Type 1 Diabetes (Young People)

Debate between George Howarth and Steve Rotheram

Wednesday 30th April 2014 Westminster Hall

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. She is quite right to say that social media has an important role to play. I will say more about that shortly, but one example was drawn to my attention where Facebook removed an image of someone injecting on the grounds that that was offensive. That is offensive, but not in the way that it thought. I will say something more positive about how social media can be used in a few moments, but it is important that more people understand exactly what we are saying.

I was talking about psychiatric services. On a national scale, psychological support is not necessarily integrated into the diabetic service, and the practitioners are therefore unlikely to have sufficient understanding of diabetes. Psychiatric services are even more difficult to access, and I am told that patients can wait up to two years for an appointment. In some cases, that is a matter of life and death. The diabetes attitudes, wishes and needs survey, known as DAWN, published in Diabetic Medicine, interviewed 15,000 people in 17 countries and found that people with diabetes are more likely to suffer from depression. Those services are therefore very important.

I want to say a little about young people with type 1 diabetes who also have an eating disorder. According to the charity Diabetics with Eating Disorders, as many as 40% of young women between the ages of 15 and 30 admit taking insulin as a means of achieving weight reduction. The phenomenon sometimes referred to—although it is not a medical term—as diabulimia is increasing. Rapid weight loss is achieved when diabetes is left untreated, but the consequences can be catastrophic. DKA, a potentially fatal condition where the body turns on itself for energy, rapidly develops. Even if it does not prove fatal, it can result in serious health complications.

Diabulimia is difficult to diagnose and there are no current NHS guidelines on how to deal with the issue. Young people can be treated for their diabetes and for an eating disorder, but there is no integrated thinking to cover the two elements of care. Yet the treatment for a diabetic with an eating disorder is quite different from that for a person without diabetes. DWED has provided an example of a young woman who was admitted to a unit dealing with eating disorders, where no insulin needles were available and where the patient was fed via a tube without any insulin being administered. That exacerbated the problem that the unit was supposed to be treating.

There is a clear need for a more integrated service, with mental health professionals who have a knowledge of diabetes. A further and tragic example from DWED illustrates the point well. Jane, the mother of Rhys, a young man who was suffering from diabulimia, repeatedly requested that he be assessed psychiatrically. She did so every time her son was admitted to A and E suffering acute DKA, which happened on several occasions. She repeatedly raised it with the diabetes clinic and with the community mental health team. Unfortunately, her pleas were ignored, despite her saying that she was terrified that she would find her son “dead in bed”, and her son lost his battle with diabulimia on 25 July 2009. The ombudsman concluded that

“had a more coordinated and holistic care plan been put place it might have resulted in a different outcome.”

Jane has been fighting for recognition since 2009, and says that there was never an investigation into why her son died, which she attributed to his mental health problems. That was another complaint upheld by the ombudsman.

There is a serious need for a much more integrated service, so that all aspects of the treatment of type 1 diabetes can be dealt with together. There must be greater investment to ensure that emotional and psychological support becomes an accepted and routine part of management for all children with diabetes and that appropriate services are in place. Incorporating psychological services with routine clinic visits would avoid much of the stigma associated with treatment for mental health problems. In addition to regular clinic attendances, young diabetics require separate appointments for special eye checks and chiropody. Those should be available under one roof in an effort to improve the care achieved.

I am grateful that the urgent need to improve access to and integration of services is now being recognised with the introduction of the best practice tariff for paediatric diabetes. From April this year, the standards included in the best practice tariff are mandatory for all paediatric diabetes units, and the tariff has been extended to cover in-patient care, which will hopefully incentivise lower admission rates. However, I would argue that the best practice tariff should be extended to include all young patients up to the age of 25. Each young person is different, and transition from child to adult services must happen at a stage and time appropriate to them. The current cut-off for the tariff is 19, but the available data suggest that that is too soon, because 25% of all hospital admissions for diabetic ketoacidosis involve young people aged 16 to 25; the annual cost is £5.3 million. Extending the best practice tariff to 25 would provide an opportunity for better alignment of the service with the needs of young people.

[Steve Rotheram (Liverpool, Walton) (Lab)]

My right hon. Friend is making a powerful speech on an issue close to his heart. I hope that hon. Members will know his family circumstances. He is raising an important matter; there is a need to inform a much wider audience, not only so that everyone will be more aware of problems and issues to do with type 1 diabetes, but to inform people with the condition who believe they can manipulate their insulin intake for one reason or another. Does he believe that more should be done to highlight the problems that can arise when people do not stick rigidly to their insulin intake regime?

[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.

Hillsborough

Debate between George Howarth and Steve Rotheram

Monday 22nd October 2012 Commons Chamber

[Steve Rotheram]

We now know that the police were not the only ones who were at fault on that day. Six agencies were also involved in the cover-up. I will try to cover them in the limited time available.

The ambulance service was engaged in despicable alterations to statements. We always knew that the police were involved, but the ambulance service was at it too. Many, many parts of the Hillsborough independent panel report are harrowing for the families and the survivors, but none more so than the news that numerous fans were alive after the arbitrary 3.15 pm cut-off point, and with proper emergency care they could and probably would have been saved.

Next, there was Sheffield Wednesday football club. As the report says, following the 1981 crush,

“there was a breakdown in the relationship”

between Sheffield Wednesday and South Yorkshire police. The two major partners in match-day safety had a fractious relationship at best. What is more, Sheffield Wednesday, a club that was promoting Hillsborough as a modern ground, fit to host major football games, failed in its first duty to ensure that it had a suitably safe stadium.

By now the failings of Sheffield city council are well known. The council allowed a major football stadium in its city to operate outside the law. The report is absolutely clear that the way the council undertook safety inspections was totally and utterly inept and it failed to ensure that an appropriate safety certificate was in place.

As Kenny Dalglish wrote in his weekend column in The Mirror, the Football Association

“knew that Hillsborough did not have a safety certificate and yet they were still adamant the game had to be played at the stadium.

If they had not insisted that the game was played there . . . the fans that died would still be alive”.

The FA must now face the full force of the law for the deadly decisions that it made at that time.

Hansard of 17 April 1989 makes for particularly interesting reading. It was clear even then that there were those in this place who were seeking to shift the blame for the disaster on to the fans—no one more ignorant of the facts than Irvine Patnick, the then Tory MP for Sheffield, Hallam, who asked the Home Secretary to

“examine…the part that alcohol played in the disaster”.—[Official Report, 17 April 1989; Vol. 151, c. 29.]

Why—on what basis—did he ask that question?

[Mr George Howarth]

In view of the recent revelations about Irvine Patnick, does my hon. Friend agree that this calls into question any honours that were bestowed on him?

[Steve Rotheram]

If there were ever a job for the Honours Forfeiture Committee, surely the scrapping of Patnick’s knighthood would be it.

The report reveals for the first time that it was a Sheffield-based news agency, White’s, that claimed that the fans had verbally and physically abused the police and urinated on them as they attended to the stricken, and had stolen from the dead and dying. That came after three days of conversations between White’s, senior police officers, the Police Federation spokesman, and Irvine Patnick MP. Fancy that, Mr Deputy Speaker—lies conjured up through collusion between the press, the police and certain politicians.

It was said on the day that the Hillsborough independent panel report was published that there were 97 victims of the Hillsborough disaster. The families, the survivors and the people of our great city were tarnished and branded guilty of the deaths of 96 of their own. The reputational damage has been incalculable. But one thing is for sure—the 97th victim of Hillsborough was certainly not Kelvin MacKenzie; how dare he claim his victim status? The police were able to make such rapid progress in their conspiracy because they were aided by ready henchmen such as MacKenzie who poisoned the atmosphere around Hillsborough. It will be interesting to see whether any charges of criminal liability are placed at his door.

I am grateful to the Home Secretary and the Attorney-General, and I appreciate their efforts and commitment to upholding the law and the pursuit of justice in this case. However, I urge the Attorney-General to complete his application as quickly as possible so that fresh inquests can be launched almost immediately. All agencies involved in subsequent investigations have made it clear that the inquests can happen in parallel alongside investigations into potential prosecutions, and there is therefore no need for a delay. South Yorkshire police have billed the taxpayer for a considerable amount of legal advice over the past 23 years as they sought to cover up their actions and the actions of senior officers. Given how badly this country has let the families down, it should be for the state to ensure that any costs of fresh inquests are met by central Government funds.

The first investigation, which is being led by the Director of Public Prosecutions, is looking at whether manslaughter charges can be brought against South Yorkshire police, Sheffield Wednesday football club, the Football Association, Eastwood—the engineering company—and Sheffield city council. Any manslaughter charges may be corporate or individual, depending on the DPP’s findings, and may relate to the actions of those agencies before the disaster. The second investigation, which is totally separate from the first, will be carried out by the IPCC. This investigation will focus on the conduct of the police after the disaster and will decide if charges for perverting the course of justice or malfeasance in public office can be brought against certain individuals.

It is vital for the families and for the justice process that three things now happen with these investigations. First, they must be co-ordinated; there is no point in having two investigations covering the same ground. It is the wish of the families that there be a figurehead for subsequent investigations. The IPCC and DPP should work together effectively and efficiently so that decisions over future prosecutions may be made within months, not years. Secondly, both investigations must be well resourced. Thirdly, the investigations must be carried out in reasonable time. The families have had to wait 23 years already. As my right hon. Friend the Member for Leigh (Andy Burnham) has said,

“What you have achieved, your dignity in the face of provocation, setbacks and defeat will forever inspire any parent fighting for their child.”

He was absolutely right.

At Hillsborough on that fateful day, we witnessed one of the greatest moments of spontaneous human ingenuity in peacetime. Heroes who were labelled drunken louts and who were apparently “unemployable” came together in a time of uncertainty, panic and immense fear to try desperately to save others by creating makeshift stretchers from advertising hoardings and by working to save the dying while the professionals did little or nothing.

This report means that half our campaign has concluded, and our gratitude must be conveyed for the work of Bishop James and the independent panel, but the fight for justice continues. The lies are now attributable to the liars. Whether or not the reported 41 or 58 could have been saved, the reality is that 96 should have been saved. We will never give up until there is justice for the 96.

Fire Service (Metropolitan Areas)

Debate between George Howarth and Steve Rotheram

Wednesday 7th March 2012 Westminster Hall

[Steve Rotheram (Liverpool, Walton) (Lab)]

Thank you, Mr Williams, for calling me to speak. It is a pleasure to serve under your chairmanship this morning.

First, I congratulate my hon. Friend the Member for Bolton South East (Yasmin Qureshi) on securing this debate. I also want to mention the constructive way that the debate has been conducted until now. I hope that the tone that I will strike will not be too different from that of others who have spoken, but it is important that I place on record the feelings of people from across Merseyside.

Before I do so, however, I think that right hon. and hon. Members from all parties will join me in praising some of society’s bravest men and women, who work as firefighters in all four corners of the country. Firefighters do the most difficult of jobs in the most difficult of circumstances; they are never questioning but always relentless. There is no greater exemplar of that fine tradition than the Merseyside fire and rescue service. We all owe a huge debt of gratitude to Britain’s firefighters and long may that continue.

Today I speak not only as the MP for Liverpool, Walton, but as a son, brother, husband, father, motorist, home owner, property owner and frequent user of public transport in and around our great city of Liverpool, including our world famous “Ferry Across the Mersey”, and I hope that the man responsible for that song—the great Gerry Marsden—soon recovers from the bout of pneumonia that he is currently suffering from.

Merseyside fire and rescue service does not just put out fires; its officers also save lives on our roads and in our factories and offices, and they protect people using the River Mersey. That is why I greatly fear what this Government have done to the service to date, as well as what they have in store for it. I sincerely hope that the dangers that the Government’s decisions will bring to me, my family, my property, my constituents and every single person who lives in, works in or visits the Liverpool city region are never realised.

[Mr George Howarth (Knowsley) (Lab)]

My hon. Friend is talking about the dangers that people are confronted with. Does he agree that there are a lot of volatile industrial processes around the Liverpool city region and in neighbouring regions, and that these cuts will make incidents such as occurred in the Sonae factory in my constituency even more difficult to deal with, if they mean that the fire service does not have the resources to meet all those challenges?

[Steve Rotheram]

Absolutely. My right hon. Friend is on record expressing his concerns about that particular factory. I must declare an interest—my brother works there, so if my right hon. Friend does close the factory down, my brother will be unemployed. But my right hon. Friend is correct, in that Merseyside and Greater Merseyside have petrochemical industries and other really volatile industries, which need the resilience of a well-funded and well-staffed fire and rescue service.

As we have already heard, it cannot be right for the six metropolitan areas outside London to shoulder 60% of the total reductions burden, with Merseyside being disproportionately affected; some may even say that it is being deliberately targeted. The disproportionate effect on Merseyside is especially true when we compare the areas that have had grant cuts with the areas that have had grant increases. For instance, while Merseyside has received a grant cut that is more than the national average in both of the last two years, Hampshire, Sussex, Shropshire, Buckinghamshire and Oxfordshire—otherwise known as “Tory heartlands”—have each received grant increases. Whether that is just a coincidence is for others to decide, but put simply the formula is flawed and unfair.

Local Government Finance Bill

Debate between George Howarth and Steve Rotheram

Tuesday 24th January 2012 Commons Chamber

[Steve Rotheram (Liverpool, Walton) (Lab)]

My right hon. Friend is making a powerful point about the needs of specific areas, and he is correct in saying that Liverpool, Walton now has, unfortunately, the fifth highest level of unemployment in the country. Liverpool as a whole therefore needs more support. How does he think the Government can justify the fact that, proportionally, places such as Liverpool have been hit the hardest and that Liverpool has had to take a cut of £141 million in the past two years?

[Mr Howarth]

I shall give my hon. Friend two possible answers to his question, and I shall leave him to decide which is correct. The first possibility is that the Secretary of State and the Ministers responsible for this Bill genuinely believe that areas such as mine and that of my hon. Friend have the capacity create to economic growth—a bit like turning on a tap—and to widen the tax base and increase the revenue that they get through the business rates. They might also think that we are not doing enough to attract new investment into our areas. My hon. Friend and I know that that is not the case, however.

The alternative answer was put forward in very explicit terms by my hon. Friend the Member for North Durham (Mr Jones) earlier. It is that these measures are a crude way of rewarding those areas that send Conservative and Liberal Democrat MPs to this House and penalising those that do not. To put it even more crudely than my hon. Friend the Member for North Durham did—although I am not entirely sure that that is possible—I think that the Government are rewarding their friends and penalising their enemies.

I am not standing here as the representative of the Knowsley constituency to cry crocodile tears or to wave around the levels of deprivation that exist there. Those are facts. This is not a question of sentiment or of special pleading. The reality is that, as a result of historical events, some of which took place at least 20 years ago, we have problems and, as a result, we have needs. Unless the Bill can satisfy me and the people of Knowsley that those needs will be taken into account when the grant formula is determined, the more bleak interpretation that my hon. Friend the Member for Liverpool, Walton drew out of me a moment ago will be the inescapable conclusion.

I hope that the Government will accept the amendment, either here or in the House of Lords, later in the proceedings. They must not fall back on the argument that we heard earlier, when they said, “Don’t worry, we’ll take all this into account in the regulations. It will all become clear then.” The risks involved are so great for my constituents and for the local authority in Knowsley that it is impossible for me to accept those assurances. I do not believe that they have been given dishonestly. I accept that they have been given in good faith, but I have been around long enough to know that promises made in the heat of the moment in Committee in response to concerns about specific provisions have a habit of getting lost in the ether later. We need clarity, but we need it now. Local authorities are expected to plan on a long-term basis to meet their needs and determine their expenditure on services. Without that clarity, we will find ourselves in a position, some years down the line, in which the worst possible interpretation that we can put on the Bill will be the nightmare reality.

Freeview Channels

Debate between George Howarth and Steve Rotheram

Wednesday 23rd November 2011 Westminster Hall

[Mr Howarth]

I am grateful to the hon. Gentleman. That is exactly the point that I want to make. I will come to it in a moment.

DMOL—Digital Television Multiplex Operators Ltd—which manages the Freeview platform and allocates channels, is owned and run by the public service broadcasters BBC, and ITV and Channel 4, as well as the infrastructure provider Arqiva. As mentioned previously, that is the equivalent of allowing a major retailer to decide where local independent competitors can site their operations.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Further to the intervention by the hon. Member for Brentford and Isleworth (Mary Macleod), is my right hon. Friend aware that ITV recently launched its own shopping channel, which adds more force to the argument about potential unfairness, because DMOL is partly owned by ITV? Does that not call into question what our hon. Friend the Member for Ellesmere Port and Neston (Andrew Miller) mentioned—the level playing field?

[Mr Howarth]

Absolutely. I am grateful for that supportive intervention. I understand that not only has ITV moved into that market and put itself in direct competition with QVC and any other shopping provider by those means; it used QVC to pilot the operation of that new service. That adds force to the point that was made earlier.

The national and European trade associations share my concerns. They said in a submission to me:

“Businesses need certainty as well as fair competition. QVC’s business is threatened by the current regulatory uncertainty around channel allocation and we call on the government and on Ofcom, to give some clarity so that UK firms, like QVC,”

can continue to serve their customers and grow their businesses. ERA Europe stated:

“Our members’ future business in the UK is under threat from an uncertain regulatory environment regarding channel allocation on the Freeview platform and we urge the UK government and Ofcom to be more transparent in this most important area.”

At the heart of the issue is the ability of the dominant players to allocate valuable channel numbers to commercial competitors without independent adjudication and due process. QVC is currently positioned on Channel 16 on Freeview. I note that my hon. Friend the Member for Ellesmere Port and Neston (Andrew Miller) said that he does not use QVC. If he takes the trouble to tune in to Channel 16, he might find some very useful bargains, but I will leave that up to him. He should remember that when he does so, he will be supporting jobs in Knowsley.

The issue is very important. Ofcom said in relation to DMOL that

“any regulatory issues would require consideration under the relevant multiplex licences. Pursuant to the Communications Act its activities are also subject to Ofcom’s concurrent competition law powers under the Competition Act 1998.”—[Official Report, 14 November 2011; Vol. 535, c. 497W.]

That quote is from a parliamentary written answer from the Minister.

Ofcom was in contact with me directly ahead of the debate. Its briefing sheds more light on the situation. It confirms:

“The multiplex operators are subject to regulatory requirements set out in the relevant multiplex licences, which include provisions to ensure fair and effective competition. Ofcom’s formal role in relation to DMOL’s listing policy is to”

consider “compatibility with our code” on electronic programme guides

“and consider complaints from interested parties (including DTT”—

digital terrestrial television—

“licensees such as QVC). Pursuant to the Communications Act, DMOL’s activities are also subject to Ofcom’s concurrent competition law powers under the Competition Act 1998.”

The problem is that those regulatory powers are in practice retrospective. They can apply only after the channel changes have been determined.

In relation to the electronic programme guide code, Ofcom informed me that it

“has considered from time to time whether it would be appropriate to review the Code, but has concluded on each occasion that there was no pressing need to do so. It is likely that there will be communications legislation within the next few years, and the government has indicated that it is minded to look at EPG regulation in this context. We would need to take this into account in considering the appropriate timing for any review of the Code…On behalf of multiplex operators, DMOL has initiated a detailed review of the DTT listings policies, including the criteria for how different types of channels should be listed in the EPG. It has completed a first round of consultation, and identified the need for a further consultation early next year, following detailed research it has commissioned into the views of consumers.”

Given the likely threat to jobs faced by QVC workers, the statement about there being “no pressing need” is of some concern. Saying that the regulation falls within individual multiplex licences overlooks the fact that with the exception of the utility Arqiva, the multiplex operators are also dominant channel operators and indirect competitors of independent broadcasters.

Fortunately, there is an easy to implement solution, which I am sure that the Minister will be happy to hear. DMOL should be regulated in the same way as any other broadcast television platform. For example, the equivalent operation at BSkyB, to which the hon. Member for Brentford and Isleworth referred and which reaches fewer homes, has been regulated since the late 1990s.

That is not an argument for special treatment, merely one for a level playing field, as my hon. Friend the Member for Ellesmere Port and Neston put it, so that independent broadcasters can compete fairly with all channels, including the public service broadcasters. I accept that public service channels should have special prominence with preferential channel numbers, but the current policy and practice for allocating logical channel numbers on Freeview unfairly disadvantages independent commercial broadcasters and disproportionately benefits the channels operated by DMOL shareholders.

We all want to ensure that the UK broadcast market remains dynamic and successful. Channel allocation on Freeview is about economic fairness, business certainty, jobs, encouragement of investment and legal principle. It is also about the importance of a broad and diverse UK television market.

In conclusion, I ask the Minister to consider carefully the full implications of the current DMOL channel allocation system and its lack of transparency. I am sure that with good will and an understanding of the problem, the Government and Ofcom will between them be able to resolve the situation. In practice, that means asking Ofcom to ensure that DMOL is regulated in the same way as other platforms.

Football Clubs (Governance)

Debate between George Howarth and Steve Rotheram

Wednesday 8th September 2010 Westminster Hall

[Steve Rotheram]

Just to build on what I said, the proposal is very doable. A recent example of democracy in action has been demonstrated by Arsenal Supporters Trust, which invited fans to invest in a new “fanshare” scheme. For as little as £10 a month, Arsenal FC supporters can now contribute to a pool, which, in time, will be used to buy a stake in the premier league club. That will entitle shareholders to vote on club policy, receive financial and corporate information and attend the annual general meeting. The club is fully behind the scheme. The chief executive described the enhanced supporter-club relationships as

“good for the club’s soul.”

The four major shareholders all fully endorse the scheme. Arsenal FC is one of the more enlightened premiership clubs, but the success of its trust demonstrates that supporters are quite capable of forming intelligent, committed and influential collectives.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate my hon. Friend on his choice of subject for today’s debate. Does he accept that the incremental nature of the Arsenal model is one way of getting over the difficulties of the vast sums of money involved in fans’ taking over at any given club, particularly in premiership land?

[Steve Rotheram]

I totally agree with my right hon. Friend; there is not a one-size-fits-all response to this problem. First, we must identify that there is a problem, to see what we as Members of Parliament can do to alleviate it. Football supporters are shouting from the rooftops about it.

In my own neck of the woods, the pressure group Keeping Everton in our City achieved its objectives by stopping its club from being used as a pawn by big business. The aforementioned SOS-ShareLiverpoolFC has more than 30,000 members and a board packed full of expert professionals with a detailed proposal for funding and securing a buy-out of its club and for governance restructuring along more democratic lines. Supporters are thinking and talking big.