In the United States, the Food and Drug Administration already provides a list of specific recommendations on reducing the incidence of surgical fires. These include conducting a fire risk assessment at the beginning of each surgical procedure, which seems to be logical. Again, maybe the Minister can give us some indication of whether that is a procedure that the NHS will adopt. Those recommendations also include additional safety procedures such as planning and practice on how to manage a surgical fire, including how to use carbon dioxide fire extinguishers. Are those things available in the NHS? They should be, so if not, is there an intention to put them in place? As a result of introducing the necessary protocols, educational tools and reporting systems, the number of surgical fires in the United States has dropped by 71% since 2004. By putting the right strategy and safety measures in place, we reduce the threat. That is my goal today, and that is the approach we should be trying to emulate within the NHS.

The expert working group’s report made a number of recommendations on the prevention and management of surgical fires. I do not intend to read out the entire report—even though I have three hours, I do not want to put people to sleep when they want to go home—but I want to highlight four of its key recommendations. First, professional associations should explore the value of a national awareness campaign for healthcare professionals. Secondly, education on surgical fire prevention should be mandated in the surgical and perioperative education and training syllabus. Thirdly, NHS England should explore how to evolve the procurement process for sanitation products, in order to reduce surgical fire risk and encourage procurement of proven surgical fire-safe technologies. Fourthly, NHS England should explore the development of a standardised patient safety alert system that aligns the processes and outputs of all bodies and teams, and ensure that they set out clear and effective actions for providers to take on safety-critical issues. If I were to ask for nothing else today, I would ask for those four recommendations to be acted on, because that would be a massive step forward.

It is clear to me, as I hope it is clear to other Members, that effective education and training are the primary means of preventing the incidence of surgical fires. Despite some form of fire safety training being mandatory for all NHS staff during their induction and ongoing employment, that training does not address the unique features involved in preventing or extinguishing a surgical fire. The response to different kinds of surgical fires can differ, as can an individual’s role, depending on who is present at the time. I know that the past year and a half—almost two years—have been extremely difficult due to covid, and that the NHS, the Minister and the Government have other priorities, but this is about prevention. It is about making sure that surgical fires do not happen again, and it is logical to try to do so: it would have stopped that £13.9 million from being paid out in damages and legal fees. Meanwhile, preventative measures and effective management strategies require additional education and training, and the absence of such training currently acts as a barrier to eliminating incidents of surgical fire and ensuring an appropriate response.

As I have highlighted, providing detailed guidance and encouraging the individuals who constitute the perioperative team to consider their role in surgical fire prevention has led to a statistically significant decline in the incidence of such fires in the United States. Their incidence has fallen by 71%—wow! I did not do the mathematics, but if we brought that 631 down by 71%, it would be approximately three quarters of that number. It is clear to me that surgical fire training should be made mandatory across the NHS and the private sector, and should be updated at least every two years. Again, I refer to those four asks: we need to make sure that those matters are taken on board, so that we have a proper system in place for the future as well.

Despite education being an essential method of preventing surgical fires, it is no use if it is not mandated, and if we still fail to tackle the institutional failure to truly record the scale of the problem. Following discussions with the expert working group and others, I call on the Minister to instruct the Centre for Perioperative Care to investigate the possibility of making surgical fires a never event, meaning that they never happen again. We would like to see surgical fires made a never event as part of the CPC’s work on redeveloping the national safety standards for invasive procedures to ensure they remain fit for purpose.

Classifying surgical fires as a never event would require mandatory reporting of incidents or near misses, while also mandating essential education for surgeons and other perioperative staff across all NHS trusts. Even without knowing the details of surgical fires, the name itself suggests they should be a never event. The concept of a surgical fire is terrifying enough that if we asked a lay person whether it should be classified as a never event, they would likely agree that it should never happen—indeed, they would probably be astounded that it even did. Only by classifying surgical fires as a never event can the national safety standards continue to be fit for purpose.

I have been paying keen attention to some of the Government’s responses to my questions about surgical fires over the past year. I realise that the Government have previously stated that they have no plans to classify surgical fires as a never event. Again, I urge the Minister, in the light of the evidential base we now have, to do just that. I note in the latest response to me that the Minister says that it is not possible to make surgical fires a never event because

“there is currently no national guidance or safety recommendations to prevent surgical fires in operating theatres”.

I say respectfully that we need to do that. If we can do that, we can move forward.

I have good news for the Minister—I always try to bring good news, and not just because it is Christmas. The expert working group has already developed national guidelines. Its report made safety recommendations for perioperative staff, and the group is waiting for them to be adopted. What the expert working group has done could be a template for exactly what the NHS needs to do. It has informed me that it is more than willing to pass on its hard work directly to Government. If the Minister is agreeable, I would be happy to have a meeting to exchange those views, and those papers as well, with the Centre for Perioperative Care expediting the process. I believe there is now no reason not to classify surgical fires as a never event.

We should not forget the most important impact of surgical fires: the human impact. As I mentioned earlier, I had the pleasure of chairing the launch of the report last year. During the event, I also had the pleasure and the privilege of listening to a patient who had experienced a surgical fire. He explained to us the impact that the incident had on his life. What happened to this gentleman is quite tragic. I will quote his story, but I will not name him, and I will be careful what I say in relation to him.

He told the group that he had visited the hospital for a routine procedure, but that when he woke up the staff informed him that his body had been set alight during surgery. He told us how he had been burnt on the left side of his chest and upper arm, and of the impact that this trauma had on him. He was not aware of the fire because he was under anaesthetic having an operation. He went on to explain how it had prevented him from continuing his career in social care, which he had been in since the age of 16, because he was disabled as a result of the incident. He explained how it had left him physically and psychologically drained, and how it had left him in pain, unable to carry out simple household tasks such as making a cup of tea—he did not have the stretch or lift in his arm any more. He told us of the impact that the fire had on his family. His partner became his carer and he could no longer spend time with his granddaughter. Having five grandchildren—three girls and two boys—I know how much I enjoy spending time with my grandchildren.

That is a jarring story—one that is all the more shocking and disturbing the more details that are revealed. I am not going to name him because there are legal discussions going on with the trusts involved and because he has nothing but praise for the nurses who have cared for him since the incident. He understands that nobody set out for it to happen, but it happened, and it happened because the precautions were not in place, because there was no safety measures and no training. The so-called never event happened.

He is a very kind man—a gentleman. However, no matter how good the nurses have been to him, it would be remiss of me not to mention how inadequately his situation was addressed. To cause severe harm to a patient is beyond the pale; it is against every medical principle that exists. The NHS and all its staff are tasked with saving life, and that is what they do to the best of their ability. We must not forget the impact on the operating theatre staff, who may also experience a psychological cost from these experiences. It is equally essential that surgeons learn how to give both physical and emotional support to the victims of surgical fires. They are the ones who have suffered most, and surgeons must be empathetic to them and their needs.

What is also concerning is that, despite this serious incident taking place, the hospital appears not to have made the appropriate changes to its systems and protocols. We all learn lessons—every day of my life, I learn lessons; I am not so proud that I do not learn from all those around me and those who I speak to. The patient required follow-up treatment in the same hospital and, on inquiring what had been done to prevent the incident from happening again, was told that nothing had changed; there had been no updates. How disappointing.

As I mentioned, I cannot name the patient, but I pay tribute to his bravery and his determination to prevent this from happening to another person. That is one of the reasons why he told us his story. He wanted to provide us with the evidential basis for what had taken place and to ensure that it did not happen to somebody else. He is truly an admirable person. I thank both him and his partner for sharing their story with me and, ultimately, with everyone in the House and Westminster Hall and with the Minister and her Department.

I am coming to the end of my speech, Ms Rees. I will begin summing up, so that we can also hear from others. I look forward to hearing some thoughtful and insightful contributions from the shadow Ministers and, specifically, the Minister. As I have stated, I hope this debate will bring greater attention to the issue of surgical fires and shine a spotlight on this danger. It is clear to me, from reading the expert working group’s report and patients’ testimonies and from listening to expert guidance, that more needs to be done to prevent surgical fires. That is why I am so pleased to play my part in today’s debate in support the aims of the expert working group.

I hope that in the short time—it feels like a long time perhaps, Ms Rees—that we have been making the case today that it is clear that we are supporting the aims of the expert working group. There needs to be mandatory reporting of both surgical fires and near misses, because until we can effectively quantify the scale of the problem, we cannot effectively address it. Similarly, we need to introduce effective and mandatory education for all surgeons and perioperative practitioners in order to prevent surgical fires from occurring and to ensure that they are effectively managed when they do occur. This can also be done by classifying surgical fires as a never event. NHS operating staff are already aware of the threat of surgical fires, but they have not received the proper support and guidance to ensure that these incidents are prevented.

I therefore hope that our actions today will start the necessary change. Whether we are talking about simple steps such as introducing a checklist to ensure the taking of appropriate preventive measures, such as using the correct antiseptic skin solution, or ensuring the presence of the appropriate tools and equipment for the management of fires, which we should have as a precautionary measure in all operating theatres, these are all necessary steps to ensure the safety of patients and operating theatre staff alike. This is about the patient; it is about the staff; it is about getting it right. If we do not, we will have to confront the reality that many more people will be harmed by our failure to act. Classifying surgical fires as a never event is, I believe, the only way to effectively prevent patients and NHS staff from coming to harm.

I thank hon. Members for attending the debate and ask them to consider the reaction of their constituents if they were asked about surgical fires. If a Member here were asked about this matter, what would he or she want done in relation to it? They would surely all agree that such fires should never be allowed to happen. Making them a never event is the common-sense option, and I hope that others will join me in urging that that rational action be taken on this issue.

The people to whom I have referred, including the gentleman who made his own personal submission, are real human beings. They are people who have gone through operations and been confronted with the reality of this issue. We know about 631 of them in the United Kingdom, and we believe there are more. Addressing this issue would put an end to the need for the £13.9 million of damages and legal charges. We live in an age in which we must also be careful with the money we spend. If we are not, things may happen that cost the NHS money. People have been affected by this issue, and people will continue to be at risk until we act. I therefore invite the Minister and other hon. Members to join me in what I believe is a very worthwhile campaign to make surgical fires a thing of the past—as I said before, a never event.

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[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to see you in the Chair, Ms Rees. I apologise on behalf of the shadow Minister for patient safety, my hon. Friend the Member for Nottingham North (Alex Norris), who is isolating, so I am afraid that you are stuck with me, the shadow Secretary of State for Health, which at least gives me the opportunity early on to place on the record my commitment to patient safety.

I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate and on underlining—in terms of the policy detail and what the data tells us or does not tell us, as well as in very stark human terms—why this issue is so significant. As he said, I have no doubt that there would have been more hon. Members present for this debate if it were not for the omicron risk and the fact that this is the final afternoon before the House adjourns for Christmas.

Surgical fires are a serious patient safety issue. In the contributions we have heard today—from the hon. Member for Strangford and the spokesperson for the Scottish National party, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar)—the case for further action to prevent these incidents is clear.

Although rare, surgical fires can cause serious harm to both patients and healthcare professionals, and, as we have heard, in some cases they tragically result in life-changing injuries. The Department for Health and Social Care has declared that it does not know how many surgical fires happen across the NHS, because it does not collect such data centrally, but we know that they happen. In the period between 2010 and 2018, there were a total of 96 recorded surgical fire incidents declared by NHS England acute trusts and Welsh health boards. A search of the NHS’s National Reporting and Learning System for the period between January 2012 and December 2018 identified 37 reports of surgical fires. There is a discrepancy between those two figures. In my opinion, even one preventable incident of surgical fire in the NHS is one too many.

Although surgical fires are preventable, the absence of national guidelines has resulted in an inconsistent approach within UK hospitals to their prevention, with fewer than 40% of healthcare organisations in England having specific protocols and training programmes in place to address the prevention and management of surgical fires. Among healthcare organisations across the UK, 50% of healthcare organisations in Northern Ireland have specific surgical fire prevention guidelines, compared with 38% in England, 20% in Wales and 10% in Scotland, and only a limited number of trusts across the UK—23—have protocols and training programmes that specifically address surgical fires.

We know that these incidents occur as a result of particular circumstances, yet the majority of local trusts rely on general fire safety guidelines, in which there is often no mention of surgical fire risks and prevention processes for them.

The hon. Members who have spoken in this debate have discussed the findings of the expert working group’s report, which was published last year, so there is no need for me to go over the report’s recommendations; we have already heard them. However, it would be good to hear from the Minister this afternoon as to whether she has had the chance to consider those recommendations and understands where the Department intends to go in taking action to respond to them.

As the hon. Member for Strangford said in his opening speech, the report also supported surgical fires becoming classified as a never event. The NHS in England defines never events as

“serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers.”

Patient groups have argued that surgical fires should be classified as never events. They argue that if they were classified in this way, they could be monitored and investigated as such. Staff would also be empowered to manage incidents in the appropriate way.

However, the Government have recently said that they have no plans to revise the NHS never events policy and framework to classify surgical fires in operating theatres as never events. As the hon. Member for Strangford pointed out, the reason for that is that we currently have no national guidance or safety recommendations to prevent surgical fires in operating theatres. I endorse what he said. I think that the way to address that is to ensure that we have national guidance and safety recommendations and then to update the NHS never events policy. It would be good to hear from the Minister what progress, if any, has been made in developing that guidance and, if the Government intend to act in that way, when it might be published.

I would also like briefly to address some wider issues related to patient safety that are relevant to the debate. Unfortunately, in the last financial year prior to the pandemic 472 serious patient safety issues were classified as never events across the NHS in England. Clearly, that figure demonstrates that there is work to be done across the NHS to ensure everyone gets the best care and that improvements still need to be made. In striving for that, we of course need to listen carefully to the experiences of the patients affected and to ensure that staff feel safe to come forward during patient safety investigations and that processes are transparent, so that lessons can be learned.

We also need to do more to ensure that the environments in which care is delivered are safe. Currently, there is a £9.2 billion repair backlog across the NHS estate. That means that broken pipes and crumbling buildings are putting patients at risk. In the past financial year there were more than 1,600 serious patient safety incidents with an estates and facilities cause.

Although I am responding on behalf of the Opposition, I am sure the House and the Minister will indulge in me making a parochial constituency point. Whipps Cross hospital is in urgent need of redevelopment and refurbishment, and I think that is very much on the Government’s radar—I am led to believe that Whipps Cross is near the top of the list. The Minister may not be able to reply on Whipps Cross this afternoon—I appreciate that it is probably without the scope of what she was expecting to talk about—but the issue is none the less on the record for the Department to consider, and we will be very persistent about it on a cross-party basis locally.

Chronic workforce shortages across our health and care services are also putting patients at risk. We went into the pandemic with 100,000 vacancies across the NHS, including a shortage of 40,000 nurses. I am struck whenever I speak to staff working in the NHS, including the shadow Minister for mental health, my hon. Friend the Member for Tooting (Dr Allin-Khan), who has enormous experience in this respect, that too often staff are coming home from work worried about staffing shortages, patient safety and whether they have been able to deliver the best care. That is really important for patient safety and the confidence of staff working in challenging environments. In June, a report by the Health and Social Care Committee warned that staff burnout caused by workforce shortages was at an emergency level and posed

“an extraordinarily dangerous risk to the future functioning of”

healthcare services.

Last month, NHS leaders warned that pressures on the system were likely to have an impact on patient safety, and a survey revealed that nine out of 10 felt that staffing pressures were putting patients’ health at risk. It is clear that the NHS is now in desperate need of a serious plan to provide the modern, safe facilities and equipment that patients deserve, alongside a long-term strategy to recruit and retain the staff to deliver safe, quality care. The safety of patients must be the golden thread running through every aspect of healthcare delivery, and I want our healthcare system to be the safest in the world. I hope that the Minister will consider the points raised in the debate carefully and assure the Members present that the prevention of patient safety incidents, including surgical fires, is of paramount importance to her Department.

Since this is the last day before we rise for the recess, and in the light of the wider challenges facing the country, I wish you, Ms Rees, and all hon. Members and staff throughout both Houses of Parliament a very merry Christmas. I say a special thank you to Ministers and staff at the Department of Health and Social Care, the agencies for which they are responsible, the entire workforce across health and social care, the armed forces and the emergency services for all that they are doing to get our country through the pandemic, to respond to the challenges of the omicron variant and to get Britain boosted. I ought to wrap up, because I am due to get my booster later this afternoon, and I do not wish to miss my appointment. I look forward to hearing what the Minister says, and I wish her and all her civil servants and colleagues in the Department of Health and Social Care a very merry Christmas and a happy new year.

[Christina Rees (in the Chair)]

I echo everything the hon. Gentleman said in wishing everyone a merry Christmas and thanking them for everything they do.

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[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

[Christina Rees (in the Chair)]

Thank you for your remarks, Minister—they are much appreciated.

--- Later in debate ---

[Christina Rees (in the Chair)]

I thank the hon. Gentleman for his good wishes. I wish you all a merry Christmas too.

Question put and agreed to.

Resolved,

That this House has considered the matter of preventing surgical fires in the NHS.

UK Rare Diseases Framework

Christina Rees Excerpts

Wednesday 24th March 2021 Westminster Hall

[Christina Rees (Neath) (Lab/Co-op) [V]]

It is a pleasure to serve under you as Chair, Mrs Miller. I was not aware of the rare metabolic disorder phenylketonuria, or PKU, until my constituents with PKU explained that it prevents them from metabolising phenylalanine, or PHE, which is an amino acid in protein foods. The standard treatment is a low-PHE diet, removing almost all natural protein and replacing it with prescribed medical dietary proteins to ensure adequate nutrition.

The PKU dietary regime is very complex, very restrictive and very difficult to manage. I joined the all-party parliamentary group on phenylketonuria, which was formed by my hon. Friend the Member for Blaydon (Liz Twist), and became vice-chair. I congratulate her on securing another PKU debate today. The National Society for Phenylketonuria, a charity set up in 1973, is remarkable. It has no premises and no full-time staff, but is run by wonderful volunteers with personal experience of PKU.

Managing PKU is extremely demanding. Every meal, snack and drink must be planned in advance. People with PKU and their families spend on average 19 hours every week preparing their diet. Many of them have applied for personal independence payment, which is assessed on the basis of how much help is needed with ordinary daily living activities, one of which is managing therapy or monitoring a health condition.

The Department for Work and Pensions has not accepted that the PKU diet is a therapy, so many people, including my constituents, have been denied the daily living activities component of PIP, even though they need hours of help from relatives every week to manage their diet. However, in 2020 a tribunal decided that the PKU diet qualifies as a therapy, following a legal challenge by a 21-year-old man whose PIP application had been refused by the DWP. He appealed to the first-tier tribunal, but it agreed with the DWP that his PKU diet was not a therapy. He appealed again to the upper tribunal, which found that the first-tier tribunal should re-examine his case, because the reasons it gave for reaching its decision were not adequate. The case re-examination found that his PKU diet was a therapy under PIP criteria, because he needed more than 14 hours of help per week and therefore met the criteria to qualify for PIP, and should receive £87.65 per week. That is good news, but it remains to be seen whether this will govern future DWP decisions about PKU. I sincerely hope that it will, to help the brave PKU sufferers who struggle every minute of every day to live with such a challenging rare metabolic disorder.

Social Media and Young People's Mental Health

Christina Rees Excerpts

Wednesday 2nd November 2016 Westminster Hall

[Christina Rees (Neath) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Cheltenham (Alex Chalk) on securing this important debate.

Perfection: the state or quality of being perfect; a state completely free of faults or defects. Perfection is popular. People are attracted it. People are attracted to you. In 2016 perfection is everything, or rather, to young people it is. Among young people, there is a pressure to be perfect, to act in a perfect way, to look perfect, to have a perfect body, to get a perfect number of Instagram likes, and to be in a perfect friendship group. If young people do not meet those high standards, the self-loathing begins and the feeling of worthlessness sets in, sometimes with fatal consequences.

While preparing for this debate, I have spoken to lots of young people. One explained how he felt about social media, saying:

“Young people are made to feel like they live an unfulfilled life, because theirs doesn’t live up to the seemingly perfect lives they see on social media”.

And that is just the way it is. With technology and social media sites making it so easy to edit and amend—or rather, correct—photographs, it is easier than ever before to manipulate the truth, allowing us to present ourselves in our own filtered sense of reality, showing only what we want to show. That can result in people critically comparing their lives with the lives of others, and using others’ posts as a measure of success or failure in their own life. That cannot be right. We must teach young people to aspire not to unattainable perfection, but to personal satisfaction, and to love themselves for who they are.

For young people today, the pressure to succeed is all around them, so much so that the National Society for the Prevention of Cruelty to Children reports a 200% increase in recent years in the number of young people seeking counselling over exam stress alone. For others, the coping method is more worrying: the Mental Health Foundation estimates that between one in 12 and one in 15 people self-harm, with some research suggesting that the UK has the highest rate of self-harm in Europe. We may be shocked by those figures, but many young people who self-harm do not harm themselves in a way that requires medical attention, so those numbers only show part of the picture. Social media do not always help with that. One person told me about a problem relating to the website Tumblr, saying:

“Young people are able to type any mental illness into the search bar and there are ineffective controls to dissuade people from seeing...harmful content. When I self-harmed, I would find Tumblr was my place to go to see material by other users that would encourage me to hurt myself.”

That illustrates that social media can not only cause mental illness in young people, but perpetuate the problem.

Social media are vital tools for young people today and we must not seek to interfere with the good they do. Another young person I spoke to explained that they suffer from chronic depression and acknowledged that occasionally social media worsen their mental health, but when they are feeling low and cannot leave the house, social media mean that they are not alone; contacting friends is instantaneous, wherever they are. It is important not to forget the benefits of social media, which can do a lot of good.

There are many lessons for us to take from the debate. Young people must know that they are valued for who they are, no matter what their Facebook timeline, Twitter feed, Snapchat story or Instagram followers say. Young people are perfect for being who they are.

Young People’s Mental Health

Christina Rees Excerpts

Thursday 27th October 2016 Commons Chamber

[Christina Rees (Neath) (Lab/Co-op)]

It is a pleasure to follow my hon. Friend the Member for Ilford North (Wes Streeting). I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and the Backbench Business Committee on allowing it.

I have a new member of staff in Westminster, who started with me only last week, Matthew van Rooyen. He is 18 going on 28. He is cool, calm and collected; I have only seen him panic once so far, which was when he lost his hair gel. By an amazing coincidence he is from the village in south Wales where I was born, Kenfig Hill; more amazing still, I used to do judo with his mother when I was a child. As I have said before, Wales is one big family, and that has its advantages and its disadvantages, so in many ways this is Matthew’s maiden speech.

Matthew is a Member of the Youth Parliament and has been elected by fellow Welsh youth parliamentarians to represent Wales at the sitting of the Youth Parliament in this Chamber on 11 November. The calibre of the debate is always exceptionally high; at times, higher than some of our debates—Matthew is obviously driving the point home here—and I urge all right hon. and hon. Members to attend to show their support for the UK Youth Parliament.

By way of background, each year the UK Youth Parliament holds a UK-wide ballot called “Make Your Mark” that allows for young people to vote to campaign on an issue that is most important to them. The five campaigns with the most votes are then debated by members of the Youth Parliament at their annual sitting in this Chamber. Matthew has asked that I thank the House for allowing this opportunity year after year. In 2014, more than 90,000 votes were cast specifically to campaign for the improvement of mental health services. Following the debate, the Youth Parliament voted to campaign on mental health services as its priority campaign. The Youth Select Committee subsequently launched an inquiry into mental health provision, publishing its report in November 2015. Today, this report comes before the House for debate.

What the report indicates, quite simply, is that there is a lack of full and proper support for young people with mental health issues. Nearly 850,000 people aged between five and 16 suffer from a mental health issue. There is clearly a real need for good quality, mental health provision. The fact that over 90,000 young people voted for this as their priority campaign is indicative that the standard of service provided falls far short of the standard of service that can be expected.

It is not even the case that the service provided is good, but young people expect excellent and they deserve excellent. It is the case that the service is simply substandard. In written evidence to members of the Youth Select Committee, one young person explained their frustration:

“After a lot of deliberation, I decided to take myself to my GP in search of support…What you must remember is the amount of courage it takes to open up about your mental health issues. It is extremely difficult for someone...who’s totally confused about what’s going on in their life, to openly talk about having suicidal feelings in a five-minute appointment to someone who feels like a complete stranger. This landed me in a vicious cycle. I ended up returning to different GPs, in a desperate cry for help, but time and time again I was refused any help. It took seven visits before I eventually got the support I needed. Seven times I had to retell that same story. Seven times I was faced with not being ‘sick enough’ and seven times I had to walk out of that same GP surgery feeling absolutely crushed and demoralised.”

That young person is only 14 years of age.

The stories from young people, up and down the country, of substandard interactions with their GPs and medical practitioners are many. With countless witness testimonies, the report highlights the many areas where improvements need to be made with regard to the medical profession and health services. I would welcome an update from the Minister.

There is not one single area that needs improvement. We need to improve the overall state of services for those suffering from mental health issues. We must also look at the education system and what role this has to play in improving young people’s mental health. The report, very thoroughly, covers the education curriculum. It suggests improvements to personal, social, health and economic education, which would provide the most effective environment for mental health education. I broadly endorse those.

A key issue that has been raised time and again by the Youth Parliament is the need for a curriculum for life—to meet the needs of young people by having a national curriculum that sets them up to succeed and not fail. This issue is so fundamental to young people that it received the most votes in the “Make Your Mark” ballot this year. In the local authority area of Neath Port Talbot, in which my constituency of Neath lies, around 2,300 young people took part in this year’s ballot. I look forward to working with the Neath Port Talbot Member of the Youth Parliament further over the coming year.

To return to the report, the findings of the Youth Select Committee make clear the need for an all-encompassing approach to improving mental health and wellbeing. Although the Department for Education has introduced character-building and resilience programmes, the report notes that this is not the best method of improving the wellbeing of young people and instead proposes further training for teachers and academic staff. The report specifically mentions that teachers said in evidence that they feel they

“need more regular training on how we promote positive mental health.”

The Youth Select Committee recommends that, as part of the core content of initial teacher training, there should be mandatory training for teachers on young people’s mental health, with the training focused on how to respond to a young person who asks about mental health, how to spot problems and where to refer young people. The committee goes on to recommend the inclusion of a trained counsellor in all schools and agrees that schools should make counselling services available to all secondary school pupils. These are recommendations that I am sure every Member of the House will agree with.

Today’s debate has highlighted the vital work done by the UK Youth Parliament, the British Youth Council and the Youth Select Committee, all of whom I commend in assisting young people to have their voices heard. In recent times, there have been multiple reports and initiatives to improve mental health services for young people, aiming to reach parity of esteem, but until equal funding is achieved for physical health and mental health provision for young people, with funding for young people’s care at least equal to funding for adult’s care, the campaign will go on. Young people are our future. It is our duty to ensure their success and wellbeing. My thanks to Matthew—great speech, Matthew, and it is a pleasure to work with you.

National Arthritis Week

Christina Rees Excerpts

Thursday 20th October 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered National Arthritis Week 2016.

It is a pleasure to serve under your chairmanship, Mr Betts. I am delighted that today, for the first time in five years in this House, there is a dedicated debate in Parliament examining the impact of arthritis. It is a privilege to speak in this House; that opportunity is not something we take for granted. It is good to come along to expound and inform on an issue that is so important. I am very pleased to see the Minister in his place. I think he and I will be in this position many times, debating health issues that interest us. It is good to see right hon. and hon. Members here. I know they will all make significant contributions.

Arthritis, along with musculoskeletal conditions, has a massive impact on people’s everyday quality of life. While I am disappointed that we have not spoken sooner in the past five years about this topic, I am pleased that time has been allocated today by the Backbench Business Committee, which I thank, for such an important debate that enjoys cross-party support. Opposition Members seem to be well balanced, and I am pleased to see the hon. Member for Congleton (Fiona Bruce), who is always here; I thank her for that and look forward to her contribution.

I should make it clear at the outset that the title of this debate is a slight misnomer, as the National Arthritis Week campaign has been replaced by the “Share Your Everyday” campaign, led by Arthritis Research UK, which is encouraging the public to share their stories of living with arthritis so that research is better targeted at the issues affecting most people with arthritis. We need to break the stigma of talking about pain and loss of dexterity and mobility, so that we can help to alleviate it. I urge Members to show their support for the campaign by sharing their own stories. I know there are Members here today who will do so, and that will be a very effective way of underlining this issue.

We should begin by discussing arthritis, because the burden on the individual is clear and substantial. It brings pain, isolation and fatigue and stops people doing the things that matter to them, keeping them from the world of work, from enjoying leisure time and from spending time with their families. Those are all key issues. I want to thank Arthritis Research UK—some people from it are in the Gallery—for supplying us all with notes and information to help the debate develop. We thank it for the hard work it does.

Arthritis should not be seen as a by-product of old age. For some it is, but for others it is not. The examples that I, along with others, will give show that arthritis is not only an elderly person’s ailment. It affects thousands of young people and millions of working-age people. One in five people over 50 have osteoarthritis in their knee. There is a young girl in my constituency who I went to appeal with several times. She suffers from chronic inflammation of the bowel—a by-product of severe arthritis, which led to her being medically retired at the age of 28. This is not an elderly person’s disease by any means.

The burden of arthritis on society warrants greater debate. Arthritis has an impact in a number of ways, particularly on our health and care system. Each year, 20% of the population consults a GP about musculoskeletal problems. The NHS spends £5 billion per year on arthritis— its fourth largest programme budget. That puts into perspective the enormity of what we are looking at today. I was struck by the stories shared on the Facebook page set up for this debate, so many of which are genuinely heart-breaking. One that stood out was that of a young girl of 27 who is waiting for a hip replacement, having suffered from arthritis since she was 20. That underlines, again, that this is not an old person’s disease. It knows no barriers, no age restrictions and certainly no class or creed barriers.

There is also the issue of workplace absence, with 30.6 million working days lost to the economy each year. The indirect cost to the economy of arthritic conditions is £25 billion. We do not necessarily want to focus on the financial aspect, but we can look at the figures as an indication of how important it is to address this issue and to raise awareness through this debate.

The scale of the burden is growing, with an ageing and increasingly physically inactive population. The numbers are sure to rise in the coming years. I briefly want to describe some of the characteristics of arthritis. When we talk about arthritis, we are talking about a number of different musculoskeletal conditions within the categories of inflammatory conditions, joint conditions and fragility falls and fractures, which are key factors.

The first group is inflammatory conditions, such as rheumatoid arthritis, where the immune system rapidly begins attacking the joints in the body. Those conditions affect around 1% of the UK population, including people of all ages, and have serious consequences. The second group is a range of conditions that cause musculoskeletal pain, the most common being osteoarthritis. Some 8.75 million people have sought treatment for osteoarthritis, with the true number of sufferers likely to be even higher. As is often the case, we are just scratching at the surface. The gradual onset means the condition mainly affects the elderly, but 2.36 million working-age people in the UK have sought treatment for knee osteoarthritis. Lower back pain, the most common form of disability in the UK, also falls into this group of conditions.

The final group is osteoporosis and fragility fractures. Osteoporosis is a silent and painless disease, but it causes fragility fractures after falls from standing height that afflict mainly but not exclusively elderly patients. The disease causes weakening of the bones and some 300,000 fragility fractures in the UK per year, of which 89,000 are hip fractures. The impact of those fractures on elderly, frail patients can often be severe, taking away their mobility, independence and, in some cases, their lives. We have to consider that.

Arthritis is not inevitable. Preventive measures must be the focus in tackling it. We need to address the risk factors for arthritis and musculoskeletal conditions. Links between being overweight or obese and long-term conditions such as heart disease, cancer and diabetes are well known—I declare an interest, as a diabetic. I am glad to say that I am almost back to the weight I was before I got married, which is quite something. I am trying to keep off all the sweet things, if I can. However, being overweight or obese is also a major risk factor in various forms of arthritis. It is the single biggest avoidable cause of osteoarthritis and increases the likelihood of developing inflammatory conditions such as rheumatoid arthritis.

Every one of us, as an MP, is aware of these issues because our constituents come to see us. In many cases, we deal with related benefit issues, and that is how we come into direct contact with people affected by arthritis.

[Christina Rees (Neath) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this really important debate. These conditions cause not only physical but psychological problems. A girl came to see me, aged 19. She said:

“Arthritis is unpredictable. It flares up suddenly. Medication problems make it difficult for me to manage. It is hard to explain to my friends why I cannot do something I could do last week, because I look so normal.”

Does the hon. Gentleman agree that we have to look at the damage these problems are causing youngsters in their everyday lives, including in how they associate with their friends?

[Jim Shannon]

I thank the hon. Lady for her intervention and for outlining how arthritis can affect people at the age of 19. I am aware of a constituent who is even younger, which really surprises me.

Rising levels of obesity, combined with our ageing society, could lead to a near doubling in the prevalence of osteoarthritis in the UK by 2035. The Government need to make sure that musculoskeletal health is always included in assessment of the population’s health locally and nationally; that the benefits of physical activity for people with musculoskeletal conditions are emphasised in health promotion messages; and that, when programmes targeting lifestyle factors such as obesity and physical inactivity are being designed and delivered, their impact on musculoskeletal health should be explicitly included. So there are many things the Minister could respond to, and I look forward to that.

Above all, the Government need to make sure that effective physical activity services are available locally. This is crucial, and I hope colleagues from all parties will join me in calling for a National Audit Office review of physical activity services for people with osteoarthritis so that services help people across the UK to maintain good musculoskeletal health. We need to address that.

I want to speak about benefits as well. I know about osteoarthritis and rheumatoid arthritis because I have sat across a table from a person helping them fill in disability living allowance forms, now personal independence payment forms. People tell me their story, because we need to know their story when we help them fill in the forms. We need to know what they have done and what they have discussed with their GPs and consultants. The issues are very clear. I know that the Minister is not responsible, but for the record I implore the Department for Work and Pensions to make sure that, when it comes to filling in PIP forms, people have their full medical story told. They need an understanding person at the other end of the phone. I am not being disrespectful to anybody, but sometimes when we phone up about PIP, the person at the other end of the phone does not understand the medical details. I respectfully and gently say to the Government that we need someone on the phone who understands the medical condition and understands the issues and can therefore empathise with the person who does their 10-minute interview at the first stage of their PIP form before they do the full form. I think every MP would recognise that particular issue.

As I mentioned earlier, falls and fractures are a pressing public health issue among older people. Falls are the second greatest contributor to the burden of disability in the UK and a major cause of mortality. Around 300,000 fragility fractures occur each year in the UK, including some 89,000 hip fragility fractures, with 1,865 cases submitted to the national hip fracture database in Northern Ireland. Hip fractures are the most common cause of accident-related death in older people, resulting in some 14,000 deaths in the United Kingdom every year. We know that 20% of hip fracture patients die within four months of their injury and 30% within a year. This is a growing problem. Projections show that by 2036 hip fractures could account for 140,000 hospital admissions in the UK each year, with care and treatment costs rising to £6 billion. Let us put that into perspective and do the sums. Let us address the issue early on and do away with the cost impact further down the line.

We need more joined-up treatment in such cases because, once a first break occurs, it is vital that a second break is avoided. A fracture liaison service, the FLS, which provides targeted assessment and treatment for those with fractures, is widely regarded as the best way to address the problem of preventing future fractures. It is both a clinically effective and a cost-effective solution. Despite this, only 37% of local health services in England have a fracture liaison service. We need local commissioners to ensure that a fracture liaison service is linked to every hospital and held to account for commissioning fracture liaison services that cross the boundaries between health and social care so that the two marry. It is important that it does so. Arthritis may not kill, but it attacks what it means to live. The normality of life will never be the same with arthritis.

The condition limits people in doing the things that matter to them, but with greater personalisation and help in managing their condition, the NHS, care services and our welfare system can help people push back the limits of their condition. Too few people with arthritis currently have a care plan. Many people cannot quickly access physiotherapy without a GP referral, and people with arthritis need more help so that they can be in work, which is where most of them want to be if only that was possible. People with arthritis know how their condition affects them better than anyone else. Personalised and person-centred healthcare is therefore essential to move forward.

Care planning is an approach that people with long-term conditions can use to manage their health and wellbeing. It is based on a two-way conversation with a healthcare professional where goals are shared and actions agreed. If we could arrange that, we could help them. A better system should be in place to make sure that that happens. This can offer important benefits to people with arthritis, yet only 12% of people with arthritis currently have a care plan. If it is only 12%, there is something wrong and we must address that. That number needs to increase if we are to enable more people to manage their condition.

There are other tools that health and care services can use to enable people with arthritis to manage their conditions more effectively. Physiotherapy is a clinically effective therapy that can substantially reduce pain and restore movement for people with arthritis. Again, is it available for everyone? If it is not, it should be. I gently ask the Minister how can we make that happen. I look to the Minister, as I always do, for a sympathetic and understanding response.

Self-referral to physiotherapy is a system that lets people go directly to an NHS physiotherapist without a GP referral. This system is associated with improved health outcomes and patient experience. It is good that it is cost-effective and reduces the burden on GPs. All people with arthritis in Scotland and across much of Wales can already access physiotherapy directly. We have many friends and colleagues here from Scotland, and I know that they will make contributions that I suspect will indicate what is being done in Scotland. I must say I am envious of some of the things being done there. I would love to see those things in place in Northern Ireland and across the whole of the United Kingdom.

In the rest of the UK, for example, only a third of clinical commissioning groups in England offer self-referral and it is still only being piloted in Northern Ireland. That needs to change. When inflammatory conditions such as rheumatoid arthritis strike, delay can be a major risk factor and the clock starts ticking once symptoms develop. Early identification and treatment is needed rapidly to control disease, minimise long-term joint damage and avoid lifelong pain and disability, but the NHS does not currently assess people with rheumatoid and other forms of early inflammatory arthritis—EIA—quickly enough, and national guidelines are not being met. Again, I gently say to the Minister: if the guidelines are not being met, what are we doing to improve that?

A recent clinical audit by the British Society for Rheumatology found that only 20% of people who see a GP with suspected rheumatoid arthritis or EIA are referred to rheumatology specialist services within three days, and only 37% of people referred with suspected rheumatoid arthritis or EIA are seen by a specialist within three weeks. Again, that needs to be addressed and I again look to the Minister for a response on that. Local commissioners across the UK need to achieve earlier diagnosis of inflammatory conditions. Arthritis and other musculoskeletal conditions are the most common diseases in our working population, and as the population gets older, an even greater proportion of workers will have conditions that include osteoarthritis and back pain. Those workers want to keep working, so we have to improve the system of healthcare to enable that.

Many people with arthritis want to work, and they can with the right support. However, only two thirds of working age people with a musculoskeletal condition are currently in work, compared with 74% of those without health problems. What is more, the rate of employment for people with arthritis is 20% lower than for people with no condition. We need better support to enable people with arthritis to work and we need to promote the Access to Work scheme that is in place, which pays for practical support and equipment. It is good that we have such a system, but I want to see better utilisation of it and fiscal incentives for employers to provide health and wellbeing initiatives that promote musculoskeletal health.

It is vital that more is known about people with arthritis so that research can be targeted at what matters most to them, but, worryingly, key data are not being collected. Arthritis Research UK is working to increase the quality and availability of data about the experiences of people with arthritis and about the public services that improve their quality of life. Arthritis Research UK and Imperial College London have developed a model for estimating prevalence using the existing NHS data currently available in England. I encourage all Members for English constituencies to visit the Arthritis Research UK website to get access to the data, which I understand will soon be available in Scotland, and later in Northern Ireland and Wales. We have a lot to do to catch up.

However, not enough data on people with arthritis are being collected, and that limits our understanding of the prevalence of the condition and action that can be taken in response. Moreover, data that are collected are not uniformly classified across the system. Definitions of musculoskeletal conditions used in other national data sets, such as those for benefits, are inconsistent. National survey content may need greater co-ordination. Again, I say gently and with respect that it is a question of how to do things better. I am speaking very quickly, Mr Betts, because I am conscious that other Members want to speak. I am probably rushing faster than usual, but I hope everyone can follow what I am saying.

A pivotal issue is the need to protect and build the UK’s excellence in medical research, so that researchers can continue working on a cure for arthritis. How important it is to find a cure. The centres funded by Arthritis Research UK have been at the forefront of research aimed at improving the lives of people with arthritis in the UK. It is marvellous and encouraging that they have uncovered breakthrough treatments that push back the limits of the condition. In the 1990s, centres supported by Arthritis Research UK—it has given us all the information—discovered that a molecule called tumour necrosis factor was causing the disruptive auto-immune inflammation of joints. The anti-TNF therapy that they developed has freed millions from the pain and disability caused by rheumatoid arthritis; it was also an inspiration for the field of biologics, medicines that use the body’s own molecules to combat diseases. It is crucial that that work, and the work of all medical research charities, should be supported by the Government in the long term with a real-terms increase in science spending. It is not something for the Minister to respond to, but I would seek his assistance and support on that point.

Within the life sciences sector, substantial investment by medical research charities drives improvements in health and generates wider societal and economic benefits. In 2013, medical research charities invested about £1.3 billion in UK medical and health research, which represents more than a third of all publicly-funded medical research in the UK. The Government have recognised that our science base is a vital national asset— a view that I and all Members present, including the Minister, subscribe to—and they have reaffirmed their intention to make Britain the best place in the world for science. We all support that ambition. It is crucial to uphold that commitment, through a real-terms increase in science spending over the long term.

That would include bolstering the charity research support fund, which provides an uplift to support charity-funded research in universities. It is a marvellous asset, investing a lot of money in research. That joint funding of research ensures that charitable donations are invested directly in research that meets the needs of people with medical conditions. In 2013, the Government’s £198 million investment through the CRSF leveraged some £833 million of investment by charities in English universities. That is a significant, marvellous, gigantic sum of money to help to find cures. When the House debates rare diseases—and we do our best in these matters—we often refer to the good work done by charities, universities and the relevant partnerships.

[Christina Rees]

rose—

[Mr Clive Betts (in the Chair)]

Liz McInnes. Sorry, Christina Rees.

[Christina Rees]

My arthritis is in many ways self-inflicted; it comes from a lifetime of playing sport. I have no cartilage in my right knee, which is severely arthritic. Then there is my lower back—I do not think anything much works any more. Does the hon. Gentleman think that there should be more research on people who have played sport and become arthritic? In this day and age we advocate participation in sport, without really looking at the long-term consequences.

[Jim Shannon]

The hon. Lady is right and I think many of us recognise what she says. We encourage people who are obese to do more sport. We encourage young people, rather than playing on computers and laptops, as they so often do, to take part in more physical activity. However, we must consider the side-effects of that as well, and ensure that we help with them. I hope that what I have said about responding early has been taken on board. With an early response to signs of deterioration, the hon. Lady might not today be in as much pain; although I can tell hon. Members that I have seen her moving around the House, and she moves at some rate. The hon. Lady is obviously not completely restricted, and I say well done to her.

Without the CRSF there would be less funding to invest in world-class research. The UK’s medical research landscape is currently undergoing major change with the formation of UK Research and Innovation through the Higher Education and Research Bill. I expect that the whole House would agree that is crucial that the CRSF should increase in line with charitable investment, within the new research funding system, to safeguard research in the long term.

I look forward to hearing the remarks that will follow in the debate, including the personal experiences of arthritis of Members’ constituents—and perhaps also those of Members themselves. Much more can be done to improve the quality of life of people with arthritis, and to push back the limits of that worrying condition. We have an opportunity in Parliament to play a huge part in ensuring that our constituents get a better quality of life. I look forward to hearing the speeches of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister.