Community Hospitals

David Simpson Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Charlie Elphicke (Dover) (Con)]

It is a pleasure to serve under your chairmanship, Mr Owen. I welcome the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for Mid Norfolk (George Freeman), to the debate and congratulate him on his elevation in the reshuffle before the summer recess. It is a pleasure to speak in such a well attended debate, with so many parliamentary colleagues coming to share my concerns about the future of our community hospitals.

The purpose of this debate is to make the case for the Government’s putting the community back into community hospitals and for recognising that such hospitals should have a central role in coping with the issue of people living longer. Community hospitals are important providers of recovery beds that speed rehabilitation and recovery, which can also help older people in particular to continue to live independently.

I was inspired to seek this debate because people in my community care deeply about the local community hospitals in Dover and Deal. Years of centralisation have taken their toll. My constituents want more locally-based health services provided by their local hospitals.

Dover was deeply concerned to see services axed at its Buckland hospital; wards were closed one by one and a much-loved hospital was decimated over a decade. When I was elected in 2010, plans for a new hospital had been going nowhere for getting on for a decade and the new hospital project was set to be axed altogether. Meanwhile, in Deal, it was agreed in 2006 that out-patient services should be axed and residents were fearful that the hospital would be closed altogether. However, after much hard campaigning, the long-stalled new Dover hospital is being built. It will open in February or March next year and will have out-patient facilities, day surgery, diagnostics and a revamped urgent care centre. The number of journeys that will need to be taken to the big, far away hospitals will fall dramatically. It will make a massive difference.

In Deal, we campaigned hard to safeguard the future of the hospital. A massive survey and a packed public meeting ensured that NHS chiefs pledged not to close the hospital and they will now seek to expand its services. We now hope that out-patient services can be maintained for people who find it hard to travel: the elderly, the partially sighted and people with broken bones.

However, we have not achieved everything that we want. People in Dover want recovery beds to be located at the new hospital. Residents of Deal would like greater community and local general practitioner involvement in the hospital and its services. Both communities would like more locally-based services, to minimise the number of journeys to the large, far away acute hospitals for simple procedures and treatments. These concerns led me to move a ten-minute rule Bill earlier this year and I was delighted that so many parliamentary colleagues supported that.

The issue is not just for Dover and Deal; I have set out the local situation to provide context for the concerns of so many parliamentary colleagues. There are some 400 local and community hospitals throughout the land and there are similar stories to be told about many of them—stories of people battling to defend their hospitals and hospital services against the NHS leviathan and the forces of centralisation.

There is a sense that the tide has begun to turn. After all, a new hospital is being built at Dover, health chiefs have pledged to secure the future for Deal hospital, and there has been a move towards a fairer share of health care for rural and semi-rural communities far from acute hospitals. We have come a long way. Today, I am making the case for going further and asking what more we can do to embrace community hospitals and bring them closer to the heart of the NHS and, in particular, support the role that they play in providing recovery beds and more locally-based services, particularly for an ageing population. We need to put the community back into community hospitals.

We should note an important moment in the history of the NHS, marked by the comments of Simon Stevens, the new chief executive of NHS England, who recently made the case for patients to be treated more often in their own communities, saying that the NHS is currently too focused on

“a steady push towards centralisation”

and that Britain should learn from countries such as Sweden, the Netherlands and the United States, which have strengthened community care around small hospitals to meet the needs of local communities.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. In Northern Ireland, of course, we do not have as many community hospitals as there are on the mainland. Ours tend to feed into a main hub and we have out-of-hours services more than community hospitals. However, Mr Stevens, whom the hon. Gentleman mentioned, also says that we should consider community hospitals developing as social enterprises. What is the hon. Gentleman’s view on that?

[Charlie Elphicke]

The hon. Gentleman anticipates the direction of my speech. I wholly support it; it is a great idea. Mr Stevens also said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS”

and that

“Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised”.

In a speech to the NHS Confederation annual conference in June 2014, he outlined his plans for reform of community health services, reiterating the problems of the ageing population and the increasing number of long-term conditions, such as obesity and dementia, as well as more expansive and expensive treatments and the need for more localised health services to tackle these problems.

Mr Stevens is right. Community hospitals have an important role to play and perform best in respect of intermediate, step-down and step-up recovery beds, particularly for people recovering from an operation who need round-the-clock care, and in respect of helping older people get better and continue to live independently, keeping them out of end-of-life or long-term nursing home care.

Organ Donation Register

David Simpson Excerpts

Tuesday 17th June 2014 Westminster Hall

[Andrew Griffiths]

I thank my hon. Friend for that intervention. Perhaps he is just a little presumptuous. I was not intending to argue for the opt-out system. All I was going to urge the Minister to do was to look at these issues on the evidence. What I suggest is not that we should come forward with a similar proposal for England and Wales, but that we should follow the evidence. We should look closely at how the system is implemented in Wales and at its impact. My hon. Friend has said that he will talk about the situation in Spain. In Spain, there was a delay before there was an increase in the number of donor organs available, but all the evidence seems to suggest that the system has led to a big increase.

Not only is the debate important, but it raises awareness of organ donation. It gets people talking; it stimulates discussion, which is important. My hon. Friend will know that the principle of the opt-out system is supported by a number of organisations, including the British Medical Association, the British Heart Foundation and Kidney Research UK. As I said, I hope that the Government will look closely at the evidence—at the results of changing the law in Wales—and look to reconsider their position as the evidence develops. My hon. Friend may well be right that there will be no marked increase in the number of organs available for donation, but we do have to follow the evidence, look at the results and decide what we do in the rest of the UK as a consequence.

There was a call by those involved in organ donation committees in our hospitals to look at the issue of the lack of family consent overriding the wishes of the deceased.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate on what can be a very controversial issue. Does he agree that we should exhaust every possible avenue, whether it be schools or the driving licence organisation or whatever, before we even look at going down the road of an opt-out system, because it is a very controversial issue? In Northern Ireland, 527,000 people—32%—are on the register. The figure is increasing every month. A consultation is ongoing. I understand that in October a consultation will also be carried out on an opt-out system. I think that we need to exhaust every other avenue and then have further debate on that issue.

[Andrew Griffiths]

I agree with the hon. Gentleman; he talks a great deal of sense. The issue is very sensitive and we do not want a backlash in the form of people deliberately coming off the organ register because of ethical and moral concerns. I agree that there is more that we can do. I congratulate the Government on what they have achieved so far, but we can do a great deal more. The issue is important not only because lives are at stake, but because it has a massive impact on NHS costs, which I hope to touch on towards the end of my speech. I completely agree with the hon. Gentleman.

I want to address organ donation in the black and minority ethnic community. I am the Member of Parliament for Burton, which has a large Muslim population—mainly Pakistani and Kashmiri diaspora—who contribute massively to the community. However, there is no doubt that there is a problem with organ donation among BME communities. There is particular concern about the lack of donors coming forward from BME backgrounds. The startling truth is that people from BME backgrounds are up to three times more likely to need an organ but are less likely to donate; they need it more, but they donate less. Only 3.6% of people on the organ donation register are from ethnic minority backgrounds, despite their making up 10.8% of the population and a staggering 27% of the waiting list. Those figures show how skewed the numbers are and how desperate it is that we do something about the issue.

More than 30% of people listed for a kidney transplant are BME, compared with just 5.6% of deceased kidney donors in 2013. Why is that important? NHS blood and transplant statistics show that, on average, people from black and Asian backgrounds have to wait a year longer for a kidney transplant: between 2006 and 2010, the median waiting time for a kidney transplant in the UK for a white person was two years and 363 days, yet for a black or Asian person the wait was three years and 320 days. That is a whole year longer, just because of someone’s ethnicity. Family refusal rates among ethnic minority backgrounds also play a big part. The Minister will know that those rates are much higher than for the population as a whole, with 30% of BME families giving their consent to organ donation, compared with 68.5% of the white population—more than twice as many. That is why it is so important that we tackle the issue of organ donation among the BME community.

Ethnicity is hugely important in organ donation because a person is much more likely to find a match with someone from a similar ethnicity. It is vital that we do more to encourage people from BME backgrounds to sign up to the organ donation register. That is not the only answer; it is also vital that we break down the cultural barriers that prevent BME families from consenting. I commend the Government on the NHS blood and transplant team’s faith and organ donation summit in May last year. It was a good event, and it was agreed that sustained engagement on organ donation by and in ethnic minority communities is needed.

Those are all good words, but I am not seeing them reflected in my community. I am not seeing organ donation being discussed in churches, mosques and community centres. I am not seeing our imams and priests talking to their communities and encouraging them to come forward and donate—to do the right thing by signing up to the organ donation register. None of the major religions object in principle to organ donations, but of course opinions in communities differ. Organ donation is often not discussed, or is called, for example, un-Islamic. We must address such things if we are to break down prejudice and save lives in BME communities as a result. Leaflets have been distributed among different faith communities to that effect, but I hope the Minister will agree that much more can be done.

One way to increase donation that has been advocated is through the use of specialist nurses in organ donation—there is a wonderful acronym: SN-ODs—who were introduced following the 2008 recommendations. We now have 250 SN-ODs, who are there to support people going through the organ donation process and to raise awareness of donating. The National Black, Asian and Minority Ethnic Transplant Alliance is calling for more SN-ODs to come from ethnic minority backgrounds, and I agree with it on that. I am not sure whether the Minister is aware that of those 250 SN-ODs throughout the country, just one is from a BME background. Is it any wonder that we are failing to break down cultural barriers at that terrible moment of loss, when we have only one person from a BME background to engage with people who are suffering such loss, and to encourage them to give life to others?

The proposed action plan arising from the summit in May last year featured a number of criteria on increasing engagement with ethnic minority communities. The aim was to fulfil them before September this year, and other criteria by a year hence. I would be grateful if the Minister would give us a little more information about what she and the Department are doing regarding those important criteria.

I know that other Members wish to speak, so I will soon draw my remarks to a close, but I want first to touch on a few points. First, I called for this debate at the request of William Saunders, the chairman of the organ transplant committee at Queen’s hospital in my constituency. It is fantastic to see William and his team, like others throughout the country, engaging as members of the community to try to encourage others to do the right thing and sign up to the organ transplant register. I hope that the Minister agrees that such people are doing a fantastic job in our community and that more must be done.

I also called for this debate because of a constituent, Katherine Sinfield, who sadly was diagnosed with leukaemia. My local newspaper, the Burton Mail, has done a huge amount to highlight Katherine’s case and to encourage people to come forward and undergo stem cell testing in order to find her a match. I am delighted to say that she has now found a match and had her treatment. We all wish her well, and she is doing incredibly well.

Through the Burton Mail’s campaign, I have seen the difference that raising awareness can make. The work of the Burton Mail and the Anthony Nolan trust has resulted in a large increase in the number of Burton residents who have come forward to be tested and who want to do their bit. It has also raised a huge amount of money for the Anthony Nolan trust. If we can encourage similar activity across the country—if Members will raise the issue in their constituencies—we can all play our part in raising awareness.

In conclusion, with such a high level of support for organ donation among the general public—96%—it is surprising that there is such difficulty in finding enough donors to meet the demand for transplants. It is clear that more work must be done. Despite these times of constrained public spending—we all recognise the difficulties in which the Government find themselves—I believe we can do more to solve this problem. Indeed, the “Taking Organ Transplantation to 2020” strategy says clearly that

“no additional funding is likely to be needed to move forward: much of what needs to be done is about working differently rather than increasing resources.”

I am sure that that is music to the Treasury’s ear, but I know that the Minister will put her shoulder to the wheel and help.

Without meaning to put it in crude terms, transplants save the NHS money in the long term. The entire transplant programme saves the NHS £316 million a year, which is money that would otherwise be spent on treatment. A successful kidney transplant operation, for example, costs £17,000, with a future cost of some £5,000 a year. A year’s dialysis for a patient with kidney failure, on the other hand, costs £30,800. The NHS blood and transplant service predicts that, for every year a kidney transplant remains functional, it saves the NHS £24,100 per patient while saving the patient’s life. If ever there was a win-win, that is it. From a financial perspective, it makes perfect sense to want to increase the number of organ donations if they can deliver such savings for the NHS, but more importantly, from a personal perspective, if any of us or one of our loved ones needed a transplant, we would do everything possible to ensure that we found a donor. We would move heaven and earth to give our loved one that chance.

I join the call of the organ donation committee at Queen’s hospital in my constituency and others across the country in saying that more needs to be done to increase the number of people on the organ donation register. Sign up; it saves lives.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Burton (Andrew Griffiths) on securing this debate. Without doubt, this is an important issue. In his brief speech, he outlined the importance of organ donation to us all.

Some of us come to this debate with personal knowledge, and other Members with a very personal understanding will speak shortly, too. I will speak not only about cold facts but as a first-hand witness who was emotionally involved with a family member in need of an organ donation. Twenty-three years ago, my nephew, Peter, was born with one kidney that was not working and another that was the size of a peanut—I think that is how the doctor described it. That clearly inhibited my nephew’s quality of life. For many years, until he received an organ donation, he was unable to have the quality of life that everyone in this Chamber today is privileged to have.

My second son and my nephew were born at about the same time, so I was always able to compare their quality of life—my son, who was perfectly healthy, and my nephew, who unfortunately was not healthy as he awaited a kidney transplant. My nephew was restricted in height and in energy, and he was always a yellowy colour. That is hard for a family, but it is much more bearable when they know that kidneys are available in the organ bank ready to be transplanted. Peter was able to get that transplant, and it literally saved his life. That underlines the importance of organ donation to every member of my family and my family circle.

I do not want any parent or family member to be dealt the blow of knowing that a relative is in need of a transplant but there are currently no organs available. I do not want anyone to experience that, but that is what is happening in the UK today. That is why I feel so passionately about this debate. It will come as no surprise that I, as a Member of Parliament and as an individual, am a registered organ donor. Registering as an organ donor is much easier in Northern Ireland because whenever we apply for or renew our driving licence, we tick a box on the form to show whether we want to be an organ donor. Those who say yes will automatically become an organ donor should their time in this world come to a tragic end.

In Newtownards in my constituency of Strangford, a garden has been constructed for people who are having dialysis and renal treatment at the Ulster hospital in Dundonald. It was felt that we needed a garden in which people could have tranquillity and peace, and to thank people who had donated their organs over the years. The council and local representatives were both involved. Rather poetically, perhaps, just two miles from that garden, a young man—I knew his father well—died some years ago. After being injured in an accident, his organs were donated to save other lives, which shows that there is an opportunity to save lives. As the hon. Gentleman said in his introduction, we can give an opportunity to those who have not had the quality of life that we have but could have it with an organ donation.

Despite all of our medical advances, some 1,000 people die each year in the United Kingdom waiting for an organ transplant, which is shocking. We desperately and urgently need to increase sign-ups to the organ donation register. With that harrowing statistic before us, what can we do, and what do the Government intend to do, to increase sign-ups? I am pleased that the Minister is in her place. I have asked her questions on this previously, and some of the answers are in the Library debate pack. There have been positive responses from the Government, and I have no doubt that we will get such a response at the end of this debate, too. We seek to add further contributions and evidence to the debate, and perhaps the Minister will be able to respond.

It is pleasing to read that, in the past five years, the number of people in the United Kingdom of Great Britain and Northern Ireland who donate organs after death has increased by 50%. That is good news and it matches a target set by the Department of Health’s organ donation taskforce in 2008. I suppose we are asking how we can do more. How can we make organ donation more appealing or more real to people?

[David Simpson]

We heard earlier that some 7,000 or 8,000 people are waiting for an organ transplant. Does my hon. Friend agree that, if we could dramatically increase the number of organ donors, a knock-on effect might be that it would end organ farming and the sale of organs on the black market?

[Jim Shannon]

That is a pertinent issue. I understand that organ farming is not the Minister’s responsibility, but we are aware of parts of the world where people are given a great deal of money to donate an organ for use elsewhere in the world. That is a travesty and an injustice for poor people who find themselves in financial difficulties and see this as a way out. My hon. Friend is right that that needs to be seriously addressed.

NHS figures show that there were almost 4,700 organ transplants in 2013-14, which is an amazing figure compared with 3,717 organ transplants in 2009. That is an increase of almost 1,000, which is a clear indication that Government policy is starting to take effect, with the general public’s co-operation. That is good news. It is about how we go over fences to get a wee bit extra and do more.

We must not praise ourselves too much, however, and settle for the progress that we have made. There is still a long way to go. NHS statistics show that on 31 March 2014, as my hon. Friend said, 7,026 people were on the transplant waiting list. Although that number has been decreasing for the past five years, it is still much too high. The Government must do more to cut those waiting lists dramatically. What new targets have been set by the organ donation taskforce, and how does it intend to raise the public’s awareness of the great importance of this issue?

During May and June 2013, Optimisa Research conducted market research on behalf of the NHS blood and transplant service to measure public awareness, attitudes and behaviour towards organ donation. The findings of that research highlight how much work the Government have to do to increase sign-ups. We must all energetically encourage those around us to sign up, but the Government need to lead, too. Some 54% of those questioned had not seen any recent publicity about organ donation. What is being done to highlight organ donation? The hon. Member for Burton referred to that, too. It is clear that, as a result of poor publicity, organ donation is not currently in the public consciousness as it should be. What steps have the Government taken to improve that and change the perception that organ donation is the exception rather than the norm?

Of those people questioned, 31% would consider donating some or all of their organs, but are yet to be fully convinced. Again, that indicates that there is a swathe of people who are susceptible to persuasion, which could lead us to the next stage for organ donation. Why are the Government not engaging with those people as they should? The research also found that the key personal barriers to donating include mistrust of medical professionals and discomfort in thinking about death. Death is a subject that we sometimes do not want to think about, but it is one that we must all consider. There is no better way of setting the scene than Mark Twain’s comment that the only two things in life we are sure of are death and taxes. Death is an issue for us all, and we must consider it.

It shows that the public are not sufficiently well informed. If the Government better presented information on organ donation, it stands to reason that the barriers preventing people from signing up would ultimately be removed, the number of people on transplant waiting lists would fall dramatically, the number of transplants would increase and, most importantly, the number of people in the UK who die while waiting for a transplant would fall significantly. We must consider that issue as well. We see so many stories in the press and on TV about those who are desperately waiting for a transplant and have a very short time between life and death. Every effort must be made to ensure that we can save the British lives of those whom we represent. Why is more not being done?

It is clear from the research that public awareness must be raised, and it therefore follows that the Government should focus on that, but there are also other means of increasing sign-ups. Although opinions are mixed on the issue of express or presumed consent, I would like to present my personal view. I encourage the Government to consider legislating for a soft system of presumed consent. Although some might disagree, I believe that such a system is right because it gives life. Perhaps the best time to ask a relative to consider organ donation is not when somebody is lying on their deathbed. Emotions take over. I am not saying that they should not; I am just saying that it is a reality of life, and we must address it. Personally, I believe in a soft system of presumed consent that allows relatives of the deceased to object to donation if the deceased died without expressly electing whether to donate their organs. Such a system is in place in Belgium, where the family’s prerogative is a legally defined right. I suggest to the Minister that we should at least consider it, debate the issue and put it at the centre of the organ donation debate.

Introducing a system of presumed consent would greatly boost the number of organs available for transplant. A 2006 study by Abadie and Gay found that countries with a presumed consent system had 25% to 30% higher donation rates than those with an opt-in system, which is a significant difference. If taken on board in the United Kingdom, such a system would cut the number of those waiting for a transplant and save lives.

I have asked the Minister what she is doing to encourage more older people to become kidney donors. She responded that there is no barrier preventing elderly people from being organ donors if their organs are healthy. It is not out of the question for those with a few more years on the clock to consider organ donation as well.

In my home province of Northern Ireland, only 32% of the population are registered organ donors, the lowest percentage of any area in the United Kingdom. That is unacceptable. Our devolved Assembly is currently processing a private Member’s Bill to increase awareness of organ donation, which proposes to provide people with an opportunity to sign up for organ donation when applying for a driver’s licence. The question will allow people to answer yes or no—they can make up their own minds—but it will be compulsory to answer; the question cannot be ignored. I am fully behind the Bill, as I feel that it will greatly boost the number of people who sign up for the organ donor register. How do the Government intend to work alongside Mr Poots, the Minister with responsibility for devolved health matters, to increase much-needed awareness in Northern Ireland? It is clear that a UK-wide strategy is the most effective way of dealing with the matter. The Minister will know that I often say here in Westminster Hall and in debates in the Chamber that it is important that the United Kingdom regions learn together and bring together all our knowledge so that we can present it.

Time has passed by, but my final point is to highlight the fact that research has found that if organ transplantation rates could be increased by 50% across the UK, the NHS would save money. The hon. Member for Burton mentioned a saving of more than £300 million. The figures depend on who is on the list, but the saving to the NHS would be significant. That cannot be ignored or denied. If we had that in place, it would help the Minister and this Government to manage their health budget better. In essence, if the Government save more lives through organ donation, they will have more money to spend on saving the lives of others. The Government and we as Members must not rest on our laurels and be happy with the progress made. The Government must take steps to ensure that the public are fully aware of the issue, and to save more lives.

Type 1 Diabetes (Young People)

David Simpson Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mr Howarth]

My hon. Friend makes his point well, in support of my argument, and I am grateful.

One in four children are diagnosed with type 1 diabetes when they are already in DKA, and the rate is even higher for children under the age of five. A number of clinicians I have met recently have advocated the removal of barriers between primary care and specialist teams, arguing that primary and secondary care teams should be sharing their expertise with one another in an attempt to close the skills and knowledge gap. In Merseyside, for example, specialist nurses have been working as mentors in practices to support primary care development and tackle deficits of knowledge, skills and confidence. Education is a major component of the improvement of care and outcomes. In many European countries, diabetes-specific training is mandatory for health care professionals who provide paediatric diabetes care. That is not the case in the UK. Although there has been a huge amount of work in the past five years to improve education for health care professionals, investment is needed to ensure that all paediatric units can access nationally standardised and accredited training.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. There are young teachers in schools in my constituency who are reluctant to inject children who are insulin-dependent. Surely, something more in the way of education and awareness needs to be done about that. Parents cannot come in to do that, so it needs to be done by someone such as a teacher or a nurse in school.

[Mr Howarth]

There are a number of problems to do with primary care. Sometimes, the lack of knowledge is appalling. The fact that on many occasions young people can go to a GP with what turn out to be classic diabetes symptoms without being diagnosed is a serious problem and needs to be addressed. The hon. Gentleman is right that education programmes for health professionals are important. It is equally important for people working in GP practices or other primary health care settings to be aware of the phenomenon that they are dealing with; otherwise they will make wrong decisions and give wrong advice, which in some cases can make things even worse.

We must prioritise access to education for self-management for children and young people. I am optimistic about the introduction under the best practice tariff of the requirement that children and young people will have access to education. There is, however, huge concern about the variety and standard of education. Considerable work is needed to ensure that what is offered is nationally standardised and tailored to meet the needs of children and young people, as well as their families. Unfortunately, there is no single best practice model throughout the NHS, although I am aware that the Government’s national clinical director for obesity and diabetes, Dr Jonathan Valabhji, understands that and is working with diabetes groups to find the best way forward. Today, I simply ask the Minister to take an active interest in Dr Valabhji’s work and to provide the support necessary to make progress.

I am told by those involved in diabetes that much research is focused on type 2 diabetes and that the principal source of funding is often pharmaceutical companies. That is of course welcome, but whereas with type 2 diabetes pharmaceutical companies can see long-term benefit in new and existing products, such a link is less clear with research into type 1 diabetes. There are some counter-examples, but it is an issue that needs addressing, so it is crucial for central Government to invest in type 1 diabetes research. Despite the UK having the fifth highest incidence of type 1 in the world, our contribution to type 1 research per capita is currently less than half that spent in the United States or Australia.

A more positive story can also be told, however. Many young people now use insulin pumps. Last week, I met 23-year-old Alex, who told me how her pump had changed her life: “It’s a little like you don’t have to think about it anymore. I don’t have to get my needles out; I don’t have to offend anyone. I can have a biscuit, go to the gym. I can change it to temporary settings and go out with friends. I can do things now. Before I used to say, ‘I can’t be bothered having to plan around it.’ It only takes two seconds; it’s hidden.”

One of the research projects that holds the most hope for people with type 1 diabetes is the work to develop an artificial pancreas, which is known as an AP. The AP is in essence a combination of an insulin pump and a continuous glucose monitor. The clever part is that the two devices talk to each other via a complex algorithm. The monitor automatically checks blood glucose levels and then, in effect, tells the pump exactly the right amount of insulin needed by the body. Such technology holds great promise to help people to safely achieve the recommended blood glucose control, as well as alleviating an enormous amount of the burden associated with self-management. Recent trials of the device have been encouraging.

A consortium led by the type 1 diabetes charity JDRF is leading the development of the AP. JDRF’s artificial pancreas consortium encompasses 22 institutions worldwide participating in the study. It is a great credit to the UK’s life sciences sector that we can count Cambridge, Leeds and University college London among the contributors, alongside Harvard, Yale and Stanford. Another artificial pancreas, developed by Professor Joan Taylor of De Montfort university, could have its first human trials by 2016. It has a reservoir of insulin kept in place by a special gel barrier, which liquefies when glucose levels rise, releasing insulin to the liver, thus mimicking a normal pancreas. As the insulin lowers the glucose levels, the gel reacts by hardening again and preserving the reservoir. Such research is an important step towards developing a portable, usable and safe AP system.

To return to the point made by my hon. Friend the Member for Wirral South (Alison McGovern), social media are increasingly used to help and support young diabetics. Many young people with diabetes experience a sense of isolation and have no contact with others who share their condition. A good example of young diabetics helping themselves is the 18-to-30 support group Circle-D, which was founded by the inspirational Shelley Bennett and is celebrating its sixth birthday today—congratulations to Circle D. They have regular social activities and a rant room where people can have a rant and share experiences before going to the pub. Their motto is “you are not alone” and they now have a massive network of diabetics of all ages offering support online, via Facebook and in person. Another group, targeted at teenagers and young adults, is Hedgie Pricks. Information about both organisations can be found online, and I would certainly encourage young diabetics to get involved and to share their experiences with others in a similar position.

The debate today is an opportunity to praise the steps that are being taken to improve paediatric diabetes care and to pinpoint where we need to do more. With that in mind, I reiterate my support and optimism for the best practice tariff. Given that the tariff was only introduced recently, I hope that the Minister agrees that it would be sensible to return to the subject of type 1 diabetes in young people once we have had a chance to see how well that is working.

In the immediate future, however, the Government can and must do more. I would welcome the Minister commenting on extending the best practice tariff to 25, ensuring that children and young people with type 1 diabetes get the psychological support that they need and ensuring that educational standards for health care professionals and for children and young people with diabetes and their families are nationally standardised and accredited. I will be grateful to learn of any steps that the Minister can take to increase our contribution to type 1 research.

I have one final point to make. I feel strongly that the issue of type 1 diabetes needs a champion within the Government. I hope that the Minister will rise to the challenge and provide the political leadership that is so needed if we are to tackle this important matter.

NHS Funding (Ageing)

David Simpson Excerpts

Tuesday 25th March 2014 Westminster Hall

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Edward. I thank Mr Speaker for granting this important debate. It is a pleasure to see that my constituency neighbour, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), will reply for the Government. As a practising doctor, it is natural that he is active on local health matters. Before arriving in Parliament, he, together with my hon. Friend the Member for Ipswich (Ben Gummer), campaigned hard to secure better cardiac facilities at Ipswich hospital, which were formally opened by Her Royal Highness the Countess of Wessex last week. I was pleased to join that campaign, although rather late on, because I was selected only three months before the general election. Nevertheless, those facilities are in place. Together, we have continued to highlight issues that affect our constituents, particularly the performance of the ambulance trust and our local hospitals.

I am proud that the NHS budget has risen under this Government and will continue to do so. I am proud, too, that my right hon. Friend the Secretary of State for Health has continued the focus on patients and has been prepared to lift the lid on when a normally high-performing NHS has let patients down. I join him on that crusade to ensure that patients are not sacrificed at the altar of targets, which is a sad, though unintended, legacy of the previous Labour Government.

From my experience as an MP with a rather elderly constituency—more than a quarter of its population are pensioners—I have come to realise that how the NHS has allocated its funding is simply not fair to older patients. That unfairness has become embedded in NHS finances over several years and significantly increased under the previous Government. We have an increasingly elderly population, and we have to tackle that funding issue. Let us remind ourselves that although the Labour party substantially increased health funding during its time in government, it did not sufficiently reform the NHS, and that includes the particular factor in the funding formula that could have helped older patients by focusing more on their needs.

The right hon. Member for Leigh (Andy Burnham) signed off on the £20 billion savings challenge, commonly known as the Nicholson challenge, which was supposed to redirect funding towards coping with demand for NHS services from the UK’s ageing population and the higher costs of drugs and treatment. As the challenge is being followed through, Labour MPs often complain loudly about cuts to the NHS, but they effectively endorsed those cuts by starting those savings when they were in government. The savings are gradually being made, but the only evidence I can see of their helping the ageing population is the Government’s transfer of some NHS money to help with social care for that ageing population, which I welcome. Labour MPs seem to forget that the right hon. Member for Leigh set that in action. Just before the emergency Budget in 2010, he said that it was irresponsible to increase NHS spending in real terms. I do not think it was irresponsible to increase NHS spending, but it is irresponsible not to have addressed a funding formula that does not help the elderly.

The date of 17 December 2013 will go down as the landmark day when NHS England turned its back on the needs of elderly patients, stuck its head in the sand on the dawning impact of an ageing population and crumbled to political pressure from the Labour party. Here was an opportunity for the board of NHS England to put right the funding formula so that the NHS was no longer a postcode lottery and would provide equally for people in need and on access to services. Frankly, I think the NHS bottled it. I do not know why. It ignored the advice of its expert committee. Was it the letter sent to them by the right hon. Gentleman? Blatant political pressure was put on the board of NHS England, and it fell at the first hurdle.

Meanwhile, the Labour party has actively campaigned against the proposed change in the funding formula, which would have started to recognise the increased demands of an ageing population. One of the points made by the right hon. Gentleman in that letter was that he felt that money was being reallocated from certain areas in the north to certain areas in the south. He wanted

“to retain and strengthen the health inequalities and weightings in the allocations formula…and a health service based on need.”

Elsewhere, he has said that the NHS seems to be ignoring the needs of elderly patients. I am concerned that we end up—is this too strong to say?—speaking with forked tongues on this issue. He said:

“A country is defined by how it cares for its older people”.—[Official Report, 14 July 2009; Vol. 496, c. 157.]

He also suggested that the problem of ageing

“will become more pressing as the population gets older…If the system is left unreformed, there are real questions about its sustainability in the long term.”—[Official Report, 8 December 2009; Vol. 542, c. 165-166.]

Since being in opposition, the right hon. Gentleman has said:

“Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?”—[Official Report, 19 November 2013; Vol. 570, c. 1099.]

He also said:

“The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.”—[Official Report, 5 February 2014; Vol. 575, c. 282.]

There are a number of times when the right hon. Gentleman has rightly highlighted the challenges facing the NHS.

The Keogh review states that much of the pressure on operational effectiveness

“is due to the large increase in the numbers of elderly patients with complex sets of health problems.”

There we have it. In responding to the Age UK report, the hon. Member for Copeland (Mr Reed)—I am sure he will participate in the debate—said:

“Older patients in the NHS are paying the price of the financial crisis this Government is inflicting on the health service.”

I am not sure what financial crisis he is referring to, given that the Government have increased health spending and are simply putting in place the Nicholson challenge set by the previous Government. He also said:

“Warnings do not come more authoritative than this report. Yet as long as Ministers remain in denial, patients will continue to face the agonising choice of going without treatment or paying to go private. Labour has repeatedly warned of the postcode lottery now running riot in the NHS.”

That is absolutely ridiculous. The hon. Gentleman will have his chance to respond later, but I put it to the House that it is consistently not addressing the funding formula that leads to the postcode lottery for elderly people. It is disgraceful that we allow it to continue in the 21st century. Patients need a board that stands up for them and does not bow to political pressures, from one side or the other.

I thought it might be useful to give a little history on the funding formulas, and I thank the Library for producing the briefing on that. Going back some time, there used to be a weighted capitation formula. That always presented a challenge, because the pace of change showed that it would take more than 20 years to reach an equitable formula. People will know that the urban authorities tend to get higher funding per head than rural authorities. We are still a significant distance from the target under the new formula released in December 2013.

The clinical commissioning group allocations are not the same as those of the primary care trusts, because they have different commissioning roles. Public health has gone to local authorities and specialist commissioning is done centrally. The PCTs started to do a person-based resource allocation, trying to allocate at practice level, recognising that they knew what problems patients had and could fund according to their needs. In 2011, the Department of Health commissioned a Nuffield Trust report to look at approaches to that particular direction, and in 2012 the former Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), was specific in saying:

“Wherever you are in the country you should broadly have resources equivalent with access to NHS services.”

He also strongly recognised that the age of a patient was the most significant factor in determining their health needs. People mainly use the NHS in the first six months and the last years of their lives. There is no doubt that an increasingly elderly population, as has already been recognised, continues to bring the NHS challenges, with more and more complex needs.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that GPs have a lot to answer for in putting pressure on the NHS? Under the new contracts, they no longer have to look after their patients out of hours, which puts a lot of pressure on the NHS and its finances. Surely we need to look at some way of getting round that.

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[Jim Shannon]

I agree with that. If more preventive action is taken at an early stage in surgeries, that will have dividends further down the line. The hon. Lady is quite right and I wholeheartedly agree with her.

[David Simpson]

Does my hon. Friend agree that more emphasis is needed on care for the elderly at home, and that adequate funding needs to be put in place so that the older generation can be comfortable and be looked after at home?

[Jim Shannon]

I thank my hon. Friend for that contribution. That is probably a subject for a different debate, but at the end of the day it is also clearly a matter for us all. Most elderly people in my constituency would like to spend their days at home. They do not want to go into homes, which may not be as homely, if I can use that terminology, but there are additional pressures on carers who support the elderly at home. That is a debate for another day, but it is an important factor. It is about balancing the budget and making the butter go even further, as it were. Many elderly people want to spend their time at home and enjoy being with their families.

That puts us under even greater pressure in providing a high-quality NHS. The number of the oldest people—those aged 85 and over—is expected to rise by 50%, from 33,000 to 48,000. When we take into account the fact that the average 80-year-old costs the NHS seven times more than a typical person aged 30, even those without a degree in mathematics can see that there is a major accountancy problem in the NHS, and difficulties with funding streams.

Thus far only efficiency savings have been requested, but they have not been enough to keep things ticking over. The Institute for Fiscal Studies has said that to keep pace with the ageing population, spending needs to grow by 1.2% a year above inflation, which has been running at about 2.4%. Again, that gives a clear indication of what the financial issues are. Such an increase has not happened so far, and the pressure cannot be sustained without something giving. I look forward to the Minister’s response on the difficult but urgent question of how that situation will be addressed.

I recently held a public meeting on the provision of cancer care in my trust area, at which were the top breast cancer consultant and the director of policy for the trust. Both cited the pressure their hospital faces due to care of the elderly. Indeed, almost 10% of the people at that meeting said they had been operated on by the consultant and owed their lives to that man, but probably only one of them was under the age of 50. Again, that shows the pressures that are on the elderly generation and the greater level of care that they need.

Those pressures, ranging from broken bones to cancer, diabetes and strokes, are increasing. Levels of diabetes are higher among the elderly population. The lifestyles we have lived over the years have contributed to that, I suppose, but it is a growing problem affecting those over 50 much more seriously than any other group. Given those increased pressures, we need to increase the funding. We cannot ignore the situation. Unless we, God forbid, begin to put an age limit on what services and treatments are available, we will have increased pressure every year. It therefore follows that funding must keep pace with that pressure. I see little point in funding research and development into cutting-edge technologies if the Government are unable to fund their use within the NHS.

I am a great believer in the notion that money does not grow on trees. I have used the analogy on many occasions. My parents said it to me, I said it to my children and they in turn now say it to their children. I understand that we need to cut borrowing and to restore a workable bank balance, but I also understand that life is precious and that if there is one thing we cannot afford to scrimp on, it is health care and quality of care for our elderly. There are a large number of elderly people in my constituency—I meet them, probably, more than any other group. They tell me what the issues are and I want to see care delivered for them in every way possible.

It is said that a society is judged on how it treats the most vulnerable, including the elderly and children. I ask the Minister to consider the compelling facts that all hon. Members have put on the record today, and which will be added to by those yet to speak, and to realise that there must be a ring-fenced increase in NHS spending if we are to do our duty by the most vulnerable in our society.

Pharmacies and the NHS

David Simpson Excerpts

Wednesday 20th November 2013 Westminster Hall

[Ben Gummer (Ipswich) (Con)]

Dr McCrea, it is a pleasure to speak under your chairmanship in my first Adjournment debate. It is also a great pleasure to address the assembled hon. Members—this is a good turnout for a 9.30 am sitting on a Wednesday—and especially the Minister, not only because he is an excellent Health Minister, but because he is my constituency neighbour in Ipswich and will recognise the local issues that I shall mention.

This debate came out of a discussion that I first had with Miss Michelle Claridge, a pharmacist in my constituency; I admit that my knowledge of pharmacies and pharmaceutical services was close to zero before that. As with so many incidents in our lives as Members of Parliament, I learned something immediately from talking to a constituent who brought a new experience—a new query—to my attention. She explained something that I had not appreciated. Perhaps you know, Dr McCrea, because you are no doubt a far more experienced MP than I, that a pharmacy’s appearing on a street, especially a new one, is not the work of a simple entrepreneurial decision. It is a minor miracle, and I will explain why.

As the Minister knows, in the centre of Ipswich there is a new development on the waterfront, encompassing several thousand new apartments and a few houses. This new community is demanding new pharmacy services. Michelle Claridge, an entrepreneur, says, “I would like to set up a pharmacy in this area, to service the new community.” But it is not that simple. People cannot just get a retail unit for which they have planning permission and start a pharmacy; it does not work like that. The system is arranged by the Pharmaceutical Services Negotiating Committee. Hon. Members will understand that, from this moment, we will begin speaking as if we were in East Germany. It will be a time warp.

We start with the PSNC. People have to apply to be on the pharmaceutical list, which is now run by the NHS England area team—when Miss Claridge applied, it was run by the primary care trust—which manages it in consultation with the health and wellbeing board for the area and determines whether there is a need for a pharmacy in an area. It draws a circle around the existing pharmacies and says, “Is there a particular need, for this population in this area?”

When Miss Claridge started, the PSNC said that there was not a need because its map did not show the several thousand new apartments and houses on the waterfront area. Even a simple consultation with the Google maps travel distance calculator could have shown that most of its calculations about walking time were defective. The first problem is that the system starts with a group of no doubt well meaning and intelligent bureaucrats having to work out whether there is a need for a pharmacy in an area.

Once people decide that they want to set up a pharmacy, they have to apply to NHS England with 21 different forms, the shortest—section 21—being five sides long and the longest being 13 sides long. In total, they have to submit about 200 sides of application forms just to say, “I think there is a need in this area for this new pharmaceutical practice.”

After that, the application can either be accepted or rejected. If it is accepted, people can go ahead and if it is rejected they can appeal, via the local pharmaceutical committee, to which other local pharmacies can also make applications, perhaps saying, “This pharmacy is coming into my patch. It is far too close.” They can make whatever objection they feel is necessary.

The system is already completely regulated from the centre. It is a state-controlled system—contracted out to pharmacists, who are working in it—even at the geographical level, before we get on to buying and selling drugs. I do not intend to offer any radical solutions. I just want to open up the matter as a Member of Parliament. I want to explain my experiences in trying to deal with this system and talk about what I have found out, as a layman with none of the medical expertise of the Minister or hon. Members in this Chamber who are members of all-party groups. I want to explain what I saw as I examined this system.

I turned over a stone and found a lot of interesting bodies lying underneath. There are serious questions about the state’s ability to buy medicines. This is not a small bill. We spend £12 billion a year on drugs, via the NHS—a huge amount. The whole thing, from beginning to end, is run by a state bureaucracy, which, in its scale, complication and anticipation of market forces, would make the North Korean Government proud.

How do we comprehend this extraordinary system and what are the problems in it? First, I have been helped very much today by NHS Southwark clinical commissioning group—in London, I live in Southwark—which posted a useful piece of information through my door yesterday. It contains a nice map showing all the general practitioner practices and mentions lots of interesting things about what it wants to do, all of them worthy. In the middle, under a heading, “Our Vision”, it states:

“Our aim is simple—we want to work with the hospitals, community teams and GPs who provide care locally to make sure that the people of Southwark receive the best care possible and live longer, healthier, happy lives.

We will work to make sure that all Southwark residents receive high-quality, safe and accessible health services and that, over time, we narrow the gap in life expectancy between the richest and poorest people.”

All good stuff, but hon. Members will notice that one significant service provider is omitted: the pharmacist, which does not even bear a mention in this list of different health providers for NHS Southwark.

I understand that this is a common problem throughout the country. Indeed, only 10% of clinical commissioning groups have a contracting relationship for additional services with pharmacies. That is unusual in the European context. As is so often the case in health care provision, this country is somewhat behind our European neighbours.

Highly qualified people are centred where they can serve local populations, yet in so many cases they cannot offer the kind of medical services that they could offer if they were in France, Germany or the Netherlands, or some more enlightened parts of this country. Pharmacists could offer such services easily and relieve pressure on general practitioners and hospitals. The scale of what they could do is significant. Why can they not offer basic diabetic treatment or flu jabs? One could—I am sure not you, Dr McCrea—go to the pharmacist for emergency contraception, but not for various other treatments that they could offer, depending on the area.

Michelle Claridge has experienced this situation. She said, “I want to set up GP provision in this new community, linked to my pharmacy.” That is sensible, but—oh, no—people cannot just hire a locum in a pharmacy, providing a medical and pharmaceutical service to a new community, because there would be a series of new arrangements and contracts to go through with the NHS area team to allow that to be done. Therein lies another problem. The contracting relationship between the two is so complicated and separate that the area for innovation in what is not really a market at all is limited. That seems to me a great sadness and a missed opportunity, and I am sure the Minister will agree. So how do we loosen things up? I will address that in a second, because we first need to examine how pharmacists sell drugs and purchase them from the various wholesalers who sell the drugs on behalf of pharmaceutical companies.

There are essentially three categories of drugs. First, there are the so-called “special drugs”—not the special drugs that you might be aware of in Northern Ireland or in the rest of the country, Dr McCrea, but special drugs as defined by the NHS. Those drugs are outside the normal regulatory regime. They are called unregulated but, of course, this being the NHS, they are regulated.

Secondly, there are the regulated drugs—the vast majority. They are drugs that are within patent and a few other sectors. Finally, there are the category M drugs, which have come off patent. The NHS tries to derive benefits from their coming off patent by ensuring that there is not excessive profiteering in the sector. I hope I have explained that properly. No doubt I am making a series of solecisms, but I hope Members will excuse me.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. He mentions special drugs, which are addressed in the research papers that we have received. I am sure he agrees that it is a scandal that the suppliers of those drugs issue invoices of, for example, £600, as it says here, when the actual cost of the drugs is £300. The NHS refunds the £600, and the pharmacy or the supplier pockets the other £300. Multiply that by the billions of pounds out there in the supply chain, and it is a scandal. Something must be done.

[Ben Gummer]

I could not agree more with the hon. Gentleman. I will address that point.

There are three separate groups that each present different and particular problems. The scandal to which the hon. Gentleman alludes, which was uncovered recently by an excellent piece of journalism in The Daily Telegraph, shows how the NHS, customers and taxpayers have been ripped off by the drug companies that are coming in and double invoicing—they are issuing credit notes to pharmacists but invoicing full amounts to the NHS. That situation is outrageous, but it is inevitable when the market is so complicated and lacking in transparency. That is the first of several problems with special drugs.

Category M drugs are incredibly complicated. In the parallel trading of pharmaceuticals across the European Union—just to take one issue—it was often beneficial to import drugs from Greece or southern Europe to the UK because of the price differences between the pound and the euro. The reverse is now true, which means that there is sometimes a shortage of supply in the United Kingdom.

The situation is addressed by a quota system imposed by the pharmaceutical companies, which inevitably causes difficulties for pharmacists because sometimes five people, rather than three, want a particular drug one week. At that point, the pharmacist rings up the wholesaler and says, “I need two more prescriptions.” The wholesaler will then say, “Actually, I don’t have them.” The pharmacist will then have to phone the supplier to ask for two prescriptions, and if the pharmacist cannot get the prescriptions from the supplier, they have to go into the secondary market to buy from another pharmacist who is keeping the prescriptions in stock. The other pharmacist, completely understandably, takes a margin on selling the drug to the pharmacist who requires the prescription.

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[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on bringing this matter for our consideration today. Although I agree with him on many things, his football team, Ipswich Town, is playing my team, Leicester City, on Saturday, so our opinions will differ on that.

[David Simpson]

You’ll get beat.

[Jim Shannon]

Well, I hope we won’t.

To return to the matter in hand, having run my own business, I can well understand the pressures on businesses—the need to make profit and to pay the bills at home. I can also understand the principle behind paying for what you get and that a good service needs to be paid for. At the same time, however, from what I have read in the media and the considerable background information to the debate today, the scandal of double-invoicing and cashback to the detriment of the NHS cannot ever be accepted.

I take my hat off to the whistleblowers who have highlighted the practice, which it is claimed has robbed the NHS of up to £120 million. The headlines are clear: “Pricing scandal sees NHS pay £89 for cod-liver oil capsules”; “Firms boast of profits on drugs that cost ‘pennies’”; “‘There’s a lot of flexibility over prices’”; “Pharmacies and suppliers accused of price rigging”, and last, but not least, “The NHS, the drug firms and the price racket”. All those headlines are cause for concern.

I have asked several questions of the Secretary of State regarding the provision of new cancer drugs, Alzheimer’s drugs or any number of other new drugs that are not accessible on the NHS. How do I tell my young constituent suffering from cancer that there is no funding for a drug that has been proven in other countries to help when she is reading about double-invoicing? Is the cost of her life so little for the House that we can allow the practice to continue? I have asked those questions of myself and my constituents ask me them, too.

I was angered when I read about £10,000 monthly kickbacks and other horror stories. It is clear that any agreement needs to stop that from being able to happen. I have the greatest respect for the Minister and I am sure he will hit on such issues in his response. If we need new legislation that enables the NHS to go deeper than merely checking invoices, so be it. It concerns me greatly to think of the number of families who could have received life-changing help this year with the money—our money, our constituents’ money—that has been lost to those who are working the system. That has to stop.

Many heads should hang in shame over how bills have been creatively put together by providers, but I cannot simply allow the Government not to understand that they need to do more.

Cancer Patient Experience

David Simpson Excerpts

Wednesday 30th October 2013 Westminster Hall

[Mr James Clappison (Hertsmere) (Con)]

Mr Owen, it is a pleasure to have you chairing the debate on a subject that is important to many families up and down the country. Some 2 million people in the UK are living with or beyond cancer, and that figure is set to rise to 4 million by 2030. Although it is a cause for celebration that more people than ever survive after a diagnosis of cancer, a significant challenge must arise in ensuring that their clinical and human needs are met and that patients have the best possible experience.

Before turning to the nature of the challenge and the points I wish to raise, I pay tribute to all those who work in and support the many charities and voluntary organisations that address the challenge posed by cancer. There are many such organisations, but, with utter respect to all those involved in the field, I shall mention just a few: Macmillan Cancer Support, Cancer Research UK, Breakthrough Breast Cancer, Marie Curie Cancer Care, Breast Cancer Care, Beating Bowel Cancer, the Roy Castle Lung Cancer Foundation and the Teenage Cancer Trust. There are many others. They all do fantastic work and much to improve patient experience and give hope to many of our constituents.

The Government have set great store by patient experience and all the issues that naturally interest cancer patients. I warmly welcome my right hon. Friend the Prime Minister’s ambition to give every cancer patient the opportunity to be a research patient if he or she so wishes; that must interest many people in that position.

The UK now leads the world in recruiting cancer patients to take part in research. One in five cancer patients in the UK takes part in some form of research, which compares with 3% of people in a similar position in the United States. I pay tribute to the research of Cancer Research UK in that regard. Last year, 36,000 patients took part in its trials in this country.

I welcome the fact that NHS England has said that it plans to continue the important national cancer patient experience survey. The results of the 2012-13 survey showed that there is room for improvement in some areas of care. I make that point not as a criticism of the NHS, but to highlight areas where there is room for improvement. Macmillan Cancer Support highlighted some such areas in particular, and has urged Ministers to take notice of and act on them. I urge Ministers to listen to the representations being made to them by Macmillan Cancer Support and others.

The national cancer patient experience survey highlighted several important issues, and I will mention three. The first is care planning and information. The most recent cancer patient experience survey reveals that before starting treatment, 45% of patients were not fully informed about the side effects that could affect them in future, that 78% were not offered a written assessment and care plan, and that 41% were not given enough support from health and social services after leaving hospital. As a result, not all patients felt that their families were given all the information needed to help care for them at home. That is clearly an area where there is room for improvement.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this important debate. He mentioned Macmillan, which says in the research paper on the survey:

“The lack of basic care, dignity and respect experienced by cancer patients in hospital is shocking.”

It also says that 15% of patients experienced humiliation. That should not happen to someone suffering from cancer.

[Mr Clappison]

The hon. Gentleman makes an excellent point, and some of the matters I will turn to in due course underline its strength. May I apologise to hon. Members? I mentioned NHS England, because that is what the survey covers, but I will turn to the situation in Northern Ireland, Wales and Scotland in due course. I am delighted that so many Members from Northern Ireland are here this morning.

The next issue is financial support. Cancer patients and their families obviously need financial support, just as everybody else does. Although significant progress has been made since the first cancer patient survey in 2010, almost half of patients who would have liked information about how to get financial help or benefits still do not receive it.

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[Jim Shannon]

I thank my hon. Friend for that contribution. The males of the species do tend to wait just that wee bit longer. I will not relate my personal case to Westminster Hall, but we do sometimes leave things a little longer than we should, which is perhaps a failing on our part. The Health Minister and his Department in Northern Ireland have run several campaigns to highlight prostate cancer in particular. It may be that MPs know more people, but I have two close friends who were diagnosed with cancer. Thankfully, in both cases, they acknowledged early that something was wrong and went to their doctors and were then referred for health checks. I am happy to say that the treatment that they are now receiving will save their lives, but if the diagnoses had been made a couple of months later, I suspect that it may have been different. My hon. Friend is absolutely right. Entire families and communities are affected by this cancer pandemic. The House must deliver an effective strategy to help those experiencing the scourge of cancer.

I read with great interest the Macmillan report and the hon. Member for Hertsmere outlined the many cancer organisations and societies that do tremendous work. Macmillan’s document, “Improving care for people with cancer: Putting cancer patient experience at the heart of the NHS”, wants patient care at the core of the NHS and I heard yesterday from carers and people involved with Macmillan how important that is. The report references England and Wales only, but the overall message is mirrored throughout the UK, and the other Northern Irish Members and I are here today to provide the experience of Northern Ireland.

I recently met Edwin Poots, the Minister of Health, Social Services and Public Safety in Northern Ireland, regarding the provision of cancer carers in my area, as it is clear that changes that could really make a difference cannot be implemented due to a lack of funding, which is part of the problem, and the lack of a strategy for the increases in demand over the next 10, 20 or 30 years. Looking at the Ulster hospital in particular—I am not going to be critical of the staff, who are tremendous and can never be paid enough for what they do—I can see greater demand and that needs to be taken on board. I ask the Minister to consider holding discussions with those in the regions, in particular with the Northern Ireland Assembly and Edwin Poots, because we need a strategy that takes into account the whole of the United Kingdom and not just the mainland. We can work together. Experiences, interests, qualifications and knowledge may differ across the UK, but it is time that we exchanged some of that in order to help each other.

Getting back to the Macmillan report, it states what I am sure that everyone here believes:

“Every person diagnosed with cancer should have a positive care experience and be treated with dignity and respect throughout their cancer journey.”

My hon. Friend the Member for Upper Bann said in his intervention that people needed to be treated as human beings and not just as numbers.

[David Simpson]

Will my hon. Friend join me in praising young carers, who look after family members until Marie Curie or Macmillan move in? Their lives are detrimentally affected by the trauma. Young carers cannot be praised enough.

[Jim Shannon]

I thank my hon. Friend for that comment. In my constituency, we have a young carers organisation that also works with adults. I have met some young carers and am aware of young sons and daughters who look after mothers, fathers and other siblings. We could not do without them. We are ever mindful of their experiences. I know young carers, my hon. Friend knows them and I suspect that everyone in the House knows individual young carers.

Some people may ask how the cancer experience can ever be positive, but although going through cancer will always be horrific, the care that is given can and does impact upon how a patient feels. The Macmillan report states:

“Good patient experience is closely connected to improving other outcomes such as recovery from an illness. However, the sad reality is that many people still have a poor experience of care.”

We can hopefully try to address that problem today. Cancer is no respecter of persons, but that does not mean that cancer treatment precludes the sufferer receiving the utmost respect and dignity through treatments that may be undignified in their essence. We have all lost a little dignity while in the doctor’s surgery and the manner of the doctor or nurse often determines how embarrassed we become. If we are treated gently and with care rather than being pushed through the process as quickly as possible to get the next patient seen, we may feel better as a result. That does not always happen and I can certainly appreciate the pressure that doctors and nurses are under to do the procedures, tick the red-tape boxes and bring down waiting lists. However, the fact that we are not dealing with lists but with people must never be far from our minds.

Again, I stress that I am not placing the blame on the providers of care, but something must be done to address the fact that, on average, only 56% of cancer patients in England said that doctors and nurses asked them by what name they wanted to be called, which was an issue highlighted by the hon. Member for Hertsmere. A little bit of consideration and allowing the patient to maintain their dignity does not take a whole lot of effort. It may seem trivial, but this is a serious point: a girl called Betty works in my office and were I to call her “Beatrice”, she would get upset and would tell me. Similarly, should I refer to the other lady in my office as Mrs Cotter when she is actually Mrs Armstrong-Cotter, she would immediately put me in my place. I use those examples because it is important that a caring bond is formed with cancer patients. A wee bit of time, consideration, humility and dignity can really make a difference. The same can be said on a greater scale when people are doing intimate things to patients while always reminding them that patients do not know them. That is a small thing that the Macmillan report highlighted that could make a patient feel that much more comfortable and indeed that much more safe.

The carers at the Macmillan reception also described some things that they thought should be happening in hospitals. They outlined the need for someone to be available to hospitals across all regions. The six people we met yesterday were all from different parts of the United Kingdom and all had different stories to tell. It seems that some trusts are responding well, but others are not. We need a universal response that encompasses all areas. The Macmillan representatives also suggested that someone should also be available to provide advice on benefits and on care and just to give support.

Another point that came out of yesterday’s discussion was about respite care. Some of the ladies we met were single carers—in other words, a wife looking after a husband, with no sons, daughters or other family members close at hand. We also need to consider the issue of respite care and how we can help such carers get a wee bit of time for themselves.

Hepatitis C (Haemophiliacs)

David Simpson Excerpts

Tuesday 29th October 2013 Westminster Hall

[Paul Goggins]

I am grateful for my right hon. Friend’s intervention. He is a fine campaigner on a range of issues, but on none more so than this. He did great work with my predecessor, the late Alf Morris. I referred to my 16 years of campaigning with Fred, Eleanor and Peter, but I was, of course, only picking up the baton; Alf had worked with them tirelessly for many years.

My right hon. Friend raises a pertinent point about Penrose, because when he reports no Government will be able sit back and do nothing. Profound questions will be posed by that report and they will apply every bit as much here as they do in Scotland. I am grateful to my right hon. Friend for his timely reminder.

In January 2011, two years after the independent inquiry led by Lord Archer of Sandwell, the Government concluded a review of the support available to those who had been infected with hepatitis C and HIV. Along with others, at the time I welcomed the additional lump sum and annual payments to those infected with hepatitis C who had reached the so-called stage 2—essentially, where cirrhosis has been diagnosed. Other improvements were made, but it was clear to many of us from the outset that for the vast majority nothing would change; they would continue to suffer without the help they needed and were owed. That suffering is deepened by the confusing arrangement of the funds that are meant to help them.

In April, the Minister’s predecessor attended a meeting of the all-party group on haemophilia and contaminated blood. I see a number of right hon. and hon. Members here who were present at that meeting; they will remember that it was fairly stormy and that a range of views were expressed about the funds. Those present will remember what was said. I made a note of some of the comments: “It is utterly bizarre....so many funds”; “a nightmare of bureaucracy”; “something is badly wrong”; and “it is not acceptable to have to go cap in hand”. Those comments were all made by the Minister’s predecessor, leaving those who attended wondering why she had not come to the meeting with solutions rather than joining in the chorus of criticism.

My constituents want one fund for haemophiliacs with hepatitis C, essentially bringing together those parts of the Skipton Fund and the Caxton Foundation that currently administer the limited financial support available. They believe that that would reduce bureaucracy and, more importantly, enable those who manage the funds to increase focus on their specific needs. Although they acknowledge others’ needs, they want and are entitled to a better response than they currently receive.

Within the new fund, the immediate priority should be a complete overhaul of the stage 2 assessment. Currently, the lump sum and annual payments start only after hepatitis C has caused cirrhosis. Three out of four people registered at stage 1 do not progress to stage 2, even though they, too, experience extreme and severe symptoms, including great fatigue and often painful bleeds.

The discrimination between those at stage 1 and stage 2 has been brought home to me through my constituents’ experience. Over the many years I have known Peter Mossman and Fred Bates, I have seen them on good days and bad. I have seen them in pain and distress, but I am aware that their most painful moments have been at times when I have not seen them, because they have not been able to get out of bed and out of the house. They suffer similarly, but one of them is at stage 1 and one is at stage 2.

The discrimination is as incomprehensible as it is unjust, and it has enormous consequences. Those at stage 1 receive a one-off payment of £20,000; those at stage 2 receive an additional £50,000 lump sum plus an annual payment, which is currently £14,191. The Minister should scrap this crude distinction and urgently consider implementing a wider assessment of the health and well-being of each individual. The payments are intended to help people cope with the difficulties that they face, and more should benefit from them.

[David Simpson (Upper Bann) (DUP)]

Like others, I congratulate the right hon. Gentleman on securing this important debate. This issue started in the 1970s, so the problem has now been with us for 43 years. More than 80% of the individuals with a bleeding disorder did not benefit from any ongoing payments for a long time. That must be rectified. The Government must review immediately how the issue is handled.

[Paul Goggins]

I am grateful for the hon. Gentleman’s support for that argument. Differentiating between stage 1 and stage 2 creates a false and discriminatory division. It is not acceptable, and it does not help the many people registered at stage 1 who are not at stage 2 because they have not been diagnosed with cirrhosis, but who still often live in great pain and distress. It is vital that they get the financial and other help that they absolutely need.

Currently, the Caxton Foundation must try through discretionary payments to address the urgent needs of those at both stage 1 and stage 2. The fund simply does not have enough money, and as decisions are made about whose need is greater, recipients feel as though they must beg even for essentials. Ministers will need to obtain and share more accurate data, particularly to assess how many of those registered at stage 1 have died and what the likely financial costs would be of a revised arrangement between stages 1 and 2. That information is vital, but one fund with the resources to make lump-sum and annual payments to all those who need them is an essential first step.

Other issues must also be addressed. People with or without haemophilia who have been infected with hepatitis C should be exempt from the employment and support allowance work capability assessment and placed automatically in the support group. It heaps indignity on injustice to put them through the Atos back-to-work test when work is simply impossible for the vast majority of them. Will the Minister hold urgent discussions with the Secretary of State for Work and Pensions with a view to creating that exemption? It would be compassionate, relatively inexpensive and a clear indication that she means business.

I also ask the Minister to consider the specific needs of those, such as my constituent Eleanor Bates, who care for their loved ones. The Caxton Foundation is meant to help them, but they frequently feel that they are last in the queue. Their lives have also been affected deeply by their partners’ infection, and their needs as carers must be addressed.

Reforming the funds and providing a fairer, more effective system of financial support would be an important step in the right direction, but no debate about the issue should omit the need for a proper acknowledgement of what took place and why, and a profound and sincere apology for the suffering created by the disaster. Campaigners still want a public inquiry, and I support fully their calls for transparency and accountability.

If the Government continue to set their face against a formal public inquiry, they should, in my view, consider other mechanisms established in the recent past to get at the truth of an historic wrong. Two years ago, the Prime Minister commissioned the highly respected lawyer Sir Desmond de Silva to undertake a full investigation into the circumstances surrounding the death of the Northern Ireland solicitor Pat Finucane in 1989. Although this approach was not welcomed by Mr Finucane’s family, Sir Desmond had access to all the intelligence files, Cabinet papers and earlier reports, and concluded that there had been what the Prime Minister described last December as “shocking” levels of state collusion.

In relation to another tragedy that took place in 1989—I am pleased that my right hon. Friend the Member for Leigh is still here—the Hillsborough independent panel, which was welcomed by the families of the 96 people who died at the FA cup semi-final, also demonstrated a determination to get to the truth. As a result of the report, inquests have now been reopened.

Whatever Ministers decide to do in this case must, of course, be discussed with those whose lives have been directly affected. Continuing to do nothing is simply not acceptable. A serious Government-backed inquiry must be held, with access to all the remaining records and the power finally to get to the truth of what happened and why. In addition to fair financial support, those who have suffered so much are still owed a full explanation and a sincere, profound apology.

Psychological Therapies

David Simpson Excerpts

Wednesday 16th October 2013 Westminster Hall

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing this very important debate. An alarming thing that I have discovered recently is that 80,000 young people across the United Kingdom suffer from severe depression, and 8,000 of those are under the age of 10. It is alarming, and it is running out of control. As the hon. Gentleman has said, personal counselling is an avenue that we can go down. An organisation in my area called Yellow Ribbon does exactly that, and it has had some fantastic results.

[James Morris]

The hon. Gentleman makes a good point; there are major issues with children and young people’s mental health, and I will come on to that later in my speech.

I want to talk today about improving access to psychological therapies. That is a big area on which I have been focused on in my role as chairman of the all-party parliamentary group on mental health. The improving access to psychological therapies programme was established under the previous Government in 2006, following work by Lord Layard, who looked at the economic benefits of a widespread programme of access to psychological therapies across the country. IAPT was initially launched with small pilot areas and then was formally launched in 2008. I do not think anyone here would deny that the IAPT service has made progress. We have seen 1 million people entering treatment and 680,000 people completing treatment, and we have seen recovery rates of about 45%, with 65% significantly improved. The IAPT programme has led to 45,000 coming off sick pay and benefits, and we have seen 4,000 new practitioners trained in the national health service.

The programme was started by the previous Government, and in February 2011, the current Government published their “No health without mental health” strategy, which committed them to investing more than £400 million over four years into the IAPT programme. At the same time as the publication of that strategy, the Department of Health also published its “Talking therapies: A four-year plan of action”, which had the objective that by March 2015, 15% of the adult population would have access to evidence-based psychological therapies that are capable of delivering rates of recovery of 50% or more. Therefore, some progress has been made, but I want to raise serious questions today about how we should take the IAPT programme forward, about the scale of our ambition, and about the extent to which real choice is embedded in the system. I believe that those questions need to be addressed urgently.

The Department of Health, in its assessment of IAPT—its very comprehensive report was published in November 2012—was clear about challenges that the IAPT programme faced in the future. In particular, its report talked about the challenge of waiting times, stating that one of the challenges is

“building adequate service provision (including number of services, and size and efficiency of workforce) to ensure access for all who need treatment within 28 days of first contact.”

The report discusses the challenge of:

“Unmet need—addressing issues concerning equitable access to services where access is lower than expected among some population groups.”

It also refers to the challenge of “Patient choice”, which goes to the heart of the questions that I am raising today, and

“increasing information on treatment options and ensuring that treatment plans are agreed by both patient and therapist.”

Another challenge is the:

“Funding distribution process—ensuring that appropriate investments continue to be made in local IAPT services, to continue to expand capacity and assure quality in line with the overall financial expectations set out in the Spending Review.”

The Department of Health is clear, therefore, about the challenges faced by the further roll-out of the IAPT programme. In order to meet the challenges that come out of the Department’s assessment, we need radical thinking. We need to build on the strength of the existing IAPT programme, but we also need to address some of its fundamental weaknesses, which I believe are holding the programme back.

A central issue that we need to have an honest debate about is the fact that the IAPT programme is still dominated by the use of one therapy—cognitive behavioural therapy, or CBT. The National Institute for Health and Care Excellence guidelines that were drawn up in 2005 made the recommendation that CBT should be the default treatment option for the NHS, because it had the most random-controlled-trial supporting evidence for its effectiveness. In 2010, the guidelines were modified slightly to allow five other therapies into the NICE recommended mix. The reality, however, is that IAPT is still dominated by CBT. Again, I am not arguing that, in many circumstances, for patients with particular forms of anxiety and depression, CBT is not an appropriate form of treatment. However, it is a short-term, highly manualised approach to mental health treatment.

There is an interesting quote from NICE’s recommendations on psychological therapies:

“In using guidelines, it is important to remember that the absence of empirical evidence for the effectiveness of a particular intervention is not the same as evidence for ineffectiveness.”

That is a wonderful little quote from NICE.

One of the consequences of our approach to research into the efficacy of particular forms of mental health treatment, and of NICE’s approach to the formulation of its guidelines, is that long-term therapies such as psychotherapy and psychoanalysis, to name just two, which require long-term commitment from the patient and from the analyst, have effectively been locked out of IAPT. In Britain, we have a mature and highly professionalised cohort of therapists in psychotherapy and psychoanalysis. They have, over the past five years, found themselves unable to provide the sort of capacity that we need in IAPT. One of the consequences of that, and of the dominance of CBT, with a focus on training up therapists to concentrate on CBT, is that we have a monolithic model.

Within IAPT, we have access, but no effective choice for the patient—choice that is focused on the individual needs of the patients and on an assessment of the patient’s particular requirements. We have a professional cohort of highly trained therapists in long-term therapies who are unable to assist the NHS in extending capacity for the provision of psychological therapies and who are unable to become part of the conversation to address the programme challenges identified by the Department of Health’s assessment of the three-year IAPT programme in 2012.

We need to recognise those weaknesses in the existing IAPT programme, because there are still 50% of people who have been through the programme who have not responded well to CBT. Some 85% of people who are currently suffering from severe mental anguish cannot gain access to any appropriate psychological therapy on the NHS. We urgently need a review of the existing NICE guidelines, and I know that Professor David Haslam, the chair of NICE, has recognised the issue and has agreed to initiate a review.

We also need to look again at how we formulate evidence on the efficacy of mental health treatment. For certain long-term therapies, it might not be appropriate for research to be totally focused on randomised control trials, which are also costly to undertake. We therefore need to look at new types of evidence base. We also need to think about developing a new commissioning model for psychological services to create real choice. I will come on to talk about how that might work.

We also need to consider other groups who may benefit from greater choice and access to psychological therapies. The hon. Member for Upper Bann (David Simpson) talked about children and young people. He is right to be concerned about them; it is a major issue that we face in Britain today. Some 850,000 children between the ages of five and 16 are known to have mental health problems. There is a children and young people’s IAPT, which provides a broad range of interventions —parenting therapy, interpersonal psychotherapy and family therapy.

I think we all know and agree that early intervention for children and young people is crucial to prevent problems from becoming more serious. Lots of evidence shows that early intervention at the onset of psychosis in children and young people and suitable psychological therapy treatment can prevent that from blowing up into something much more serious later on. Perhaps we can learn some lessons from the children and young people’s IAPT for adult services, while recognising that the children and young people’s IAPT needs to be developed further.

Also, we must not exclude or not think about the needs of people aged over 65. As we all know, we have an ageing population, meaning that mental health in older people is an increasing problem. The Department’s “Talking Therapies” action plan committed the Department to address the underrepresentation of older people using IAPT. A quarter of people over the age of 65 have symptoms of depression that require intervention, but only one in six will consult their general practitioner. Therefore, IAPT needs to be tailored to meet the needs of older people. Those needs are not just one, single need; the needs of a 65-year-old may be different from those of a 90-year-old.

--- Later in debate ---

[Jim Shannon]

I thank my hon. Friend for raising that matter. That is exactly the problem; if I wanted to sum it up in one phrase, that is the phrase I would use. There was a taboo around mental ill health in the past, but hopefully we can discuss it now. I hate the word “mental”, because it almost puts the thought in one’s mind of someone to be kept at bay. We must be able to find another word in the English language that is more sympathetic. I am not sure what it would be, but we should give the matter consideration.

Psychological therapies are defined as an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behaviour—all issues the hon. Member for Halesowen and Rowley Regis mentioned—that have proved troublesome to the person seeking help from a trained professional. That is what we want to achieve.

The psychological therapies in the NHS 2013 event marked the halfway point of the coalition Government’s mental health strategy. Psychological therapies generally fall into three categories: behavioural therapies, which focus on cognitions and behaviours; psychoanalytical and psychodynamic therapies, which focus on the unconscious relationship patterns that evolved from childhood, which are important; and humanistic therapies, which focus on self-development in the here and now. We need to focus on those three categories.

I presume that most Members catch up on the news on BBC or Sky before they come here. A story today covered the role of carers and what they do for elderly people, but it also mentioned their role for those with mental health issues and focused in particular on the time that carers have to deliver care to people in those two categories. It underlined where we are in the debate about those who suffer from psychological imbalance and emotional issues.

The improving access to psychological therapies programme was built on evidence, produced in 2004 by the then National Institute for Health and Clinical Excellence, on treating people with depression and anxiety disorders. It was created to offer patients a realistic and routine first-line treatment, combined, where appropriate, with medication, which traditionally had been the only treatment available.

Things have changed. The Minister, whom I respect greatly, will outline the issues when he responds. The IAPT programme was dedicated to spending more than £700 million on psychological therapies between 2008 and 2014. It was first targeted at people of working age, but in 2010 was opened to adults of all ages. There has been success—it would be wrong to say that there has not.

In the first three years, 900,000 people were treated for depression and anxiety; 450,000 patients are in recovery, with another 200,000 moving towards recovery; 25,000 fewer people with mental health problems are on benefits; and the average waiting time has reduced from 18 months to a few weeks. In terms of what has been done so far, that is good news, but it is fair to say that there is a lot more to do. There has been a significant increase in the number of people with such issues, and all statistics indicate that that number will continue to grow.

People require psychological therapy for many reasons. Members have spoken about the things that lead to the position we are in today and why society and Government must respond. Reasons for therapy can be to do with home life and bereavement. On many occasions in my constituency office, we deal with bereavement and how it affects not only the partner, but the young people in the house. The hon. Member for Halesowen and Rowley Regis referred to that in his introduction. I regularly see it in my office—the frailty of life, the suddenness of death and how that affects people.

Unemployment, when young people who cannot get the jobs they need or the discipline that a job brings, and trouble in the workplace are other reasons for therapy. Another reason is childhood trauma, as we can see from the sexual abuse cases of the past few years. Many people were not aware of such trauma, but it existed. Social deprivation is another one, and all those issues contribute to where we are.

[David Simpson]

My hon. Friend mentioned young people again. Surely our schools, whether primary or secondary, need to focus on our teachers being trained to identify when a child has difficulties—the hon. Member for Halesowen and Rowley Regis (James Morris) mentioned early intervention—so that treatment can be introduced at an early stage, which could solve the problem for a lifetime.

[Jim Shannon]

As my hon. Friend and colleague mentioned, education is one of the areas in which Government can play a role, as can, I would say, Departments responsible for health, social services and welfare. They all need to come together.

Among many other factors, one comes to mind to do with young carers who look after their mum, dad, brothers or sisters. In my constituency, there are about 230 young carers, which is a massive number. They are making a contribution to society, but they are also the main carers for their adults or siblings. Again, that is a real issue.

In Northern Ireland, unemployment, too, causes problems because, among the regions of the United Kingdom, it has the highest percentage of working-age population not in paid employment—the figure is 30% higher than the UK average, which is 19% of individuals receiving a form of out-of-work benefit. The highest rates are recorded in Londonderry with 29%, Strabane with 29% and Belfast with 26%. Some 9% of the working-age population receive disability living allowance, including the 3% who receive DLA for mental health reasons. That proportion has risen by 25% since 1998, and is more than the UK average, while 70% of those registered with a disability are not in paid work.

Incidentally, am I the only elected representative to have had an increase in referrals for those who have served in the forces suffering from post-traumatic stress disorder? I know the answer: no, I am not. In all my years as an elected representative, I cannot recall having so many referrals of soldiers, male and female, for emotional, mental-health trauma suffered as a result of their service.

The Prince’s Trust, which many of us have knowledge of and great faith in, has found that one in four young people at work are down or depressed “always” or “often”—for people of that age to be downhearted or depressed is incredible. Unfortunately, that leads to an increase in the suicide rate among young people. In parts of our Province, suicide is at frightening levels. A few years ago in my constituency, there was a spate of suicides by young people, which was saddening for the people of our area, because we knew most of them—young people who did not feel that there was much for them in the future. We must address that issue.

The figure for young people who are down or depressed always or often, but are unemployed, is 50%. That is a massive figure. Clearly, a large section of people are at risk and, in my opinion, early intervention can and will make a difference. However, to establish it, there must be funding. My hon. Friend the Member for Upper Bann (David Simpson) referred to those in education diagnosing cases early, and that is one thing we can do. Our own Health Minister in the Northern Ireland Assembly, Edwin Poots, has taken steps to address the issue, but a UK-wide strategy would be useful and must be considered. I am keen to hear what the Minister will say.

Improving access to psychological therapies in all areas such as health and employment for individuals, families and carers in Northern Ireland could relieve anxiety, depression and distress. The long-term benefits would be more than worth any initial cost. The funding has to be in order, but it has to be there to discharge effectively what has to be done.

In addition, improving mental and social well-being can help to prevent antisocial behaviour and family breakdown for children and young people—again, in my constituency, we regularly witness the effect on people of family breakdowns. It also might make a positive input into the rehabilitation of offenders and assist in the maintenance of independence, reducing reliance on residential and hospital care. The benefits are numerous and clear.

Due to the years of suffering through the troubles, many people in Northern Ireland have poor physical, emotional, behavioural and/or mental health conditions. Dr Nichola Rooney, chair of the division of clinical psychology in Northern Ireland, said that there is

“historical underinvestment in psychological therapy services for people suffering from mental health difficulties in Northern Ireland”.

I am sure that is replicated UK-wide.

Clearly, we must continue to invest and see the rewards of such therapy, not simply as a method of cutting the costs of help in the future, but because it changes the quality of people’s lives and—a knock-on effect— the lives of the people around them. Everyone benefits.

Suicide Prevention

David Simpson Excerpts

Wednesday 6th February 2013 Commons Chamber

[David Simpson (Upper Bann) (DUP)]

It is good to follow the excellent speech by the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott). A number of points have been raised by right hon. and hon. Members about the whole issue of suicide. The overall figures are a startling reminder of just how serious that subject is in society today. In the whole of the United Kingdom—England, Scotland, Wales and Northern Ireland—6,045 people died from suicide in 2011. In Northern Ireland, the level of suicide has increased, with about 4,000 people having committed suicide between 2000 and the end of 2012. It is estimated that the final figure for 2012 will show that close to 300 people died last year in Northern Ireland through suicide. In the first nine months, the figure was 223 and it is estimated that it will reach 300 when the final analysis has been done. Those are startling figures.

The awful impact of suicide on families has been mentioned numerous times, and we cannot mention it enough. It is horrific when we, as elected Members, have to go to homes and give our sympathy to those who have lost loved ones—a child or an older person—through suicide. We mean well as we go to pay our respects, but we can walk out of the house again and go back to spend time with our families whereas those people must live with the impact day in, day out. People ask questions, as we heard earlier, such as, “Why did it happen? Why did we not see something that would have shown us that there were problems or that there was an issue that we could have dealt with?” Those questions linger for years; they never leave those people, who think that there must surely have been something they could have done to prevent the suicide. Nothing in life is too serious for us not to sit down and talk about it and not to try to resolve it. The individual who died through suicide might have found that the issues were not as big as they originally thought if they had only sat down and talked to someone about them.

In my constituency of Upper Bann, we have had our share of deaths of younger and older people through suicide. From memory, I would say that the youngest person to die through suicide in my constituency was 12 years of age. That was a very difficult home to go to and we must ask what would make a 12-year-old do that. There must have been something traumatic in that child’s life to make them do what they did, and the mark left on the family has been horrific.

Many organisations across the United Kingdom deal with the issue and offer a lot of counselling. We have a number of them in my constituency. One that I deal with a lot is Yellow Ribbon, run by Dr Arthur Cassidy and a group of fantastic volunteers. I spoke to him earlier this week and over the past two years the organisation has counselled almost 400 people in my area. Its office is in the town of Portadown and many of those who have gone through its doors were referred by their GPs. The organisation has done a lot of work with young people and older people; it has a great passion for the people in the area and it has tried to help to the best of its ability.

As I said, Dr Cassidy is helped by a group of volunteers, and finance is very hard for them. The organisation is run mostly on donations from families, churches and other such organisations. My right hon. Friend the Member for Belfast North (Mr Dodds) mentioned that some £30 million has been given to organisations that deal with the issues surrounding suicide, and although a large amount of money has been poured in, the situation is worsening in Northern Ireland. That is very, very worrying. Reference has been made to the legacy of the troubles and the difficulties in the Province. Another generation is emerging that is living with what has happened in the past. Perhaps their parents died in the same way, and it is a copycat: people are trying to copy what has happened. That is an awful blight on society.

Dr Cassidy’s organisation counsels many people, and he does not believe that counselling is working as it ought to work. Perhaps we have to think outside the box and come up with more innovative ways of trying to help people and identify the issues that they face. When he talks to those people, he finds that they have very low self-esteem. Men who have worked for 25 or 30 years in one job are paid off and feel that they are not worth anything. They feel that the family would be better off without them, then tragedy strikes. That is the way it happens. When it does, they believe that it will solve an issue for them, but unfortunately it leaves a major problem for the families who are left to pick up the pieces.

The economic crisis that we are going through is a difficult time. Only at the weekend, I spoke to families who are finding it so hard to make ends meet that in the week at the end of the month when they have to pay their mortgage—if they do not, they could go into arrears and lose their home—they do not buy groceries or food to feed the family. In society as a whole, life has become more difficult. Those of us who are in jobs and enjoy the benefits of work may not see it as much, but people who are out of work and who have lost benefits and so on are going through a difficult time.

We need more innovative thinking, and we need to see whether we can help young people and get them into work projects and youth clubs, and help them to meet other young people. We have a lot of work ahead of us to do.

Induced Abortion

David Simpson Excerpts

Wednesday 31st October 2012 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

It is a privilege to speak in this debate. I am the vice-chair of the all-party pro-life group. My colleague, the hon. Member for Heywood and Middleton (Jim Dobbin), would have been present but was detained on constituency business.

I hope that my contribution will be received with the respect and compassion with which I give it, for pregnant women and the unborn child. There is growing support for a reduction in the upper limit for abortion for a number of reasons, including improved survival of very premature babies since the Abortion Act 1967, as well as advances in ultrasound imaging, foetal sentience and practice in much of Europe. In 2011 2,729 abortions took place after 20 weeks, with the majority taking place for what are called social reasons.

The fact is that medical advances have been made and survival rates have improved. Indeed, I understand that in America the world’s most premature baby has survived: Amillia Taylor, who was born at 21 weeks. Is not the fact that science has moved on a sufficient argument for looking again at the number of weeks? Such scientific capabilities were never envisaged in 1967, and stories of babies born alive after failed abortions are also not uncommon.

It is interesting to note that many people criticised the Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt), for suggesting that a 12-week abortion time limit should be considered. Yet his views are not controversial. In the European Union, 12 weeks is the average time limit.

What about the effect on the medical profession? It is becoming increasingly difficult and discomfiting for doctors in one part of a hospital to fight to save premature babies, but in another part to abort them at the same stage, as highlighted by Max Pemberton recently in The Daily Telegraph. The discomfort felt by doctors and nurses can be further understood when the reality of abortion in private clinics is made clear. I want to pay tribute to the gracious and principled stand against abortion made by Lord Alton in both Houses over many years. Indeed, a quarter of a century ago he described what happened when a child is aborted at a late stage:

“Because this is a long-drawn-out business”—

and there is a chance that the child will be born alive—

“the method of late abortion used in private clinics is primarily dilatation and evacuation. By this method, the cervix is dilated and the baby’s body removed piece by piece. To facilitate its extraction from the womb, the skull is crushed, the spine snapped and the body removed piece by piece. An attendant nurse then has the job of reassembling the body to ensure that nothing has been left behind”.—[Official Report, 22 January 1988; Vol. 125, c. 1232-33.]

[David Simpson (Upper Bann) (DUP)]

The hon. Lady is describing the removal of a baby. Today in the debate we have heard Members referring to babies as foetuses, but they are human beings and the smokescreen needs to come down. Does she agree? The hon. Member for Mid Bedfordshire (Nadine Dorries), who introduced the debate, said that at 24 weeks a needle is put into the heart of the baby and it is killed. If that happened to any individual in the Chamber, it would be murder.

[Fiona Bruce]

I thank the hon. Gentleman for his contribution. I want to ask the Minister to clarify whether the procedure as described 24 years ago by David Alton is the same today. If so, may we have an inquiry into the foetal pain suffered during such a process, which cannot be imagined? Can some research be carried out? The procedure for late-term abortion is traumatic not only for the child but for the woman, physically and psychologically, so could such research also consider the effect on the woman? Moreover, will the Minister consider the impact on women of repeat abortions? Can something not be done in the “caring, compassionate” way mentioned by the hon. Member for East Londonderry (Mr Campbell) to help women who are facing repeat abortions, so that we can help them to avoid that in future?

The 24-week limit is in fact not a limit at all for certain unborn children. As mentioned, abortion is legal in this country up to and even including birth on the ground of disability. I am delighted that here in Britain we are doing more than ever to help those with disabilities, but we have a paradox. A child diagnosed with a disability can be aborted up to and even during birth, but the minute that the child is born a whole panoply of rights and medical and social support comes into play for that child, and quite rightly so. The child is born with rights protected by the Disability Discrimination Act 1995. The law is therefore at odds. The Disability Rights Commission states that a law that permits abortions at any time up to birth for disability alone

“reinforces negative stereotypes of disability; and there is substantial support for the view that to permit terminations”

for such a reason is something that needs to be reviewed. I ask the Minister to look into that law, given equality and diversity legislation. My son has a club foot, which is a disability that under the present law of the land permits abortion up to birth, but it is an entirely correctable defect.

Will the Minister clarify what action has been taken following the revelations earlier this year of abortions being carried out on gender grounds? Finally, what action was taken following the police inquiry and the breach of abortion laws whereby HSA1 forms were pre-signed by one doctor at up to 14 NHS trusts? The life of both mother and child are equally valuable and deserve equal respect accordingly. I hope that I have expressed that today.