Vaping

David Simpson Excerpts

Wednesday 1st November 2017 Westminster Hall

[Gareth Johnson]

It is good to see some enthusiasm for this subject. The hon. Lady is absolutely correct: it tends to be more vulnerable people, if I can put it that way, who are affected by smoking, but smoking affects the whole of society. Almost everybody knows somebody who has died from smoking or has been seriously affected by the consequences. As she rightly says, we have potentially found what is almost a silver bullet that will allow us, at long last, to tackle the issue of smoking among those who want to stop.

[David Simpson (Upper Bann) (DUP)]

Does the hon. Gentleman agree that more needs to be done with our young people in relation to vaping and the dangers of smoking? How can we achieve that?

[Gareth Johnson]

Importantly, over the last 20 or 30 years we have moved away from the James Dean image of smoking. For many people, it is no longer seen as being cool, although it was when I was growing up; it was somehow seen as being acceptable. An increasing number of people look to vaping rather than smelly tobacco, if I can put it that way. It is increasingly recognised that there is huge problem with smoking.

Unfortunately, statistics show that more and more people are viewing vaping as more dangerous than smoking. Vaping is clearly a lot safer than smoking tobacco, but unfortunately the public perception is different from the facts presented by reputable organisations. Some 7 million people smoke in England alone, and some 8 million people do so across the whole UK, so potentially a large number of people can benefit from vaping. Although we have spoken briefly about smoking, my approach is not at all nannying. If an adult wants to smoke, that is their choice; I do not seek to lecture people on their tobacco use. It is an individual choice, but it needs to be an informed choice. We should therefore not obstruct people who want to access smoking cessation products, and vaping forms an important part of that.

I do not claim that vaping is risk-free; indeed, I would urge anybody who does not smoke not to take up vaping. There are risks, and it is unnecessary for non-smokers to take them. I also urge that our approach to vaping be evidence-based. When the Government make decisions on issues that affect vaping, they should base them on the best evidence available. Vaping should not be treated in the same way as tobacco simply because the term “e-cigarettes” has been adopted to describe vaping products.

We also need to be open-minded and objective about the pros and cons of vaping. Our views may change as more research is carried out, and that is fine. We may, over time, become more negative or more positive about vaping, but that should always be based on the facts available and not on a general dislike of smoking.

I am not a medical man at all, and I certainly do not claim to be an expert on health issues, so I have looked at what reputable organisations have to say about vaping. It makes incredibly interesting reading. For example, Cancer Research UK has said:

“the evidence so far shows that e-cigarettes are far safer”

than tobacco, even in the long term. It also says that

“Growing evidence shows e-cigarettes are helping people stop smoking”.

That is a pretty clear position. The British Heart Foundation has also looked into vaping and said:

“e-cigarettes are not harm-free.”

It has said:

“We would not advise non-smokers to take up e-cigarettes, but they can be a useful tool for harm reduction and to stop smoking.”

It also points out that long-term studies are, of course, not available just yet. That point is frequently brought up in this debate: because of the relative newness of vaping, we do not have the long-term studies that many people want to see. As I say, we need to be open-minded about vaping, but we should not turn our backs on the opportunities that it offers simply because we do not have long-term studies. It would be wrong for us not to engage with vaping for the next 50 years while we wait for long-term studies to be carried out. The opportunities are in front of us today.

Autism Diagnosis

David Simpson Excerpts

Wednesday 13th September 2017 Westminster Hall

[Bambos Charalambous]

My hon. Friend makes a valid point: consistency is required across the range.

[David Simpson (Upper Bann) (DUP)]

The hon. Gentleman talked about diagnosis times. In Northern Ireland, we fall foul of the 13-week standard, with some times peaking at 22 months. We have a vast shortage of psychologists. Does he agree that a massive recruitment drive is needed to reduce those times and achieve the standard?

[Bambos Charalambous]

The hon. Gentleman makes a very good point; I will refer to the requirement of additional resources later.

Autism usually first manifests itself in young children: four to five years old is the average age at which it is diagnosed, with girls being diagnosed later and less frequently than boys. Some people are not diagnosed until they are adults, after which they are then able to make better sense of things. Some of the early signs of autism include underdeveloped communication and attention skills, such as not establishing eye contact or responding to one’s name. It is widely acknowledged that autism can be reliably diagnosed at age two, and that early diagnosis is absolutely critical to allow parents and carers to receive the support they need so that they can give their child the best start in life that they can. It is safe to say that everyone supporting a child with autism benefits from early diagnosis.

Before looking at the NICE guidelines, I will reference the primary piece of legislation that covers autism: the Autism Act 2009, introduced as a private Member’s Bill by the right hon. Member for Chesham and Amersham (Mrs Gillan). It was adopted by the Labour Government of the day and became law. Section 1 of the Act states that the Secretary of State must publish an autism strategy by April 2010, and must keep that strategy under review. In March 2010, an autism strategy was drawn up, and it covered: increasing awareness; developing a consistent pathway for diagnosis; improving access to services; helping adults with autism into work; and enabling local partners to plan and develop local services. Section 2 deals with guidance about implementing the autism strategy, with subsection (5) stating that that must include guidance about diagnosing autism, identifying adults with autism and assessing their needs.

Following the granting of Royal Assent to the Autism Act and the drawing up of the autism strategy, NICE acknowledged the need for early diagnosis. In paragraph 1.5.1 of its “Autism spectrum disorder in under 19s: recognition, referral and diagnosis” guidance, under the heading “Autism diagnostic assessment for children and young people”, it states that autism diagnostic assessment should start

“within 3 months of the referral to the autism team.”

Preventing Avoidable Sight Loss

David Simpson Excerpts

Tuesday 28th March 2017 Westminster Hall

[Jim Shannon]

It is always a pleasure to serve under your chairmanship, Mrs Gillan. I give special thanks to the hon. Member for Wealden (Nusrat Ghani), who very capably set the scene for us all on a subject that is obviously close to her heart; I believe it is close to the hearts of those of us who are here to participate in the debate as well.

As someone who has needed glasses from eight years of age—I am over 50; well over 50, let me tell you—I have never really known any other way; that is the fact of it. I can well remember those first glasses, with those round circles of glass like milk bottle bottoms. Those were the prescription glasses I wore in the ’60s; we have come a long way to the perfection of eyesight and glasses today. In my case, I wear varifocals, and others in this Chamber probably have the same. I look down to read and look up to look away. Varifocals give that better vision, and it is good to have that.

I certainly have compassion for those whose sight is deteriorating or lost completely. I think losing sight is probably one of the worst things that can happen to anyone. How much do we all appreciate seeing things in colour and all around us? There are some who cannot. My dad lost his sight at a late age in life, and I know it is one of the things that he particularly missed. He used to read his Bible in braille in the last few years of his life. To understand that sight loss can be prevented in some cases is something that we must all work towards achieving, and we must play our part in the House.

The Library pack has been quite helpful, and some of the information it gives is particularly applicable. The fact that sight loss costs the UK economy £28 billion is something that cannot be ignored when it comes to adding equations; we understand and appreciate that we have to balance the books, but when balancing the books we should sometimes do the necessary preventive action that the hon. Member for Wealden referred to.

[David Simpson (Upper Bann) (DUP)]

Only yesterday in my surgery some folk came to see me about sight loss, the lack of appointments and the length of time they had to wait. We have been given the figure this morning of 20 people per month losing their sight, which is a precious thing. If there is a drug that can help to prevent that, surely the onus is on the Government to give people the gift of sight? That is worth pursuing.

[Jim Shannon]

It absolutely is. The hon. Member for Wealden referred to England in her introduction, but Scotland, Wales and Northern Ireland have taken some steps in that direction. At the end of the day, we can certainly do this much better.

Sight loss affects people of all ages, but older people are more likely to experience a sight-threatening condition. That is clearly understandable. Having celebrated another birthday on Saturday past—I have stopped counting birthdays, which I think is probably the best idea; I try to forget about it, but the family keep reminding me that I am of a certain age—I certainly feel a deterioration process in action. That old saying that the spirit is willing but the flesh is weak becomes more and more a reality as I mow the lawn at home and carry out maintenance on the farm.

My glasses prescription has changed greatly over the years, and not for the better. That, again, is part of the ageing process. I am also a type 2 diabetic, so I have to be particularly careful with my eyesight. The former health Minister, now the Financial Secretary to the Treasury, replied to a question I asked about diabetes, and I think the hon. Member for Wealden referred to diabetes in her speech. The hon. Member for Erewash (Maggie Throup) also mentioned it in an intervention. We need to be aware of the complications of diabetes. Early diagnosis is very important.

It is critical to have regular appointments with an optician. I am not sure if everybody has one as regularly as they should. In Northern Ireland, I see my optician twice a year—probably because I am a diabetic. Others probably do it at least on a 12-month cycle. It is important to do so, because an optician can spot things in someone’s eyesight and signs affecting other parts of the body. It is important that the role of the optician is encouraged.

One of the lesser-known reasons for sight loss is leber hereditary optic neuropathy. It is an ultra rare and very disabling disease that leads to blindness in approximately 80% of those affected within one year of the onset of symptoms. It affects just one in 50,000 people and is caused by a disorder of the mitochondria; it usually strikes young men aged between 15 and 35. Again, it can be prevented by early diagnosis, but there are no treatment options routinely available to patients with it in the UK. I often look with envy towards Scotland, because Raxone is currently undergoing a review there, whereas in England it was not selected by the National Institute for Health and Care Excellence. That is a bit of a disappointment. If the Minister does not mind me asking, perhaps he could respond to me on that as well when he gets a wee chance. It is most important.

I will give a Northern Ireland perspective, but I will not be taking the time that we talked about at the beginning. In Northern Ireland, the 2011 census reported that, out of a population of 1.8 million, a total of almost 31,000 people self-reported a long-term condition related to blindness or partial sight loss, representing some 1.7% of the population. However, the figure is set to increase dramatically in the future, as the population ages.

I am not sure if anyone has mentioned this yet, but we have an ageing population. We are getting older, and people are living longer, so this issue will become a bigger factor than ever before. Recent population statistics from 2016 reveal how the age structure in Northern Ireland is projected to change. I will give an example. The population aged 65 and over is projected to increase by 74.5% to almost 500,000 people from mid-2014 to mid-2039, with the result that one in four people—24.7%—will be in that age category. The population aged 85 and over is projected to increase by 157.3% to 88,600 people over the same period, which will see that share of the population increase from 1.9% to 4.4%.

The reason for giving those stats is simple: there will be greater demand on the NHS. The increasing prevalence of sight loss over the next decades requires additional planning, a long-term strategy and policy development now in order that the Government best respond to people’s needs and concerns. That is what we are asking of the Minister, for whom we have the utmost respect, and I know he will reply with conviction and a desire to answer our questions.

I wonder whether this could be done better together, through a UK strategy. I am a great believer in the Union of Great Britain and Northern Ireland. I have been told off this morning for saying that once or twice too often, but I continue to say it because it is important, as it is for my colleagues close to me in the Chamber.

In Northern Ireland we face a particular challenge in relation to timely and responsive ophthalmology treatment. In recent years, many new treatments have been developed, saving the sight of thousands of people who previously would have gone blind. One of our universities in Northern Ireland has been involved in perfecting new drugs and systems to prevent sight loss. An enormous amount of work is going on behind the scenes. Those new treatments are an enormous and welcome step forward.

Some conditions, such as dry age-related macular degeneration, can cause permanent sight loss in a matter of weeks or months. That is why early diagnosis and treatment is vital if a person’s sight is to be saved. It is no surprise that delays to treatment can have a severe impact on patient outcomes. Everybody who has spoken so far has said that, as will those who speak after me.

Many new treatments for sight-threatening conditions require frequent follow-up appointments for monitoring and re-treatment. That has caused a rapid increase in demand for services. Northern Ireland faces a waiting list crisis across a number of specialties, including ophthalmology. I know this is a devolved matter, but I want to give some stats. As of 31 December 2016, some 23,000 people were waiting for a first out-patient appointment in ophthalmology, while 14,221 patients—approximately 62%—were waiting longer than 18 weeks. Statistics also show that patient numbers within ophthalmology are increasing year by year. On 31 March 2013, there were more than 8,000 patients waiting for first consultant-led outpatient appointments, compared with 23,000 in December 2016. That is an increase of 184%.

Severe financial constraints on the health service mean that increased demand for eye care services has not been met with increased resources. That has led to some patients losing sight unnecessarily because they are not seen within clinically safe timeframes. That is the core point we are all trying to make. In March 2016, the Royal College of Ophthalmologists released preliminary findings from a national study indicating that at least 20 patients per month suffer severe and unnecessary sight loss due to appointment delays. That is avoidable—if it is avoidable, for goodness’ sake let us try to address that issue.

The situation in Northern Ireland is similar to that in other parts of the United Kingdom; urgent action is needed so that preventable sight loss is avoided and people do not come to harm while waiting to be seen. With more than 14,000 Northern Ireland patients waiting 18 weeks for an initial appointment with a consultant, and more than 30,000 planned appointments missed due to hospital cancellations or the patient’s failure to attend, now is the time to address the provision of eye care services. This is putting an enormous strain on busy hospital eye departments and overworked NHS staff.

To conclude, while the lessons learned in Northern Ireland must be shared and there must be central learning for all the United Kingdom’s devolved Assemblies and the Government’s Developing Eyecare Partnerships strategy, it is important to resource and implement that strategy if effective change is to happen. We are looking for effective change, because without it, this debate will have failed. We are here to be positive, but we need Government assistance to make this happen.

While additional resources are needed, the reconfiguration or development of services does not necessarily need resources; it just needs a more effective way of approaching services. We cannot wait any longer, as each month of waiting for proper funding and implementation is a month in which people are losing their sight unnecessarily. I have said before that I have the greatest respect for the Minister. I look to him for UK-wide action now, and for the Government to work in conjunction with the devolved Administrations.

Children’s Wellbeing and Mental Health: Schools

David Simpson Excerpts

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

It is a pleasure to serve under your chairmanship, Mr Nuttall, I think for the first time. It is timely to be discussing the incredibly important issue of children’s mental health and wellbeing, particularly in the context of schools, given what the Prime Minister said yesterday. I welcome the fact that the Prime Minister of this country chose to make a speech that was significantly about mental health. That in itself is quite a novelty and should be acknowledged as such. She spoke powerfully about the “burning injustices” in society and focused particularly on those who suffer mental ill health.

My problem is that the response must match the scale of the injustice, and I think that the response has ultimately fallen short, but as a society we are on a journey and it is an important step that the Government are now saying the right things. I suspect that it is acknowledged by many Conservative Members that there is still a gap between the rhetoric and the reality for many people throughout the country, particularly families experiencing mental ill health, who sometimes have to wait horribly long for any access to treatment.

I will briefly describe my own family experience. This goes back to the last decade, which makes the point that the situation we are discussing is not the fault of any individual party or Government. When our oldest son required treatment and as a family we were fairly desperate, we were told that he would have to wait six months to start treatment, so we did what I guess any family would do and paid for treatment. Of course, very many people cannot do that. I do not want to live in a country in which people who have money can access great care, but those who do not are left waiting. That for me is the injustice that we must confront, but I welcome the fact that the Prime Minister has raised this incredibly important issue.

One in 10 children are estimated to have a diagnosable mental illness, and 75% of mental health problems in adulthood started before the age of 18, so there is both a moral and an economic case for dealing with mental ill health among children and teenagers, because by neglecting it we store up enormous problems for people later in life, at enormous cost to the state—that is the key point that we must recognise. However, despite the prevalence of illness among children and teenagers, three in four children and young people with a clinically significant mental illness are not in touch with appropriate mental health services, and sometimes it can take up to 10 years before the first symptoms are diagnosed and addressed.

I stress that I do not want to over-medicalise this problem; we do not want to drive everyone into treatment. What we want to do, of course, is prevent the need for that, so we must shift the system so that it focuses much more on preventing ill health and deterioration in health, and schools are necessarily central to that.

[David Simpson (Upper Bann) (DUP)]

I am sure that the right hon. Gentleman will agree, in relation to mental health and schools, that it is important that young teachers are trained to recognise the difficulties that some children have, so that there can be early intervention to try to prevent the need for all the children to go into treatment.

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention. I totally agree. As I will explain later, giving professionals the tools to manage the issues in front of them seems to me to be fundamental to a sensible approach.

There appears to be growing evidence of increasing mental health problems among young girls. In August 2016 a survey for the Department for Education found that rates of depression and anxiety have risen among teenage girls in England, although the rates appear to be more stable among boys. The survey found that 37% of girls reported feeling unhappy, worthless or unable to concentrate; that was more than twice the percentage for boys. According to the Children’s Society’s latest “Good Childhood” report, a gender gap has opened up between girls and boys in relation to both happiness with life as a whole and appearance. One in seven girls aged 10 to 15 felt unhappy with their lives as a whole, and the figure had gone up over a five-year period. We need to seek to understand that situation better in order to make the right response. I pay tribute to the Children’s Society, which has supported me in bringing this debate to Parliament. I also thank, as I should have done at the start, the MPs who joined me in applying for the debate.

There also appear to be problems among women between the ages of 16 and 24, according to a major report by NHS Digital. Reports of self-harm in that group trebled between 2007 and 2014, so something very serious is going on. Research is urgently needed to understand the causes of the trend. Social media appear to be part of the picture—there are concerns about sexting, cyber-bullying and so on.

We must also remember the issues that relate to boys and young men. Horrifically, suicide remains the biggest killer of men under the age of 45 in the UK, and the rate has been increasing in recent years. In 2014 the male suicide rate was three times higher than the female rate. I am pleased that the Government focused on suicide in yesterday’s announcements. Ultimately, there is nothing more serious or important than seeking to prevent lives from being lost in that horribly tragic way, with the impact that it has on families—my family, along with many others in this country, have gone through that experience—so we need to give it the greatest possible attention.

The overall lifetime costs associated with a moderate behavioural problem amount to £85,000 per child, and with a severe behavioural problem they are £260,000 per child. That is why it is so important to deal with these issues early, rather than allowing them to become entrenched.

The Children’s Society has highlighted school-based counselling, which can be highly effective for children experiencing emotional difficulties. It can be used as a preventive measure, an early intervention measure, a parallel support alongside specialist mental health services, and a tapering intervention when a case is closed by the specialist services to help a child or teenager through to recovery. Research shows that children perceive it as a highly accessible, non-stigmatising and effective form of early intervention.

Studies have also shown that attending school-based counselling services has a positive impact on studying and learning. In 2009 Professor Mick Cooper assessed the experiences of and outcomes for 10,000 children who had received counselling in UK secondary schools. More than 90% reported an improvement, which they attributed to counselling, and 90% of teachers reported that counselling had a positive impact on concentration, motivation and participation. So we end up achieving better academic attainment if we make the investment for those children who need it. It can be cost-effective, given the long-term cost to the economy of problems that continue into adulthood; some studies have indicated that the long-term savings can be in the region of £3 saved for every £1 invested, and data from Wales indicate that the average cost of school-based counselling is significantly lower than the specialist treatment children get if that is the only alternative. So we save money by giving children access to school-based counselling rather than delaying intervention and referring the child to a distant service, probably with a long waiting time, which is also far more stigmatising.

The British Association for Counselling and Psychotherapy has estimated that the overall cost of statutory provision of school-based counselling across all of England’s state-funded secondary schools would be in the region of £90 million per year. On the basis that 60% of schools are already delivering it, the additional delivery would cost around £36 million. I suggest that that investment is well worth making given the improved preventive care.

Accelerated Access Review

David Simpson Excerpts

Tuesday 13th December 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Dudley North (Ian Austin) on bringing it forward. One of the major issues that I seek to raise with Government, as the Democratic Unionist party’s health spokesperson, is the treatment of rare diseases and cancers.

Cystic fibrosis is a most debilitating life-limiting disease. It is believed that one in every 2,500 babies in the UK is born with cystic fibrosis. It is a disease that affects too many households in our nation and as such one that we must address to the fullest degree and in the best way possible. As a member of the all-party parliamentary group on cystic fibrosis, I have a great interest in this work and noted, with a small amount of hope, what was being labelled as a wonder drug—Orkambi, which was touted as having significantly reduced hospital admissions and slowing the decline in lung function in people with the genetic mutations that it targets. However, we all know that this year NICE was unable to recommend Orkambi, despite acknowledging the drug as an effective treatment for the management of cystic fibrosis. Since then, negotiations between the manufacturer Vertex, the Government and NHS England have reached a deadlock. Orkambi is a precision medicine that treats the underlying genetic cause of cystic fibrosis rather than just the symptoms, and is therefore very important.

Like the hon. Member for Dudley North and others, I would like to quote people from my constituency and from Northern Ireland—one is from my constituency and one is not. I was emailed by a man from Castlederg, the hometown of my mother’s family, regarding the failure of the NHS and NICE to recommend this drug for the prescription list. Although I had read much about the drug, the human aspect was made so clear in his letter:

“With the power to lift so many of the limits cystic fibrosis can place on people with the condition, it’s vital that access is granted without delay.”

I believe that many of us in this Chamber are here to highlight and draw attention to the plight of our constituents who are crying out for the hope that this drug could bring—the difference of quality years of life for someone suffering from cystic fibrosis. My friend from Castlederg also wrote about this example of a young lady who quite clearly needs help:

“I have first hand knowledge of this drug Orkambi because my daughter Rachel who suffers from cystic fibrosis has been on it for over three years now. Rachel took part in clinical trials for two and a half years and it has transformed her life. Her lung functions have risen by 19%”.

These are more than stats—this is about her life and how Orkambi has changed it.

[David Simpson (Upper Bann) (DUP)]

A constituent of mine, Charlene Barr, passed away at the age of 20, just days before she was due to visit this House to campaign for cystic fibrosis drugs. I ask the House to pay tribute to her and her family for the fantastic work they do in Northern Ireland to raise awareness of this issue and of cystic fibrosis.

[Jim Shannon]

My hon. Friend has put his constituent’s name in Hansard as part of this debate, and I believe that is a fitting tribute to her.

My friend from Castlederg also wrote of Rachel:

“Her lung functions have risen by 19%, she has gained a stone in weight and has had very little coughs or colds in this period of time. In CF terms this is massive.”

He said that Rachel was 25 years of age last January and that she

“is currently doing a PhD at University and Orkambi has really given her so much energy and strength to be able to carry out such a big undertaking. Rachel has been very fortunate as Vertex have kept her on Orkambi after the trials because I suppose it would be bad looking on their part if they took her off it...I think that its only right that people that are eligible for this drug should be given the chance to receive it and to prolong their lives for many, many years and maybe even save their lives. The problem is that NICE have told the NHS that it’s too expensive at around £104,000 per year. What price do you put on a person’s life?”

I understand the way things work and I understand well the arguments regarding the likes of pancreatic cancer drugs that could add an extra year to someone’s life versus more money for the research to find a cure, but this drug could make a life such as Rachel’s much better and could help her. The new 96-week data published recently show that Orkambi slows decline in lung function, which is the main cause of death among people with cystic fibrosis, by 42%. The data were unavailable to the NHS, as others have said, but they are available now. We look to the Minister to ensure that the opportunity is available for people to have Orkambi. People who are on Orkambi through the compassionate use programme are beginning to report total transformations in their health, including enough improvement to come off the lung transplant list.

I understand the time restrictions, but I will give one more example. So many people have contacted me, including Martin Keefe, whose beautiful granddaughter, Evie-May, was diagnosed with CF at three weeks old. She is now seven years old. Surely this is the time to begin this treatment, so that she has less irreversible lung damage and can look forward to a longer, healthier life. To be clear, I am not a scientist, a doctor or a researcher, but as an elected representative, I can listen to the difference that these drugs have made and could make to people’s lives—to Rachel’s life, Evie-May’s life and the lives of many others. The research that was not available at the time of the NICE guidelines is now available and it is compelling. With great respect, we are all conveying compelling evidence and information directly to the Minister.

The review is an opportunity to do the right thing by those suffering from this disease, particularly those such as Evie-May and Rachel, who has noticed such a change. It is for those people that I ask the Department of Health to end the stalemate and make a new decision. We look forward to the Minister’s giving them the Christmas present that they want and that we in this House all wish for. I understand the budgetary constraints, but the benefit of the drug appears to outweigh the financial cost. Rachel, Evie-May and others like them, UK-wide, deserve the chance to have the drug.

Diabetes Technologies

David Simpson Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered access to diabetes technologies.

It is a pleasure to serve under your chairmanship, Mrs Gillan. It is also good to see the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), in her place; I served under her chairmanship when she chaired the Select Committee on Science and Technology. I intend to use this debate to consider what can be done to accelerate access to new, innovative diabetes technologies.

This is a complex subject. I know there are patients who would benefit from technologies such as insulin pumps and glucose monitoring systems but are not able to access them. For many, access to diabetes technologies will have a transforming effect on their lives, enabling them to live full lives, be economically active and reduce the burden on primary and secondary care.

First, I recognise that progress is being made in this area. The intention behind the debate is to highlight the opportunity we have dramatically to transform people’s lives by accelerating access to diabetes technologies. I am here not to criticise but to say, as my schoolteachers regularly said to me, “You could do better,” because I believe we can in this area. Secondly, I want to use this opportunity to pay credit to the work of the all-party parliamentary group on vascular disease, and in particular its inquiry into patient access to technology last summer. The APPG recognised that access to technology facilitates the earlier and more accurate identification of people at potential risk of diabetes-related complications.

I want to refer to three of the 12 recommendations listed in the APPG’s report. The first is that the NHS must consider steps to become more flexible when commissioning or supporting the commissioning of new technologies designed to improve patient outcomes. Its second recommendation is that the NHS and industry should work together to harness innovation and promote better treatment for patients. Thirdly, it recommends that NHS England should consider how to introduce measures to incentivise the screening and diagnosis of patients at risk of peripheral arterial disease in primary care settings. Those recommendations help me to impress on the Minister a matter of great urgency, importance and opportunity for diabetic patients in the UK.

I would like us to consider the need to accelerate access to existing technologies; how the NHS can accelerate the development, testing and application of new technologies; and how information technology can be used to inform and educate patients, giving them greater power to manage their condition and lead full and free lives.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. He will be aware that in our schools today there is a problem with young children administering insulin where teachers are not trained to do it and cannot, because of child protection rules. If new and innovative technologies were used, we could perhaps get over that difficulty.

Psychosis: Early Intervention

David Simpson Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered access and waiting time standards for early intervention in psychosis.

It is a pleasure to serve under your chairmanship, Sir Roger. May I welcome the Minister to her new role? I spent a great two and a half years in the Department of Health; it was the most invigorating time in my life. I wish her every success.

The debate is on something that I care a lot about: a new standard of access for people who suffer a first episode of psychosis, a cruel and punishing condition that can have a massive impact on people’s lives—incidentally, at enormous cost to statutory services. When I came into my role as Minister, I recognised that there was a complete inequality of access, standards and rights between those who suffer from mental ill health and those who suffer from physical health problems. That inequality of access has existed for many years. In the last decade, the Labour Government introduced comprehensive access standards in the NHS for physical health problems, and they were right to do so—the cancer standards that have transformed cancer care in this country are a leading example of those—but they left out mental health.

It is not just that individuals sometimes end up having to wait interminably for treatment in some parts of the country; that complete imbalance of rights between mental health and physical health drives where the money goes. There is enormous political interest in meeting those demanding access standards. The national media look at the four-hour A&E standard. Certainly in my time in the Department of Health, all the great and the good of the NHS gathered around the Secretary of State’s table every Monday morning to look at spreadsheets showing the performance of every hospital in the country against those access standards. That extraordinary almost micro-management from the centre on access standards in physical health sets the tone for the whole system and makes it clear that meeting them is critical. So what do clinical commissioning groups around the country do? They trim a little bit off funding for mental health, which is still funded primarily through block contracts, to feed the beast of those exacting access standards in physical health.

I was determined from the start to address that injustice—that is what it is; it is a discrimination at the heart of our NHS—and introduce access standards in mental health. We went through a long deliberation before coming up with two specific standards, which were set out in a Government document published in October 2014, that we wanted to introduce as the start of a process that would lead ultimately to comprehensive access standards in mental health so that everyone with a mental health problem had the same right to get treatment in our NHS as anyone else.

The first standard that we identified was a six-week standard for access to psychological therapies. That is part of the improving access to psychological therapies programme, a well-regarded, world-leading programme that does not do everything but has been a significant development. The other was a two-week standard to start treatment when someone suffers a first episode of psychosis. Those people are typically teenagers or perhaps in their 20s—that is the most common age—but such an episode could happen at any time in one’s life.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing this very important debate. He has hit somewhat on the point that I was going to raise about early intervention. At what stage does he believe that we should deal with this condition? He talks about 18 or 20-year-olds, but should we go right back to primary or secondary school and deal with it in younger children?

[Norman Lamb]

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.

Diabetes-related Complications

David Simpson Excerpts

Tuesday 7th June 2016 Westminster Hall

[Paula Sherriff]

I thank the hon. Gentleman for that relevant contribution, and I absolutely agree. It is worth noting that, as with many conditions, education is often the key, and I will allude to that later in my speech.

[David Simpson (Upper Bann) (DUP)]

Will the hon. Lady give way?

[Paula Sherriff]

I will make some progress and then take further interventions.

The starkest figure of all is that every year, more than 24,000 people die prematurely due to diabetes and its complications. However, there is significant room to improve diabetes care, which would reduce the risk of diabetics developing complications and tackle the rising costs of diabetes to the NHS. First, we could take action to reduce avoidable amputations. There are more than 7,000 diabetes-related amputations every year in England alone, and foot ulcers and amputations cost £1 of every £150 spent in the NHS. I am sure hon. Members will agree that that is quite an incredible statistic. In 2013, the Secretary of State for Health committed to reducing the rate of diabetes-related amputations by 50% over five years, but the national amputation rate has since remained steady.

Action could be taken to meet that commitment. For example, the Government must ensure that clinical guidance is properly implemented and followed. The National Institute for Health and Care Excellence recommends that all people with diabetes have their feet checked every year, but in the worst-performing clinical commissioning groups, one in four people still are not receiving that annual foot check. There also appears to be a significant disparity in what the annual foot check actually means. Those at increased risk of foot problems should be referred for an assessment by a foot protection service. Having multidisciplinary foot care teams in place can reduce the risk of amputation, but almost one third of hospital sites do not have one.

That is of particular significance to me, because along with my hon. Friend the Member for Heywood and Middleton, who will no doubt have more to add during the debate, I recently visited King’s College hospital diabetic foot clinic here in London, which provides some of the best diabetic foot care in the country, if not the best. Care such as that provided at King’s is unfortunately not universal. There are currently no national drivers to lower the rate of amputations across the country, of which we believe about 80% are avoidable. With the right care in place, such as acute multidisciplinary foot teams and a robust care pathway, amputation rates could be significantly reduced. Not only would that have significant cost-saving benefits for the NHS, but more importantly, the people involved would not need to go through such a life-changing experience.

I will briefly reflect on a gentleman my hon. Friend and I met during our visit to King’s College hospital. He was due to have an amputation at another hospital within 48 hours. He was then referred to King’s College for a last chance to have his condition reviewed, where he was told that he did not need any surgery, nor an amputation. When we saw him, he was almost completely cured of his foot problems. A huge amount of money and a huge amount of distress to that man were saved. Will the Minister please confirm that the Government are still committed to the 50% reduction that the Secretary of State spoke about and tell us when they expect to see figures showing year-on-year decreases? Will she tell us what they are doing to ensure that CCGs meet the NICE guidance, and how they can ensure that multidisciplinary teams such as that at King’s operate much more widely across the NHS? The benefits we saw that morning were absolutely clear.

There is a similar need to improve in-patient care. One in six people in hospital now have diabetes, but one in three hospitals have no diabetes specialist nurse and an unacceptable number of in-patients experience diabetes-related harm while staying in hospital. Diabetes UK has pointed to evidence showing that specialist diabetes in-patient teams save three times what they cost the NHS to provide. Specialist teams make fewer prescribing errors and deliver better outcomes for their patients, so there are fewer expensive complications in hospital and shorter stays. Although most hospitals report increasing referrals and patient contacts, there has been no increase in staffing levels in diabetes teams.

I do not think that the number of in-patients who suffer diabetes complications while in hospital is acceptable, and I hope the Minister agrees. The national diabetes in-patient audit showed that 38% of in-patient drug charts had at least one diabetes medication error and 22% had at least one prescription error; that 30% of in-patients had one or more hypoglycaemic episodes, with nearly a third being severe; that 33% of people with diabetes did not think the staff looking after them knew enough about the condition; and that one in 10 hospital sites did not have any consultant time for diabetes in-patient care. Will the Minister tell us what action she intends to take to reduce those figures, assuming that the Government do not think they are acceptable?

[David Simpson]

We have heard education and early intervention mentioned. Does the hon. Lady agree that in order to help patients, and especially children—there is a reluctance for teachers to give insulin to young people within nursery provision and at primary school level—the mindset needs to change? We need to make sure that there is preventive medication as well as early intervention for children.

[Paula Sherriff]

I thank the hon. Gentleman for that intervention; once again, I agree with those points.

It makes sense both clinically and financially to improve access to diabetes self-management education. Managing diabetes well is time-consuming and can be complicated, but 69% of diabetics said they did not fully understand their condition. On average, people with diabetes spend only three hours a year with a healthcare professional. For the remaining 8,757 hours they manage their diabetes themselves, for which they need the right skills and knowledge—not to mention confidence. Diabetes self-management courses empower people with diabetes to take charge of their own care. Nine out of 10 people with diabetes who attended a course stated that they felt more confident about managing their diabetes afterwards.

Evidence collated by Diabetes UK shows that diabetes education courses reduce an individual’s risk of developing serious and costly complications and prove very cost-effective. However, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance, and less than 2% of people newly diagnosed with type 1 diabetes—and just 5.9% with type 2 diabetes—attend a diabetes education course. Investing in diabetes education is the big missed opportunity in diabetes care. Will the Minister agree to look at what can be done to ensure that we do not continue to miss it?

Support for Life-shortening Conditions

David Simpson Excerpts

Tuesday 7th June 2016 Westminster Hall

[Stuart Andrew]

The hon. Gentleman makes an important point, which I will come to later.

Some 49,000 children and young people are living with conditions that are life shortening, by which we mean conditions for which there is no reasonable hope of a cure and from which most of those young people are expected to die. The conditions can include conditions for which curative treatment may be feasible but can fail, as is often the case with cancers or congenital heart diseases; conditions for which premature death is inevitable but where there may be prolonged periods during which the child is well, such as Duchenne muscular dystrophy; progressive conditions such as Batten disease, without any curative treatment; and irreversible, but non-progressive, conditions that cause severe disability, leading to susceptibility to health complications and premature death, such as severe brain injuries.

The number of young people affected by one of those four categories of condition is equivalent to one child in every single school, and 50% of the 5,000 children who die in the UK each year will have one of those conditions. Of course, the number of people affected in other ways is much higher. Parents, siblings and other family members and friends can bring the number close to 400,000 people, which equates to more people than the population of the city of Leicester.

The 49,000 children and young people need palliative care from the point at which their condition is diagnosed or recognised—often at birth—until the end of their lives. There is an entire package of outcomes that good palliative care should achieve, which is quite different from that which adults receive given that children often need care throughout their entire life. Good care should meet children’s physical, social and emotional needs, enhancing their quality of life to ensure that the child and their family can come to terms with such life-altering issues.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this important debate. I am sure that many people here will have come into contact with children with such difficulties. Does he agree—he touched on this point—that more psychological help is needed for the parents, especially when the children are approaching the time of death? It is a very difficult time. There need to be very quick results. Help is needed for the parents as well.

[Stuart Andrew]

I absolutely agree. During the time I spent in the hospice movement, I learnt that those final few weeks are incredibly distressing. None of us can possibly imagine what it is like unless we have been through it. The support for the parents and the wider family is what makes much of what happens in the children’s hospice movement such a success.

The care must be age appropriate—suitable for a child’s particular stage of development—and administered by people who have the exact skills needed to get the person through their care pathway. A comprehensive local children’s palliative care service spans health, social care and education. Joint commissioning is vital and should be accessible 24/7, 365 days a year, from diagnosis to bereavement. As a result of the complexity and severity of patients’ needs, the transition from children or youth services to adult services can be particularly daunting.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Pudsey (Stuart Andrew) on clearly outlining the case and how we all feel about this important subject. I apologise in advance for not being here to hear the shadow Minister and the Minister—I have apologised to them both. I have to attend the Select Committee on Defence, otherwise I would look forward to hearing what they have to say.

This issue is important to me, as it is to the hon. Member for Pudsey and others in the Chamber, which is why we are here. We are here to represent our people and their viewpoints on issues that they want to be debated. There are Members here with personal stories, some of which we have heard before, and I look forward to hearing some of those stories again.

Life-shortening conditions are those for which there is no reasonable hope of cure and from which children are expected to die, or for which curative treatment may be feasible but can fail. Children with life-shortening conditions need continuing palliative care throughout the trajectory of their illness. As I always do in Westminster Hall and in the House, I will give a Northern Ireland perspective. The Minister knows that health is a devolved matter in Northern Ireland, and I will therefore add to the debate and the knowledge we all have by addressing some of the positive things we are doing in Northern Ireland. By sharing knowledge from across the United Kingdom of Great Britain and Northern Ireland we have an opportunity to enhance and enrich our lives and to help ourselves to do things.

In Northern Ireland alone there are currently estimated to be some 1,300 children and young people living with life-shortening conditions. Many of those children have extremely complex and unpredictable conditions, and they are under the pressure of requiring round-the-clock care seven days a week. Due to medical advances and improved care, that prevalence is growing and more of those children are living into adulthood.

The hon. Member for Pudsey and my hon. Friend the Member for Upper Bann (David Simpson) referred to families and how important it is for children under pressure and in need of medical assistance to have family support. It is about their parents, their siblings, their grandparents, their family circle and their friends coming together to give support and help at the right time. Because the proportion of young people and children in the Province with life-shortening conditions is less than 1%, people might be inclined to believe that they are an underfunded and perhaps neglected section of the population, but fortunately they would be wrong. More can always be done, but in Northern Ireland the work to support young people and children affected by life-shortening conditions has been positive and is ongoing.

Health may be a devolved matter, and this debate may be most pertinent to NHS England, but such conditions affect British children across the whole United Kingdom of Great Britain and Northern Ireland, and it is therefore important to make such points. It is important to link the work of Government institutions across the United Kingdom to determine what is best practice and what is not, and to share ideas on the way forward. Hopefully this debate will give us an opportunity to do just that.

[David Simpson]

We have discussed palliative care. Does my hon. Friend agree that it is important that complete, wrap-around palliative care is given to those affected? What happens to children with life-shortening illnesses post-19 has been an issue across the whole United Kingdom for far too long, and we need to address it.

[Jim Shannon]

My hon. Friend has hit on the kernel of the issue.

We need to exchange medical advances among all regions of the United Kingdom. We want to ensure that we in Northern Ireland have information about what is happening in London, Scotland, Cardiff or wherever it may be. I also want to put on the record my thanks to all the doctors, nurses and consultants involved, and to all the other people who genuinely, consistently, honestly and energetically give their time for the children affected. I have some constituents who have attended Great Ormond Street children’s hospital, not only for life-threatening conditions but for life-changing ones, and we thank everyone for what they do.

Community Pharmacies

David Simpson Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas]

That is exactly right: it is pharmacists’ skills that we must be careful to maintain and develop.

I know that you have concerns about this matter as well, Mr Streeter, especially concerning the pharmacy in Modbury in your constituency, so I appreciate your support on this issue and the way you are chairing this wonderful Westminster Hall debate.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing this debate. The letter that he read out hits a lot of the points. Removing the funding will make waiting lists longer, when GPs are already under pressure; in fact, we are losing hundreds of GPs every year, as they go to other countries. Pharmacies can see people at the point in time that they would usually see GPs; sometimes people have to wait two or three weeks to get an appointment with the GP. So this proposed cut seems to defeat the purpose of the planned change.