Type 1 Diabetes (Young People)

Gregory Campbell Excerpts

Wednesday 30th April 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Member for Knowsley (Mr Howarth) for bringing this issue to our attention in Westminster Hall today. It is good to have a subject that we can all relate to and on which we can speak on behalf of our constituents. The right hon. Gentleman has knowledge of it on a very personal basis.

I was just sitting here and thinking about those deep sleeps that people get into—not that we often have them, Mr Havard. Young children who are diabetic are woken out of their sleep and will wonder what is happening to them. Someone—one of their parents—takes their hand, pricks their finger and checks their blood. That is the reality that many children in the UK face today, and many parents have the same reality because they have to wake them up during the night and have to set the alarm for that purpose. They have regularly to monitor and check their child’s blood sugar levels. It is surprising just how many children have to go through that every day.

The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, there are 1,092 children with type 1 diabetes. The hon. Member for Cities of London and Westminster (Mark Field), who has just left the Chamber, referred to there being 400,000 diabetics in the United Kingdom. In Northern Ireland, we have almost 80,000; one fifth of the diabetics are in Northern Ireland.

[Mr Gregory Campbell]

When my hon. Friend refers to the high prevalence of diabetes in Northern Ireland, as well as across the UK, does he agree that need for greater emphasis on research, which has been repeatedly raised this morning, is a fundamental way to address the increasing problem? The UK, and the various regions thereof, must place greater emphasis on higher expenditure and greater research to ensure that future generations do not suffer in the same way as the present generation.

[Jim Shannon]

I thank my hon. Friend for that contribution. He and other hon. Members have reiterated the need for research, including stem cell research, to enable us, I hope, to come up with a cure for diabetes. The prevalence of diabetes in Northern Ireland is now more than 4%. In addition to almost 80,000 people in Northern Ireland who have diabetes, some 10,000 have not yet been diagnosed. As an elected representative, I have had the opportunity to fight cases on behalf of parents who are under intense pressure because they have a type 1 diabetic child. In Northern Ireland, health is devolved. We have been able to speak to the Minister, Edwin Poots, and through his office and through the pressure that we and others have created, we have succeeded in getting the health service in Northern Ireland to provide 400 insulin pumps for type 1 diabetics. Getting the pumps is only one part of the story. The second part is to train people to use them, so the second stage of the process has been training parents how to do that. Good things have happened.

Diabetes has increased in Northern Ireland, but it has also increased worldwide. Type 1 and type 2 diabetes have increased by 33% in Northern Ireland, by 25% in England, by 20% in Wales and by 18% in Scotland, and some 24.5 children in every 100,000 aged 14 and under have diabetes. That shows the magnitude of the problem. The Minister is responsive and has a particular passion for health. He has attended, as have others in the Chamber, the type 1 diabetes events that have taken place here with young children. Those events have given us all a chance to see how important the issues are. We have far higher rates of diabetes in children than do Spain or France. In Northern Ireland, there are 1,092 children under the age of 17 with type 1 diabetes, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

In my constituency, the number of diabetics has gone up by 30%, with 800 people becoming diabetic in the past seven years. I should have registered an interest at the beginning of my speech. I am a type 2 diabetic, and I am one of those 800 people who were diagnosed in the past seven years. In our small part of the United Kingdom, the total number of adults aged 17 and over who have diabetes and are registered with GPs is just shy of 76,000, and there are a further 1,092 under the age of 17. Diabetes UK Northern Ireland has launched a report that highlights the latest findings into diabetes in Northern Ireland, and I think it is important to put those figures on record. The Diabetes UK Northern Ireland national director Iain Foster said:

“The State of the Nation report is a timely and important piece of work which highlights, not only that Northern Ireland has seen the biggest rise in people being diagnosed with diabetes compared to the rest of the UK but that there is a real difficulty in collecting data as Northern Ireland is not included in the National Diabetes Audit. Our State of the Nation report gathers limited local information and we have found that there are now over 80,000 people living with diabetes in Northern Ireland.”

The official figure is just shy of 76,000, but the latest figures from Diabetes UK Northern Ireland indicated that more than 80,000 people are affected. Therefore, within the past five years, there has been a 33% increase in Northern Ireland in the number of people living with type 1 or type 2 diabetes. More than 100 new diagnoses are expected each year if the current trend continues, and 4% of the local population now has a diagnosis of diabetes.

I cannot emphasise enough that diabetes is a ticking time bomb, which has the potential not only to destroy lives, but to bankrupt the NHS. The financial cost of diabetes cannot be discounted. I agree with Iain Foster:

“It is not enough to shout from the side-lines: ‘something must be done’”—

we have been talking today about what must be done, and we want to see what will be done—

“so instead we have outlined ways in which we think the situation could be helped, for example, working to enable access to available treatments including insulin pumps for both adults and children and integrating diabetes clinical databases to create an accurate diabetes register.”

My hon. Friend the Member for Upper Bann (David Simpson) and the right hon. Member for Knowsley referred to education. It is so important, as hon. Members have said, for teachers, classroom assistants and staff in our schools to be aware of what it means to be a diabetic in school. In Northern Ireland, we have implemented a system of training for teachers and classroom assistants to ensure that they have the knowledge to deal with the condition.

In conclusion, I ask the Minister to outline what co-operation exists between regional assemblies to deliver a better strategy for the whole United Kingdom. He will be aware of the 10-year strategy that ended in 2013. I have asked on a number of occasions for a new strategy to be put in place, because it is important that all the regions of the United Kingdom of Great Britain and Northern Ireland work together to deal with the problem. To address the issue of the many children who suffer from diabetes, and many more who are predicted to be diagnosed, we must take action and take it now. I congratulate the right hon. Member for Knowsley on bringing the matter forward, and I urge the Minister to do more than simply talk about it. He must take action quickly, while there is still time to make safe this ticking time bomb.

Stillbirths and Infant Mortality

Gregory Campbell Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Loughton]

It is horses for courses. I am glad to say that my maternity unit delivers well in excess of 3,000 babies a year. It is a centre of excellence, and the customer votes with her feet by choosing to go there from outside the area. My hon. Friend is absolutely right that the assessment of units must be primarily based on the quality and safety of care for mothers, but I fear we are straying slightly beyond stillbirths and infant mortality rates into the availability of maternity services and hospitals. You would not want us to go there, Mr Davies.

My hon. Friend also raises an interesting point about delivering services in the most appropriate way. There are certain constituencies of women and certain parts of the country where the problem is that much greater. To take one of the classifications, the infant mortality rate in the UK overall is 4.4 deaths per 1,000 live births, but the variations for mothers born outside the United Kingdom are worrying. For babies of mothers born in the Caribbean, the figure more than doubles to 9.6 deaths per 1,000 live births. For babies of mothers born in Pakistan, the rate is 7.6 deaths per 1,000 live births, and so on.

There are also regional variations, particularly for perinatal mortality overall. In the south-west, the figure is 4.7 deaths per 1,000 live births, but in the north-east it is 5.8 deaths per 1,000 live births—a 23% difference. Why are there those differences? We simply do not have enough research; we have not commissioned and are not doing enough research to find out why certain types of women and certain geographical locations are faring worse. Such research would enable us to focus, say, additional scans or support services, or whatever is required, to ensure that we make the best use of our NHS resources. My first call is for there to be rather better research across perinatal mortality.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On geographical differences, we heard earlier about the improvement recently reported in Scotland. Does the hon. Gentleman agree that when Ministers from across the United Kingdom and beyond meet either at a joint ministerial council or at other levels, best practice, where it has been established, should be carefully researched and, where possible, implemented immediately?

[Tim Loughton]

I agree. My hon. Friend the Member for Bracknell (Dr Lee) gave the example of Scotland, where people have clearly examined the matter a bit further; they appear to be achieving more than people in other parts of the United Kingdom. We should be sharing that best practice, rather than being parochial and not sharing it beyond the United Kingdom, with or without Scotland after 18 September. That goes beyond sharing ministerial best practice on health issues; I would guess that not just health considerations but deprivation, housing and other local environmental factors are involved, too. More than just the Health Ministers of the respective parts of the United Kingdom need to be involved. If we compare deprivation with infant mortality rates, some signs certainly start to emerge.

Last year there were 3,558 stillbirths; in 2011 there were 3,811 and in 2003 there were 3,612. The stillbirth level has remained persistently high for a long time. One in 200 pregnancies ends in stillbirth, but stillbirths are currently defined in law as being after 24 weeks of gestation, which still means that there are 15 times more stillbirths than cot deaths—the progress on cot deaths was alluded to earlier. The problem with the definition is that it masks the higher number of stillbirths that happen before the 24-week gestation qualification currently in legislation. If a woman gives birth to a stillborn child at 23 weeks and six days or earlier, the child counts not as a stillbirth but as another “miscarriage.”

That was the case for my constituent Hayley, who came to see me and was present when I presented my ten-minute rule Bill in January. She had been through the dual tragic experience of giving birth to a stillborn son at about 19-and-a-half weeks. She had to have her pregnancy induced, and she went through labour. She experienced all the pains and anguish of labour in a hospital for more than 24 hours before giving birth to her son. She and her partner, Frazer, held their son and took handprints and photographs. To all intents and purposes, their son had been born, but sadly born dead. In the eyes of the law, their son did not exist, because he had been born after less than 24 weeks. That child had no recognition in the eyes of the law. Some months afterwards, Hayley tragically went on to have a miscarriage after five or six weeks. Those two experiences were different—that is in no way to belittle the pain, anger and trauma of going through a miscarriage—but in the eyes of the law, they were identical: neither of those children was recognised as having been born.

That is what my Bill is all about. Since introducing it, I have been swamped by the experiences of women and families up and down the country. To take one example, a woman gave birth at about 21 weeks to twins. It might have been slightly more than 20 weeks—I forget now—but it was less than 24 weeks. One of the children was born just alive and lasted for a few hours. The other twin was born dead. As the first was born alive, albeit at less than 24 weeks, that child was recognised. The other twin, born dead, did not exist. How traumatic and cruel is that on the part of the state? Someone gave birth and had two dead children, but only one existed in the eyes of the law. That is why the law needs to change.

I will persist with the Bill well beyond the confines of this Session, when it will expire because of the constraints of this place, until I persuade the Government to take the issue on. It is about fairness and recognition for people who have had to go through trauma, anguish and pain unimaginable to those of us lucky enough to have had healthy, albeit slightly annoying, children. It is not acceptable for those who have lost a child before that child was ever able to breathe then to have the second blow of the state not recognising that child.

My Bill would amend the Births and Deaths Registration Act 1953, but not in a way that says that we should redefine the 24-week limit. I do not want to make it 23 weeks or 22 weeks; this has absolutely nothing to do with abortion thresholds and things like that. I want to make a differentiation between what are clearly miscarriages and instances of when women, to all intents and purposes, go through all the pains and experiences of giving birth to a child. The definition in my Bill of a “stillborn child” does not mean a child born dead from 24 weeks’ gestation onwards, but

“a child which has issued forth from its mother and which did not at any time breathe or show any other signs of life, following the recognised processes of labour including regular, painful uterine contractions resulting in progressive cervical effacement and dilation; and the expression ‘still-birth’ shall be construed accordingly.”

It is a bit technical and a bit physical, but it is a way of giving some comfort to mothers: if they gave birth to a stillborn child, it would be a birth. The Bill would say that they had had a child, that there had not been a miscarriage and that the state should recognise that.

We have not introduced the Bill to meddle with the abortion laws—it has nothing to do with that—and it is not intended to meddle with bereavement leave entitlements or benefit entitlements. The more enlightened employers of someone who has been through such an experience would give the employee some allowance on the time they need to get over the death. For them to receive some sort of closure and to give them the support and relief that they desperately need to be able to move on, the state needs to recognise what they have been through in giving birth to a stillborn child.

At the moment, a hospital or clinical practitioner can issue a certificate of birth. It has no status in law. It is of some comfort to some people, but it is certainly not sufficient comfort for many of our constituents. That is why I am putting forward the changes to the law. They are simple and do not involve a lot of cost, but they would offer huge support, relief and comfort for mothers and their partners who have been through these sorts of experience.

As well as wanting to change the law and calling for better research into why we appear to be so vulnerable to perinatal mortality and stillbirths, we need greater research and better guidance. I do, however, pay tribute to the existing guidance, particularly that issued by the Royal College of Obstetricians and Gynaecologists on recurrent first and second trimester miscarriage, and some of the best practice.

I echo the points that my hon. Friend the Member for Chatham and Aylesford made about foetal alcohol syndrome, which strays slightly beyond the confines of the debate. When I was a shadow Health Minister, I considered the issue. I visited children’s homes in Copenhagen that specialised in children born with foetal alcohol syndrome. In many cases, the child was born to parents from Greenland’s Inuit community, which has high alcoholism rates. A lot of research has been done on that in Denmark.

It is undeniable that a lot of our children are being damaged due to excessive drinking through pregnancy and that an awful lot of that is not being properly diagnosed. In my simple layman’s view, a lot of the symptoms have parallels with autism and the autism spectrum, and there may be links between autism and foetal alcohol syndrome.

The issue is very little researched in this country, but it potentially affects an awful lot of our children, and we need to do much more to identify it. More importantly, we need to give clear, stark, but accessible warnings to women about the practical perils of drinking irresponsibly at all stages during pregnancy. That is not to say that pregnant women must not drink at all, but we need to set out clearly what is and is not tolerable, just as we should for women who smoke during pregnancy.

To make a side point—a point I made during a debate on the Children and Families Bill—I cannot understand why the Government have set criminalising smoking in cars with children in them as a priority, yet have done nothing to criminalise, if that is the principle they want to follow, smoking for pregnant women whose foetuses are in rather more confined spaces than the back of a car. Smoking and drinking are highly damaging to children before and after they are born. People are irresponsible if they do that, and we need a much clearer and more pungent health message to mothers. We need to disseminate best practice better than we do now, whether that is from Scotland or other parts of the country that appear to have achieved some success in reducing some of these mortality rates.

This is a bigger public health crisis than we have given it credit for. I have met constituents and heard some tragic stories from around the country of families who have been through stillbirths and other perinatal mortalities. We need to take this issue much more seriously.

Adult Autism Strategy

Gregory Campbell Excerpts

Wednesday 5th March 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am pleased to make a contribution to the debate, and I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on bringing this matter to the House for consideration. Autism is an issue that I have helped constituents with on many occasions, as an elected representative. I am mostly aware of it, probably, in respect of how we can help those with autism through the benefits system. That is perhaps people’s first introduction to the issue. The right hon. Lady clearly laid out the issues pertinent to those with autism, and also mentioned the pressure that families are under. I want to dwell on that.

Diagnosis of autism has been increasing. I have been involved in the support of autism services for many years in Northern Ireland, through my constituency work and, formerly, in my role as a Member of the Northern Ireland Assembly and as a local councillor. I am sure that all hon. and right hon. Members in this Chamber can think of examples of when they have fought to have a child statemented, so that they could receive the help that they and their family needed for schooling, and so that support could be given to the family. Although this debate is about adult autism, autism affects people from the very beginning. I shall try to speak about that as well.

I recently spoke to a young mother of three who, with her husband, was beginning to attend parenting classes to help them better deal with their daughter. It was not that they were not willing to deal with her, but they needed help dealing with the behaviour issues of those with autism. We are talking about lovely children—and lovely adults—but they need help. The couple have two other lovely children, a great family support network and a close group of friends who help out, yet they recognised at an early stage that they needed more help and needed to be better equipped to deal with this. They said that they needed help understanding autism, so that they could understand and interact better with their child.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that even in 2014, after a number of years in which awareness of autism has increased significantly—it has done so particularly in the past 15 or 20 years—there is still a need for many statutory agencies to act and react much more sympathetically and proactively, particularly in dealing with parents who have autism and have difficulties with parenting skills?

[Jim Shannon]

I thank my hon. Friend and colleague for clearly setting out the issue for the bodies responsible for helping parents. The parents I mentioned came to me about parenting skills, and they got the help, by the way, which was good. They told me what a blessing these classes were. That is why I am happy to stand with my colleagues today and highlight the needs of sufferers of autism and their families.

I am familiar with the care of one autistic young man. Many hon. and right hon. Members here have personal knowledge of such situations, and I hope that some of them will have a chance to contribute to this debate. That young man’s parents do everything for him: they dress him, cook for and feed him, clean, bathe and toilet him, amuse him, and hug, kiss and love him. He depends on his parents entirely for his every need. When he is at his day classes, they do the washing, ironing, cleaning, and shopping and try to find time to work to pay the bills at the same time.

The pressure on the parents and on the family unit is greater because of the problems and behavioural issues related to the autism of their child. They love their son—that is never in dispute—but love is not enough to get the family through the sheer exhaustion and the emotional and mental strain. Sometimes help is needed on matters outside of parental skills—through social services, for example, giving a bit of respite. Difficulties in the benefits system are practical issues for parents and those with adult autism; they relate to how parents can help their child through the school years and into the early years of adult life. It is up to the community and us as elected representatives to step up to the plate and help that boy and his parents. We can do that by supporting them and offering them the best that our society can do to ensure that they do not reach the point of no return.

We can all relate to the story of Susan Boyle, who has Asperger’s syndrome, which is also autism. She found out that she had it later in life. After she was diagnosed, she said that she almost felt relieved to know, after all those years, what was wrong and why she was different. That is a practical example of how someone the nation knows has been affected. She said what she said because she felt it was important that other people knew that autism cannot and will not hold people back, but they need help to get along. That is the thrust of this debate.

Pharmacies and the NHS

Gregory Campbell Excerpts

Wednesday 20th November 2013 Westminster Hall

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that one of the most significant recent statements in the press was when a senior executive of one of the large companies said that it would be more than happy to agree to a 70% discount if that is what it took to get the contract? That is a damning indictment of the original price.

[Jim Shannon]

I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.

On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:

“Medicines should not just be seen as a cost.”

They should first and foremost be about healing and curing illnesses. The letter continues:

“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”

That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:

“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”

Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?

Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?

Cancer Patient Experience

Gregory Campbell Excerpts

Wednesday 30th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am grateful, Mr Owen, for being called to make a contribution to this debate. It is on cancer patient experience, but we will all have personal experience of the issues. I congratulate the hon. Member for Hertsmere (Mr Clappison) on tabling the subject for debate. In his introduction he rightly said that the debate refers to the NHS in the UK, and there are four Northern Ireland MPs here because each of us can contribute to the debate by relating our experiences. I hope that the Minister will consider a strategy that involves not just the mainland, but all four regions.

As I was saying to my hon. Friend the Member for Upper Bann (David Simpson) earlier today, when I first considered my contribution to the debate, I realised that I have never before known so many people in my age group, so many of my friends and so many of those just older than me who have had cancer, and I have never experienced so many people passing away as a result of it.

I have had a number of meetings with the Minister back in Northern Ireland, Edwin Poots, and I intend to have a public meeting in my constituency to review cancer care with the general public and the trust and look at how best we can do it. My frustration is compounded by discussions with the trust. I do not want to be critical, because that is not how I do things—I try to see how we can move forward and be more positive—but I am concerned about the magnitude of cancer cases in my area and across the United Kingdom. I suspect that other Members will confirm what I already know. A 10% increase in cancer cases in Northern Ireland is extremely worrying.

My father and sister suffered from cancer. Of the four staff employed in my Newtownards office, my parliamentary aide had two grandparents die from cancer and her father suffers from cancer, my secretary had her mother die from cancer and she recently buried one brother-in-law to cancer and has another undergoing chemotherapy. Only my office manager seems to have escaped cancer in their immediate family. Some 75% of my office staff have experienced cancer in their close family and individually.

If we look into the community, we can see that my examples provide an accurate reflection of the way that cancer affects entire communities. Someone in the United Kingdom is diagnosed with cancer every two minutes. More than one in three people in the UK will develop some form of cancer during their lifetime, which is a horrifying statistic. The risk of developing cancer before 50 is 1 in 35 for men and 1 in 20 for women, so the situation is more extreme for ladies.

As elected representatives, our constituents often come to our offices to ask how to find their way through the benefits system. They experience health pressures to start with, but financial pressures soon follow. Just yesterday, my hon. Friend the Member for East Londonderry (Mr Campbell) and I went to the Macmillan Cancer Support reception here in the Houses of Parliament and we had the important opportunity to speak to carers. I will highlight some of the issues raised as we go through this debate.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Before my hon. Friend moves on to discuss carers, which is an important matter, does he agree that a big issue is people’s reluctance and sometimes failure, in particular among us males, to visit the GP when there may be a problem? We should encourage everybody, but males in particular. I do not understand the logic. If my television does not work, I get a TV repair man in. If the washing machine does not work, I get the washing machine repair man in. If people have a health problem, they go to their GP. Unfortunately, however, males seem reluctant to do that.

[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.

Hepatitis C (Haemophiliacs)

Gregory Campbell Excerpts

Tuesday 29th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on bringing this important matter to the House’s consideration. I will speak specifically on behalf of my constituents, as I think will everyone who speaks today, from a heartfelt understanding of the problems that those constituents have faced for a number of years. My hon. Friend the Member for Upper Bann (David Simpson) illustrated the time scale. If ever there were a powerful case for the Minister to answer, this is one. Many of the speeches made today will be impassioned. I welcome the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) to her position, and I look forward to working together on many issues in future.

The background to the case is clear. I have spoken to constituents of mine who are victims. Some of my constituents live daily with these illnesses through no fault of their own but rather as a result of the Government’s inaction at a time when action was important. My constituents have sent me a briefing, and I have relied on them for information as well as for the personal details that they have given me, although I do not intend to mention any names out of respect for confidentiality and personal issues.

The Archer inquiry investigated the fact that between the 1970s and late 1980s, 4,670 people with haemophilia were infected with hepatitis C through treatment by the NHS that they loved and respected, which ultimately, unfortunately, let them down. Of those, 1,243 people with haemophilia were also exposed to HIV, as the right hon. Gentleman said. Almost half of those infected with hepatitis C and almost three quarters of those co-infected with HIV have since died and many have tragically left families behind. When looking at the impact on the individuals, we can never forget about the effect on their families; many individuals have experienced poverty and discrimination as a result of their infections. People, either through mistrust or lack of knowledge, sometimes unfairly discriminate against those with infections. The provisions recommended by the Archer inquiry would offer appropriate support and compensation to those affected and would ensure that steps were taken to improve blood safety.

The previous Government argued that the reason why financial support was not made available at comparable levels to those in the Republic of Ireland, for example, was that the disaster affected the two countries differently. I am unsure how that was worked out. Perhaps the disaster was measured in numbers, but the disaster is the same to each individual and each family. No-fault Government payment schemes were established to provide support to those affected. The Archer inquiry, which was non-statutory and funded from private donations, reported in February 2009 on the Government’s response. Among its recommendations was a call for reform of support for those affected in line with the scheme used in the Republic of Ireland. If we had had in Northern Ireland and the rest of the United Kingdom a scheme similar to that of the Republic of Ireland, our constituents would have been much more satisfied. What does the Minister think about the Republic of Ireland’s scheme? Is it possible that we can try to match it?

Despite the Government’s announcing on 10 January 2011 an increase in payments to some of those infected with hepatitis C, what has been put in place is not adequate to support people through their illnesses. The Government’s scheme now has two stages, as outlined by the right hon. Member for Wythenshawe and Sale East. A first stage payment of £20,000 is available to eligible people. Following that, successful recipients of the first stage payment whose hepatitis C infection has led to advanced liver disease can receive a second stage payment of £50,000. Those who have received the second stage payment are also entitled to additional annual payments of £14,000, paid monthly or quarterly. The money may look good and it sounds like a lot of support, but, as always, there is more than meets the eye to the press release. As the saying goes, the devil is in the detail, and that is clearly the case here. The Hepatitis C Trust supplied an interesting briefing and is calling for a rethink of the strategy and policy. The trust, with which I certainly agree, asks that the first and second stage categories be removed. As a constituent of mine said, the payment can never compensate for what has happened, but it can offer support and help people to adjust to and live a life affected by it.

People infected with hepatitis C can experience severe symptoms, including extreme fatigue, depression, aching limbs, headaches and abdominal pains, which may mean that they are unable to work for long periods of time. The right hon. Member for Wythenshawe and Sale East referred to Atos in his speech—I think it was also mentioned in an intervention. The situation of people who are unable to work for long periods of time needs to be understood. Symptoms can lead to difficulties in holding down a job and receiving an income. Sufferers rely on help from family and sometimes from other carers, and the fact that the annual sum starts only when a person’s hepatitis C has caused cirrhosis does not take any of that into account. Understanding the problem is the crux of the issue. The briefing I received from the Hepatitis C Trust put it succinctly:

“Some patients without cirrhosis are far more symptomatic than some who have reached that stage. Indeed, some patients die whilst still in stage 1. Therefore there should be no distinction between stage 1 and stage 2 payments for people who have been infected with hepatitis C through contaminated blood. They should be entitled to the full and on-going support immediately.”

The second point raised in the briefing is that there has been no Government apology to date. The right hon. Member for Wythenshawe and Sale East referred to the Pat Finucane case and the apology that the Prime Minister made, so I urge the Minister to consider an apology for those infected, who have suffered many years of illness as a result. Having listened to some of the apologies, which should never have been uttered, that have rolled off Government Ministers’ tongues to pacify and placate people for political gain, I find it difficult to believe that there has been no Government apology. I have sometimes heard Members of this House and the Prime Minister apologising on my behalf when no apology was needed and yet here, when there clearly was a fault and when innocent people lost their lives following treatment by the NHS, mouths seem to be suddenly closed. I cannot understand that mindset. A mistake was made that has cost lives and has cost other people the price of living with horrific diseases, and if that does not deserve a heartfelt apology then I am at a loss to think what does.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that what sufferers and their families need are empathy, an apology, to which he has alluded, and a commitment to ongoing support for the remainder of their days? If they saw that coming from the heart of Government, we would have accomplished a significant amount of what the right hon. Member for Wythenshawe and Sale East (Paul Goggins) and his predecessor have sought to achieve.

[Jim Shannon]

I thank my hon. Friend for that contribution, which refers to something that we would all want to see. I am reminded of what my mother told me as a child: “Compassion is your pain in my heart.” She was referring to an understanding of the problems facing other people, which, in a way, is why we are here. We are here not just because we want to be MPs, but because we are privileged to be elected by our constituents. We see their problems and we must illustrate and expand those problems in this great House, of which we are privileged to be a part.

Psychological Therapies

Gregory Campbell Excerpts

Wednesday 16th October 2013 Westminster Hall

[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.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Earlier, he alluded, as my hon. Friend the Member for Upper Bann (David Simpson), did, to the problems in the younger age group, and now he is talking about the older age group. Given the significant increase of referrals in the past couple of years, does he agree that one of the overarching principles is that we will need significant additional resources to deal with the problem right across the age groups, from the young to the old?

Herbal Medicine (Regulation)

Gregory Campbell Excerpts

Tuesday 9th July 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Bosworth (David Tredinnick) on bringing this matter to the Chamber for consideration. Many of us have herbal shops in our constituencies. We are aware of their good work, and that has been backed up in interventions today.

I have been contacted about the issue by a small local health food shop in the main town of my constituency, Newtownards, and by numerous patrons of that little shop who benefit from it. That is the point I want to make. The issue is clear: if EU interference continues, it will put businesses out of operation and people out of jobs, and it will result in more people searching the internet for remedies that may not be safe. That will not bring about any benefits. The EU lingers like a shadow over almost everything. Regulation is needed, but it is also necessary for common sense to prevail, and the balance may be difficult to achieve.

[Mr Gregory Campbell (East Londonderry) (DUP)]

My hon. Friend has touched on the crucial point of the debate. Balance is needed to try to avoid people accessing unauthorised, unprofessional and perhaps harmful products, but to enable them to access products made by professional herbalists that they believe and evidence shows improves their condition. We must ensure that we get the balance right between the pursuit and prosecution of those who engage in bad practice and the promotion of those who engage in good practice.

[Jim Shannon]

My hon. Friend has gone to the crux of the debate in those few words. It is about getting a balance between allowing people to continue to use their herbal medicines and ensuring that they do not indulge in anything outside that.

I beg your indulgence, Mr Bone, because I would like to take this opportunity to highlight the save our supplements campaign, which has been well publicised. We should all be aware of the goals of that campaign and the ramifications for today’s topic of regulation. The issue that is causing concern in health shops is maximum permitted levels. It has been suggested to me that interference by Brussels—the shadow of Europe is almost like the grim reaper who hangs over everything that we do in the House—will set low doses for dietary supplements, so removing choice from consumers and adversely impacting on high streets.

--- Later in debate ---

[Kate Hoey (Vauxhall) (Lab)]

It is a pleasure to follow the hon. Member for Strangford (Jim Shannon). I congratulate the hon. Member for Bosworth (David Tredinnick) on securing the debate, which is very timely, given that the House is about to rise for the summer recess, and we are seemingly still no nearer to getting what was promised some time ago—indeed, by the previous Government as well. It has been a long saga, as the hon. Gentleman outlined. I shall speak only briefly, because I want to give the Minister a long time to explain why we are in this position.

I start by reiterating my view that when people voted to join the common market back in 1975, they never would have dreamt that the EU would interfere in this kind of thing. However, it is absolutely crucial that if we are going to prevent the very well-established and effective herbal medicine products from disappearing, literally, from our shops and stop the consequent blow that that would mean for the retail sector, we need to get this regulation as quickly as possible.

I dislike regulation and want to see less of it. I believe that most people have common sense; they know what is good for them and want to do what they think is right. They do not need bureaucrats from the Department of Health telling them all the time what they should and should not be taking. We hear that all the time in so-called public health adverts, when most of what is said is either common sense or complete nonsense. I am a great believer in using not only herbal medicine, but natural products from our countryside. There are so many common-sense things that most of us grew up with—not necessarily only people brought up in the countryside but them in particular. If someone got stung by a nettle, they went immediately and looked for a docken leaf. We did all sorts of things naturally, and now, very few people seem to feel that that is what we should look to. I am afraid that vested interests are the reason for a lot of that. The pharmaceutical industry does not want to see it happening and would love to get rid of all health food shops.

[Mr Gregory Campbell]

Does the hon. Lady agree that as well as the vested interests that she alludes to, at times, in the medical establishment, there is almost a form of elitism that denigrates herbal medicine, suggesting that it only has a placebo effect and is not practically of benefit to people, even though many testify that it is?

[Kate Hoey]

The hon. Gentleman puts it very well. That is what happens, not only in the pharmaceutical industry, but with doctors, who have a very narrow view of what health is, in my opinion. That makes it all the more important that we ensure that alternative medicines are available. It is great that we have an heir to the throne who believes that some of this is really important. I wish that the Department would listen to His Royal Highness Prince Charles, because some of what he says on the matter is absolutely right.

The other issue that I want to raise is about the Health and Care Professions Council, which I think the Minister has overall responsibility for. It is based in my constituency and does a brilliant job. However, recently, it seems as though the Department’s general view on what it does and how it works has changed. We have been trying to get sports therapists registered for a very long time. Everyone agrees that that should happen. The HCPC, which is meant to be the body that gives advice, has gone and said, “This must be registered. We must do this.” Sport England wants it to happen, as does anybody involved in sport; yet somewhere in the Department, there is a block. I actually do not think that it is Ministers; I think that it is officials. Officials do not care who is in government; they do what they want to do; and they will continue to pull a line. It seems as though the Minister or the new Secretary of State could be dangerously close to heeding advice from officials to drop the whole thing. I worry very much about that.

111 Telephone Service

Gregory Campbell Excerpts

Wednesday 5th June 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I had not expected to be called quite so early. First, I should like to put on the record that health in Northern Ireland is a devolved matter—I understand that—but I am observing the 111 system from my position as a parliamentarian. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate. She has encapsulated many people’s concerns. I appreciate the Minister’s efforts on health issues. I am sure that she will, in her response, deal with some people’s issues.

I support the idea behind this phone call triage, as it is called, and its being free to contact, bearing in mind that many GP surgeries have an 0844 number, which costs a great deal from mobiles—we have discussed that in Westminster Hall previously on many occasions, and will continue to do so—but there are clearly major issues with it. Although I accept that sometimes the girls in my office have to stay on the phone for an hour or more to fix some computer glitch with the printer or scanner, we are talking about lives in respect of this service. There have been too many difficulties to ignore.

We have background information on many areas, including those the hon. Lady touched on. Yorkshire and Humber provide examples of the figures and information, which state that there were three deaths and 19 potentially serious incidents coming through the system, clearly underlining the problems.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that NHS 111 should immediately answer the phone to all those who contact it—that is obvious—offer direct, accurate communication and provide people with reassurance that they are getting an accurate diagnosis? Those things will be the judgmental touchstones upon which people will base the success, or otherwise, of 111.

[Jim Shannon]

I thank my hon. Friend for his intervention, which clearly outlines exactly what the 111 system should be trying to achieve. Sometimes, when hon. Members ask if I will take an intervention, they are looking over my shoulder to see what I am going to say next. My hon. Friend made exactly the point that I was going to make.

There have been lots of complaints about calls going unanswered and poor advice being given, which reiterates the point made by my hon. Friend. That follows concerns prior to the national roll-out, after pilot schemes showed disastrous results, with tales of patients waiting hours for advice and others being asked to call back later. That situation is quite unsatisfactory and must be addressed. NHS England stated:

“The safety of patients must be our paramount concern”.

So it should be, and if it is not, we want to ask why. It also said:

“NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service to the public, but one which is also safe.”

Examples mentioned by all hon. Members—we have them in front of us—provide information that contradicts that. In Greater Manchester, the 111 service was started and then abandoned. Dr Mary Gibbs, a GP providing out-of-hours cover when the system crashed there, said:

“Calls just weren’t coming through.”

Quite clearly, that is the issue. She stated:

“It was totally inadequate. Patients’ health was put at risk.”

The 111 service tends to be busiest when local surgeries are closed. Dr Laurence Buckman, chairman of the British Medical Association GPs committee, stated:

“We are still receiving reports that patients are facing unacceptably long waits to get through to an NHS 111 operator and suffering from further delays when waiting for calls back with medical advice should they manage to have their call answered… The quality of some of the information being given out appears, from anecdotal sources, to be questionable in some instances.”

The advice that people are being given does not always seem to have been up to scratch and is not of the quality that it should be. He added:

“If any area of the country is failing to meet high standards of care, then its NHS 111 service needs to be suspended.”

This is what the experts in the field are saying. NHS England needs to be more transparent about how the system is functioning across the country.

Home Care Workers

Gregory Campbell Excerpts

Wednesday 6th March 2013 Westminster Hall

[Alison McGovern (Wirral South) (Lab)]

I begin by congratulating my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. There could not be a more important subject on which to have a Westminster Hall debate. I also thank the hon. Member for St Ives (Andrew George), who made a very important contribution. To add more thanks, the recent CQC and Unison reports have been incredibly helpful; for those of us who have been thinking about care for some time, the two reports have crystallised and explained, in a well researched way, the substantial challenge that we face.

If I may make a slightly parochial Merseyside remark, this is an extremely important issue for us, especially in Wirral, where we have an ageing population, which, I must say, we are very glad about. We are glad and proud that our grandparents and parents are living longer, but with that pride comes responsibility. That is why the challenge that we face is very important. I would like to thank my constituents, who have been very good in coming to several public meetings with me on the subject of care. I have asked them to help me think about that issue, because I know that many of them face this challenge. They have willingly given up their time to inform me about their concerns, and I am incredibly grateful.

I have also been lucky in the Wirral because home care staff have met me and given me the benefit of their experience, along with council officers and councillors. I recognise that the problem is shared across all those groups. We are going to fix the problem together, and we are here today to ask the Minister whether he will join us in helping to do that.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On the point she just mentioned, does the hon. Lady agree that one of the pleasing aspects of this issue is the number of active senior citizens in all our constituencies who want, in a voluntary capacity, to involve themselves in the debate to try and lift the standards and ensure that we give the proper care to people in their own homes?

[Alison McGovern]

I could not agree more. Only last Friday, I was with Heswall Soroptimists, a very committed group of women who volunteer in our community, and who raised various issues about care. That is only one example of committed groups of citizens who are keen to be involved in finding a solution.

It is important that we make the moral case for change. Too often, people in need of care in their homes are hidden from our society, and people who need support, by their nature, can find significant barriers to their participation in democracy. Therefore, it is extremely important that politicians take the time to speak up for them. I have been meeting regularly with Wirral officers to try and work through some of those issues, and specifically, to discuss whether there is a way that we can improve the quality of care in our borough.

On that note, I flag to the Minister that such conversations are made much more difficult by the funding settlement that local government has received. The fact that local government has taken the biggest cuts from Whitehall has certainly impeded my ability, locally in the Wirral, to get change. I ask the Minister to note that point, and next time that he has conversations with Cabinet Ministers and the Treasury, to remind them of local government’s role in care and of the important challenge that we are trying to meet.

In discussions with Wirral council officers, we have also been trying to consider how to tackle the problem of information that has already been flagged. For people who are trying to procure care, it is difficult to know what quality standards they can expect and what the market looks like. I sympathise greatly with the points made by my right hon. Friend the Member for Oxford East about the role of markets in what is, I would argue, a bit of the economy that does not necessarily lend itself well to markets. I hope that hon. Members will forgive me if I sound like a bit of an economics geek when I say that, in any case, markets do not work well when participants have insufficient information. I believe that if we cannot solve that problem, the current system will never work.

I will move on to talk about two aspects of home care that have repeatedly been shown to be very important to my constituents. As I mentioned, we have had several public meetings in the Wirral to discuss these issues, and we have tried to bring together both those who work in care and those who receive care so that we can see the problems from either side of the coin. Those two aspects are 15-minute appointments and zero-hours contracts. Those two issues typify the insecurity at work and low investment in skills that home care workers face.

First, on 15-minute appointments, it might have been mentioned that the recent Unison report found that 46% of staff felt that they had to rush visits—that is nearly half the workers going into the homes of people who are very important and need help. The result is the feedback that I receive that due care and attention cannot be given to people. I am talking about basic matters of respect, such as addressing the person concerned as they would wish to be addressed.

Let me give an example from my own constituency. A care worker was in a couple’s home to make some food for them, but said that they were able to do that for only one member of the couple—the husband or wife—because that was all that they had been allocated time for. Most people expect to be able to sit down to a meal with their partner. That is a basic thing that we all expect to be able to do in our lives. Fifteen-minute appointments may or may not have been the cause of the problem in that case, but if 15-minute appointments mean that the normal standards that we would all expect to be upheld have to be disregarded, that is not a system that will work well.

I will read out a quote from one of the care workers to whom Unison spoke:

“When the person you go to needs more care or has incontinence you are only allocated 15 minutes for a meal and have to leave them. I haven’t left a client like that and would go over my time (although not paid for it), but it does mean you are running late for other calls.”

I cannot imagine what it must be like for someone to turn up at a person’s home and find, if they are incontinent, that the worst has happened. They are supposed to be there only to make them a sandwich or whatever and they must decide between being late for the next person, which will cause stress, or, frankly, rushing around doing things that they know they will not be paid for, which will cause them stress. At the same time, they are trying to make that individual feel better about what has happened. What skills and talents does someone need to make that situation go well? We should first admire the people who do this job, but also question what in the system is causing such a breakdown.

One aspect of this subject that I have highlighted as a result of listening to my constituents is that too much of the way in which our system works is task-orientated, not person-orientated. Dignity is extremely important. Increasingly, people have recognised that the way in which we treat others in society is ever more important. When we are asking people to do a list of tasks—no more and no less—rather than think about the individual and try to help them with whatever their needs are, we will not fix the problem. Individuals will feel bad about the care that they receive rather than feeling that it is a help to them. Another care worker quoted in the Unison report expressed that very clearly:

“I never seem to have enough time for the human contact and care that these people deserve.”

That is a lesson to us all.

Secondly, on zero-hours contracts, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) and I have recently commenced a survey that is designed to listen to people across all industries who have experienced being asked to do or have taken on zero-hours contracts. Of course, for people who want a bit of work but do not need it to be regular—students or others—zero-hours contracts may not be such a problem. However, I think we all recognise in this Chamber the problems with that flexibility and insecurity in a world in which people are trying to provide routine, predictability and attention to detail for some quite vulnerable people. I think we would all question the appropriateness of zero-hours contracts.

There are two problems with zero-hours contracts that we need to consider. The first is inconsistent care. My constituents tell me that they would like to know who the person is who will be turning up and they would like visits to be predictable and regular, not least because of respect and dignity issues, such as knowing the little details. Often, people who need care face communication barriers. Understanding in detail how a person communicates is extremely important, so consistency of care could not be more important. How do zero-hours contracts support consistency of care?

The second issue is stress. Insecurity at work causes stress, and in a world in which we are asking people, as I mentioned in my example, to turn up and help vulnerable people, we need them to feel confident and secure and to have enough skills to be able to tackle whatever problems are there. Recent research has shown the impact of stress and insecurity for those working in care on the manner of treatment received by the people for whom they are caring. That is an important message to us all as politicians. What responsibility can we take for creating more security at work for those who care for vulnerable people?

Comments have already been made about the pay levels in the sector. They are clearly low. Low pay plus zero-hours contracts mean that we will have people of relatively low skill. I mean “low skill” in the technical sense; I would argue that people who work in care are extremely skilled and extremely able practically, given what they have to deal with. However, investment in skills will clearly not happen where there is low pay and an insecure labour market.

Having described the problem, I will conclude by describing what I believe might be part of the solution. First, working in home care needs to be seen as an aspirational job. There is no reason why someone should not work in care and aspire to management, to moving up in their career. We need to find pathways through the career chain so that we can make this a genuinely aspirational job. A significant number of our young people are out of work. We need to demonstrate to them that home care work is valued in society and that if they pursue such a career, they will be invested in and respected as members of our society. We need to make that absolutely clear.

I again thank my right hon. Friend the Member for Oxford East for securing the debate. There could not be a more important subject than this. I hope that the Minister will respond positively and explain what we can do to bring some change to the sector.