Physical Inactivity (Public Health)

Iain McKenzie Excerpts

Tuesday 18th November 2014 Westminster Hall

[Mr Iain McKenzie (Inverclyde) (Lab)]

Thank you, Mr Weir, for calling me to speak. It is a pleasure to serve under your chairmanship again.

I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this important debate, because we are very aware that inactivity has a direct impact on health, as we are so obviously seeing across the country.

Quite simply, our lives have changed. Many people now work in non-physically demanding jobs, where they spend many hours in front of a screen, before heading home to spend many more hours in front of a screen. Our leisure pursuits have changed as well, and even more so for our young. As we have heard, online games etc. are providing great competition for the more traditional games and sports in children’s leisure time.

Inactivity and poor diet are taking their toll. We see that in our hospitals and in our health centres. As you will know, Mr Weir, many GPs in Scotland are now prescribing activity, in the form of “gym prescriptions”.

The UK is staring at an epidemic of poor health brought on by obesity, which is due to a lack of activity and a poor diet. This is happening across the UK, where the only thing that seems to be getting faster is our eating habits. Drive-through food outlets can be seen everywhere. These are fine if they are visited infrequently, but unfortunately some people visit them frequently.

As we know, prevention is always better than cure. In Scotland, we are ahead of other parts of the UK and the world in suffering from this obesity epidemic; I suspect that you will agree with me, Mr Weir, when I say that that is the only world league table that we do not want to top. The problem hit us some years ago, and we had to take serious action to try to reverse the trend and prevent another generation from becoming inactive.

Top of all the unhealthy league tables—that is where we in Scotland found ourselves. Heart problems and diabetes brought on by a poor diet and people being overweight, coupled with smoking-related illnesses and the impact of over-drinking, all damaged our health, and at younger ages. We were seeing health problems associated with people in their 80s taking hold while people were in their 40s. We needed to get more active, and to improve our quality of life in so many ways. We needed to promote activity and sport for all. I am glad to say that that message is getting through. I myself am a Zumba orphan; my mother spends more time doing Zumba than she does on the phone, or talking to me.

My constituency of Inverclyde built all-new schools with state-of-the-art sports facilities. Inverclyde schools’ sport facilities are first class and free for use by our communities. We also employed sports co-ordinators to introduce kids to a variety of sports and even more importantly to continue that sporting activity by linking up with clubs after school. The last time we did that I myself was in secondary school. That was when we built new facilities and I was introduced to a new indoor sport called basketball. In Inverclyde, we also offer free swimming to kids under 16, as well as free hire of 2G, 3G and—even in Scotland’s climate—grass pitches for under-19 teams. Funding all that is not easy, but if we did not, the cost in the future would be quite simply unbearable. We bought into the legacy of the London Olympics and the Commonwealth games in Glasgow, using those events to excite people and promote activity.

Inverclyde educates and promotes the importance of getting active, and of healthy eating. You are what you eat. We tell youngsters that if they put rubbish in, they will get rubbish out, especially in sport. We are educating our kids to cut out as much sugar as possible, and to eat “five a day”. The message is getting through. I paid a visit to a school, where I ate a school meal, and one of the pupils told a teacher that I had only three pieces of fruit and not five. I was guilty, and had to take another two pieces. So, as I say, the message is getting through.

We have been removing fizzy drinks from schools, and replacing them with water. However, we cannot do that on our own. We need our supermarkets to buy into this process too. We simply need to ask: why is fruit more expensive than sweets? We should remove sweets from the checkout area. We should also make things easier for hard-working families, because the fruit and vegetables that they are taking home are not lasting the full week and they have to make further trips to the supermarket to stock up.

In conclusion, what can the Government do? I should like to offer some low-cost solutions that I am sure they would be interested in. They could do more to promote sport and an active life style; they could approach supermarkets about their short sell-by date food-laden shelves and about ready meals; and they could emphasise the reduction in sugar consumption. Activity can be a small part of people’s day, but it is a big part of their life.

Antibiotic Resistance

Iain McKenzie Excerpts

Wednesday 15th October 2014 Westminster Hall

[Julian Sturdy]

I agree entirely with my hon. Friend. I said earlier that we must tackle misuse in the livestock sector, as well as misuse in human medicine; we must tackle misuse across the world. Regarding food security and imported food, antibiotics are misused throughout the world in the livestock sector.

It is worth putting on the record that in the UK we have some of the best animal welfare standards in the world, but we do not misuse antibiotics to any extent in the food chain, as is seen in the US. Such misuse has to be stopped and action has to be taken on that.

For far too long antibiotics have been used as if they were a bottomless pit of cure-all miracle treatments. Some 30 years ago, the battle against infectious diseases appeared to have been won, at least in the developed world. The old drugs could handle whatever bugs came along, which meant there was no market for new ones. That is why, since the year 2000, just five new classes of antibiotics have been discovered, and most of these are ineffective against the increasingly significant problem posed by gram-negative bacteria, which are also difficult to detect. The fact is that misuse, over-prescription and poor diagnostics have driven an environment that favours the proliferation of resistant strains of bacteria, rendering once vital medicines obsolete.

[Mr Iain McKenzie (Inverclyde) (Lab)]

I congratulate the hon. Gentleman on securing this important debate. What does he think about the growing pressures on GPs from their patients to prescribe antibiotics, which causes over-prescription?

[Julian Sturdy]

The hon. Gentleman makes a valid point. I hope that, through this debate and beyond, we can get the message out there that the misuse of antibiotics is potentially the greatest threat to mankind that we have seen, and in doing so, I hope that the pressures on GPs will start to subside. He is absolutely right. GPs in my constituency tell me that as soon as some people get a common cold or a sore throat they are breaking down the door, asking for antibiotics. Sometimes it is difficult for GPs to resist those calls. If we are going to secure our long-term future in the medical industry, those calls have to be resisted and that is where it has to start.

If we look at deaths related to MRSA, which is a bacterial infection resistant to a number of popular antibiotics, mortality rates rose steadily in the UK from 1993 onwards to peak at more than 2,000 in 2007. Bacteria and parasites are already developing resistance to front-line antimicrobials, which are over-prescribed and under-regulated, leading to 25,000 people dying each year in Europe from infections that doctors were unable to treat with the drugs available to them. Those statistics, however, are just from the developed world; the misuse of antibiotics is a much more serious problem in lesser developed countries, as my hon. Friend the Member for Stafford (Jeremy Lefroy) said. Hotspots of antimalarial-resistant parasites are springing up in south-east Asia, as are cases of extreme drug-resistant tuberculosis in South Africa and other parts of the African continent. Those are among the many examples that illustrate the urgent nature of this health problem.

In an increasingly interconnected world, an infection that emerges in Delhi today will have an impact in London tomorrow. More needs to be done on a scientific level to develop new antibiotics and to improve diagnostics, but science alone will not solve the problem. Pharmas, which is the collective term for pharmaceutical companies —I put on record that I was a farmer, not a pharma—need to be incentivised to develop new antimicrobials. As with other resources, antibiotic effectiveness can be used up. The eventual loss of current antibiotics is sadly inevitable, but, depending on the actions taken now, it can happen at a much slower pace.

While there are many examples of misuse in lesser developed countries, I want to look specifically at the case of India, as the challenges associated with controlling antibiotic resistance there are many and multifaceted. India has a problem with the overuse and underuse of antibiotics. The underuse is mainly due to the lack of prescriptions. For example, prescriptions were not presented for one fifth of the antibiotics purchased recently in Delhi. However, in 2005-06, a large proportion of infant and childhood deaths from pneumonia would not have occurred if the children had been properly treated with antibiotics. On the overuse, patients with coughs and colds are often prescribed antibiotics, which wastes their effectiveness. As I said, many continue to purchase antibiotics without a prescription.

India has emerged as the world’s largest consumer of antibiotics, with a 62% increase over the past decade. They consume an average of 11 antibiotic tablets a person a year—that is five days of antibiotics for every person in the country. Additionally, the use of last resort drugs such as carbapenems has gone up significantly. That is due to the enzyme known as NDM-1, which makes bacteria resistant to a broad range of antibiotics, including the antibiotics of the carbapenem family. Bacteria that produce carbapenemases are often referred to in the media as superbugs, because the infections they cause are difficult to treat. In India, 50% of all superbugs are resistant to all known antibiotics. The only exception to that is colistin, but that is because the antibiotic, which was introduced in 1959, is considered toxic.

In India, it is commonplace for someone with a sore throat to go to the chemist and choose the antibiotic they want to use. From there, many people will go to a clinic and are given their chosen antibiotics intravenously to treat the sore throat. Usually, the full dose is not administered. That is a horrendous example of the misuse of antibiotics and simply cannot be allowed to continue. Over-the-counter regulation needs to be tightened in lesser developed countries and people need to be better educated on the problems associated with misuse.

On funding and bringing new drugs to the marketplace, when pharmaceutical companies are deciding where to direct their research and development money, they naturally assess the market for a drug candidate. They have an incentive to target diseases that affect developed countries, because they can afford to pay. The pharmas also have an incentive to make drugs that many people take, and take regularly for a long time, such as statins and antidepressants, which leads to enormous under-investment in certain kinds of diseases and certain categories of drugs. Diseases that mostly affect poor people in poor countries are not a research priority, because it is unlikely that those markets will ever provide a decent return. That problem can still be seen with antimicrobials. Again, the trouble is the business model. If a drug company invented a powerful new antibiotic, Governments would not want it to be widely prescribed, because the goal would be to delay resistance. Public health officials would, appropriately, try to limit sales of the drug as much as possible. That makes for good public health policy, but a bad investment prospect.

As we all know, pharmaceutical companies form a major part of how the problem can be addressed, but we have to keep regulation in mind. By that, I mean the ability to identify infected patients quickly and cost-effectively and, indeed, to identify whether antimicrobials are needed at all. Failure on that is a root cause of the blanket drug usage we are seeing around the world. Surveys in the UK have shown that many doctors, as the hon. Member for Inverclyde (Mr McKenzie) said, still prescribe antibiotics far more often than necessary, and they are often under intense pressure to do so. A significant number of patients fail to complete a full course of antibiotics, and I hold my hands up and say that I have done that, as I am sure have many other Members. As resistance becomes more commonplace, it increases the chances that the initial antibiotic prescribed will be ineffective. As a result, resistance to antibiotics, such as carbapenems, has grown from five patients in 2006 to 600 in 2013.

While improved diagnostics would increase the effectiveness of the antimicrobials already available, the need to develop more sophisticated drugs that can keep pace with resistance is critical. The development of new drugs, however, will only come when pharmaceutical companies invest once again in antibiotics. That will occur only when those companies know they can recoup their investment costs. Of the 18 to 20 pharmaceutical companies that were the main suppliers of new antibiotics 20 years ago, just four persist in the field. Ultimately, given the choice between making an antibiotic that a person might take for two weeks once in a lifetime or developing an antidepressant that a person would take every day for the rest of their life, pharmas will naturally opt for the latter. It is thought that we need some 200 new antibiotics to cope with the growing problem. However, pharmas are clearly wary of funding this type of investment if the scope for use afterwards is limited.

I originally believed that the best way to tackle the problem would be for the Government to agree a decent unit price for antibiotics. However, it is likely that pharmas would not trust the Government—of whatever colour or combination—to deliver on that promise, so the best option could be to let the market handle the unit price, meaning that Government would stop restraining the price of antibiotics and allow them to increase to entice pharmas to invest. The more I have researched the topic, however, the more convinced I have become that that idea would not succeed. Introducing a targeted antimicrobial and selling it for the price of a cancer drug is likely to be impossible, because this is a market where people are used to getting antibiotics for next to nothing. Why would they suddenly start paying such high prices? As a result, the best solution may be incentives. The key would be to reward companies for creating substantial public health benefits, and the simplest way to do that would be to offer cash prizes for new drugs. For example, the Government would make a payment to the company, and the company would in exchange give up the right to sell the product. That would ensure the pharmaceutical company would be paid, and it would avoid all the expenses of trying to push a new product, as touched on in a report by the Select Committee on Science and Technology.

Additionally, Governments could use the approach that worked with vaccines and new pre-purchase antimicrobial drugs for a set number of years. Such pre-purchasing agreements would mean that the health care system becomes responsible for the proper usage and surveillance of antimicrobials. Currently, no Government grants are aimed at antibiotic discovery, but I welcome the independent review into antimicrobial resistance that the Prime Minister announced in July. I also welcome the brilliant news that the public recently voted to focus the new Longitude prize on antibiotics. The money will go to whoever can develop a rapid bacterial infection diagnosis test within five years. Announcements such as that ensure that antimicrobial resistance is kept in the news and on people’s minds.

Another way to ensure progress is to set up a global organisation that focuses solely on antimicrobial resistance. The World Health Organisation is now devoting considerable time to the problem, but it only produced its first global report in April this year. We are entering a perfect storm with no global organisation or global pharmas tackling the issue head on. Ultimately, a global network needs to be created to fund global antibiotic discovery. In addition, we need to ensure that people are aware of the problem and how it can be solved. Only with the public’s interest can we rally enough support to ensure antimicrobial resistance stays at the top of the political agenda, which will ensure that action is finally taken.

Overall, the purpose of today’s debate is to raise the profile of the devastating threat of antimicrobial resistance and hopefully to strike a chord across the House. Solving the problem will not be easy and will take considerable time. However, if we do not act now, things will only get worse. Many people in positions of authority in the medical profession consider antimicrobial resistance to be one of the biggest threats to mankind and I agree with that assessment. Therefore, I would like to outline a three-step plan to the Minister, which is essential to tackle the problem head on.

First, I have always believed that an in-depth report is needed into antimicrobial resistance. As such, I am extremely pleased by the Prime Minister’s announcement in July that a report will be carried out by the renowned economist Jim O’Neill. The report will look at the increase in drug-related strains of bacteria; market failure, which is crucial; and the overuse of antibiotics globally. Secondly, a global network needs to be created to fund global antibiotic discovery. Finally, the Government must step up and support small companies that invest in antibiotic discovery. As the Prime Minister said in July, the UK should be proud to lead the way in tackling antibiotic resistance, but we must ensure that the rest of world keeps pace. All Governments have a responsibility to tackle the problem and only with full co-operation across the world can we make a real impact.

We live in a globalised world, and 70% of the bacteria in it have developed resistance to antibiotics. We have been through a golden age of discovery and have sadly become complacent. We cannot become the generation that squanders that golden legacy. As the director of the Wellcome Trust, Jeremy Farrar, said:

“We are sleepwalking back into a time where something as simple as a grazed knee will start to claim lives.”

The golden age of medicine could well be behind us. It is time to step up to the plate as politicians and take decisions which might not bear fruit in the short term and might not secure votes in forthcoming elections, but can help to secure the golden age of medical discovery that we in this room have had the fortune to benefit from. We must ensure that it is not squandered for future generations.

[Mr Iain McKenzie (Inverclyde) (Lab)]

It is again a pleasure to serve under your chairmanship, Mr Chope. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an important and alarming subject: infections becoming increasingly resistant to antibiotics.

Without doubt, antibiotics revolutionised health care around the world, and penicillin has saved tens of millions of lives since its discovery. However, the life-saving role of antibiotics is threatened by the emergence of antibiotic-resistant superbugs. At the G8 Science Ministers’ meeting in 2013, antibiotic resistance was highlighted as one of the top threats facing humanity today, and the World Health Organisation has highlighted the difficulty in tackling the global spread of resistance. Its report suggested that no single factor or isolated intervention would prove successful in reducing the threat of antibiotic-resistant superbugs. We are only too aware that antibiotic resistance is rising. Worryingly, multi-drug-resistant tuberculosis is on the increase around the world. Only a couple of drugs still work against it, and even they may soon stop working. In 2011, over 25,000 people in the EU died of antibiotic-resistant bacterial infections. That growing resistance raises the spectre of a return to the pre-antibiotic world, when many diseases were cured—or not—just by the body’s own defence mechanisms and the passage of time.

Antibiotics were designed to kill or block the growth of bacteria, so why have they stopped working? There would seem to be several reasons, one of which, as we have heard, is certainly overexposure. Overexposure to antibiotics promotes resistance in bacteria by favouring mutations with antibiotic resistance, which can be passed from one species of bacterium to another. The reason why bacteria develop resistance so quickly is that they multiply incredibly quickly. Some bacteria can double in population every 20 minutes, meaning that mutations can emerge quickly and nullify drugs.

We are now warned that a crisis situation is developing around the world. We have not had a new class of antibiotics for decades, so growing resistance is disturbing, but it is not only antibiotics that are losing the battle against resistance. Resistance also applies to antivirals. Why? As I have said, the more a particular antibiotic is used, the greater the chance that bacteria will develop a resistance to it. As we have heard from the hon. Member for York Outer, Sir Alexander Fleming foresaw that danger way back in 1945, when he said:

“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them…The time may come when penicillin can be bought by anyone in the shops.”

That now happens in some countries. He continued:

“Then there is a danger that…man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

We are adding to the problem by overuse, inappropriate use, not finishing the course of the antibiotic, and a lack of basic hygiene. All contribute to the ineffectiveness of antibiotics. Experts are concerned that we are reaching a point at which some previously manageable infections will become untreatable with antibiotics. The superbug MRSA is now resistant to so many drugs that it is already hard to treat, though outbreaks have been heavily reduced by people taking simple hygienic precautions. Recently, there have been reports of cases of difficult-to-treat sexually transmitted diseases; antibiotics normally used to manage the infection are again proving ineffective. Similarly, as I have said, we are seeing cases of multi-drug-resistant tuberculosis throughout the world. WHO says that 150,000 deaths a year are caused by multi-drug-resistant TB.

Given the recent outbreak of Ebola, we are only too aware that increased international travel means that people infected in one country can spread the infection to another country very quickly. Experts say that the danger posed by growing resistance to antibiotics should be ranked alongside terrorism on a list of threats to the nation. They described resistance to antibiotics as a “ticking time bomb”. The implication is that routine operations could become deadly in only 20 years if we lose the ability to fight infection, returning us to the medicine of the 1930s or before:

“If we don’t take action, then we may all be back in an almost 19th Century environment where infections kill us as a result of routine operations. We won’t be able to do a lot of our cancer treatments or organ transplants.”

If pharmaceutical companies do not develop new antibiotics within a matter of decades, we risk losing the war against microbes. Standard surgical procedures would become riskier, as would treatments that suppress the immune system, such as chemotherapy or organ transplant.

We can take steps right now. As I said, basic hygiene has reduced MRSA infection rates by up to 80%. The use of condoms can of course prevent STDs as well as HIV. We can reduce antibiotic use, and advise doctors to be frugal in their prescribing to help avoid resistance developing. We can educate people about hygiene and unnecessary antibiotic use. Pharmaceutical companies can produce new antibiotics and develop degradable antibiotics that do not persist in the environment. We are looking at developing new vaccines as well. Vaccines for MRSA should be ready within a decade. Finally, we need joined-up thinking and new approaches.

The rise in antibiotic-resistant bacteria is a global problem that requires international action to reverse. Developing new antibiotics and vaccines, however, is very expensive. To take a drug from discovery to market is estimated to cost about £700 million. Cost will always be a major factor in the development of new antibiotics, which is why Governments must somehow find a way to incentivise research and development in the area, because if companies do not develop new antibiotics, the future is unthinkable, with previously preventable infections claiming the lives of many.

Ebola

Iain McKenzie Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

First, on what happened in Lewisham hospital, the moment the individual was identified as a potential Ebola case, he was put into isolation. We learned, from what happened there, the importance of making sure that the guidance is widely understood. Making sure that everyone on the NHS front line knows what happens is an ongoing process. It is important to say, as I did in my statement, that the chief medical officer is satisfied that the arrangements in place right now are correct for the level of risk. The additional processes that I talked about are to make sure that we are ready for an increase in that risk.

[Mr Iain McKenzie (Inverclyde) (Lab)]

Did I hear correctly that the Secretary of State said that 21 days is quite a lengthy time for the incubation of this particular disease? Will he commit to putting a further screening in place towards the end of that 21 days so that he can be assured that those entering the country are free of Ebola?

[Mr Hunt]

I am not sure that I entirely understood the hon. Gentleman’s question, but the incubation period is 21 days, so if we identify through the screening and monitoring process someone who is higher risk, we will want to stay in touch with them for that period of 21 days on a daily basis to make sure that we are monitoring their temperature and that we get help to them as quickly as possible if they need it.

Carers

Iain McKenzie Excerpts

Thursday 20th June 2013 Commons Chamber

[Mr Iain McKenzie (Inverclyde) (Lab)]

I congratulate the Backbench Business Committee and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this important debate. It is a pleasure to contribute to it. I was delighted to be invited last week to Inverclyde’s national carers week event, the theme of which was “Prepared to Care?” A marvellous week of activities was organised to highlight caring, and special thanks must go to the secretary of the local carers forum in Inverclyde, Mrs Christina Boyd, who put together an interesting week of activities for the carers who attended.

On the day I attended, my local leisure company demonstrated keep fit with carers. It was announced as low-impact seated aerobics, and of course I took part. It is difficult to describe it, and perhaps difficult for Members to visualise it, without the accompanying music. Perhaps we should consider introducing it in the House, although I dare say that some members of the public think that we already have.

The focus should be on carers all year round, not just for one week. We need to recognise and support the work that they contribute, both on a personal level and to our community and society as a whole. That contribution has never been greater. The statistics on caring up and down the country are quite staggering. One in eight adults is a carer, which equates to about 6 million people. Every day, another 6,000 people take on a caring responsibility, equating to more than 2 million people a year. More than 1 million people care for more than one person. It has been estimated that carers save the economy £119 billion a year—an average of more than £18,000 per carer.

[Katy Clark (North Ayrshire and Arran) (Lab)]

I congratulate my hon. Friend on making those points. He will appreciate that many carers are older people. Has he, like me, been approached by constituents—women in particular—who are upset that they will lose their carer’s allowance when they reach retirement age? Does he agree that it would be appropriate to have some form of carer’s supplement for such people, not only in recognition of their contribution but to meet the additional costs involved in caring?

[Mr McKenzie]

I agree wholeheartedly with my hon. Friend. Many of my elderly and women constituents have approached me with that very big worry in mind. It is something that we need to look at, and that the Government need to respond to.

More than 3 million people juggle care with work, but the significant demands of caring mean that many carers are forced to give up work altogether. The main carers benefit is £58.45 for a minimum of 35 hours. That is the equivalent of £1.67 per hour, which falls far short of the national minimum wage. However, 1.25 million people provide more than 50 hours of care per week.

Carers’ health can also suffer. People providing high levels of care are twice as likely to fall sick. The fact that 625,000 people suffered mental and physical ill health last year as a direct consequence of the stress and physical demands of caring illustrates the true impact on carers’ health. Research by Carers Scotland found that almost half of carers with health problems reported that their conditions began after they started caring. Of those whose condition pre-dated their caring role, a quarter said that their condition had worsened since becoming a carer.

Caring clearly takes a huge toll on carers’ physical and mental health, and those not receiving respite are far more likely to suffer from mental health problems. The impact is often exacerbated by carers being unable to find time for medical check-ups or treatment for themselves, with two in five carers saying that they are forced to put off treatment because of their caring responsibilities. Research by Carers UK includes cases of carers discharging themselves from hospital because of an absence of alternative care.

I took questions from carers at the carers forum last Friday, and it was no surprise that their biggest worry at the moment is the bedroom tax. The Government should urgently review the impact that the charge is having on carers, because the vast majority of care in the UK is provided by family and friends. The work that family and relatives do so willingly is often ignored or goes unseen. Family carers are truly the unsung heroes of our communities. Social services and the NHS rely on carers’ willingness and ability to provide care, yet we as a society seem to put very little value on carers or recognise their commitment.

Social isolation and social exclusion are often remarked on by carers. They feel very isolated and report not having enough respite to have personal relationships of their own. They also report the stress and guilt associated with taking time off from their caring role. Many have not had even a day off in a whole year.

Many carers and carer households are often in poverty because carers have had to give up work or take on part-time work. They say that they could not otherwise fulfil their role as a carer. Of those in part-time work, many are in low-paid employment, and young carers are more often found in the NEET category—not in education, employment or training—or leave school with fewer qualifications.

What of the professional carers? According to a recent report on the plight of carers in the UK by the union Unison, the current system of home care is failing the people who receive it and the people who provide it. Unison describes the treatment of those receiving care and of workers as an outrage. It says private home care workers are being exploited—effectively paid below the minimum wage and given little or no training. Care workers are among the most poorly paid workers in the country; most are on the minimum wage, and there has been an increase in the number of zero-hours contracts. More than half of the care worker respondents to the recent survey reported that their terms and conditions had worsened over the last year.

What about the level of training? Can we say it is adequate? Well, 41% of care staff are not given specialist training to deal with their clients’ specific medical needs, such as dementia and stroke-related conditions. Standards and training are insufficiently regulated. We should compare this with Germany, where carers require several years’ training.

What of the care provided by our local authorities? Local authorities are being squeezed at this time of austerity and having made all the efficiency savings they can, they are now in a dilemma—at least they are in Scotland. They have to make very hard decisions and have to meet the challenge of delivering core services such as care with reduced funding while maintaining the same level of quality. I fear that things will only get more difficult for local government to continue to deliver high-quality care.

In conclusion, we owe the millions of carers out there the respect and all the assistance we can give them because some day we may just find ourselves performing a caring role or being cared for ourselves.

Childhood Obesity and Diabetes

Iain McKenzie Excerpts

Wednesday 24th April 2013 Westminster Hall

[Mr Iain McKenzie (Inverclyde) (Lab)]

It is a pleasure, Mr Davies, to serve under your chairmanship. I also thank my right hon. Friend the Member for Leicester East (Keith Vaz) for securing this important and timely debate. Across the UK, childhood obesity is soaring and, with it, diabetes. We need to deal with childhood obesity sensitively and robustly, and we must not make the mistake of thinking that one solution will fit all children. Obesity in childhood is a complicated condition and can have many different causes. Childhood obesity often persists into adult life, and adults who are obese as children have a higher risk of diseases associated with obesity, particularly type 2 diabetes, hypertension, cardiovascular diseases and, yes, even cancer.

The UK has one of the highest levels of childhood obesity among developed countries. I will take a moment to discuss what has been happening in Scotland, because we share that problem. In fact, it is probably multiplied. In common with most of the developed world, Scotland is experiencing an obesity epidemic, and the west of Scotland heads up all the wrong health leagues in Europe. Scotland has one of the highest levels of obesity among OECD countries. Only the USA and Mexico have higher levels. Recent figures show that 26% of adults in Scotland are obese and 65% are overweight. For children, the corresponding rates are 15% and 31%.

Worryingly, the prevalence of type 2 diabetes is increasing rapidly in Scotland, as well as across the UK, with the largest part of the increase likely to be due to poor diet and low levels of physical activity, resulting in increased levels of obesity. Our diet in Scotland was a response to a life spent in the heavy industries, but it is totally unsuitable for a career spent in front of a computer screen. Activity levels are far too low to burn off our daily calorie intake. To give children the best start in life, early-life interventions need to begin before and during pregnancy, continue through infancy into early years settings, such as nurseries and childminders, and carry on into primary school.

In my constituency of Inverclyde, we have had to take steps to address the growing problem. Many years ago, we started to educate children and parents about healthy eating. In primary schools, our classes are in competition to see who the healthiest eaters are and which are the most active classes in their school. Our schools have sports co-ordinators, who introduce and encourage kids to participate in a wide variety of sports. It is not only that—our schools link up with local sports clubs to encourage kids to continue to be active after school and at weekends.

As we heard from my right hon. Friend the Member for Leicester East, we continue to have vending machines in our schools, but in Inverclyde we have put healthy foods in them. Fizzy drinks are no longer available in our schools; the only thing that can be bought from vending machines is water. Granted, it is difficult to get companies to participate in that, but our schools have been encouraged to do it off their own bat, if need be. Fast food and mobile vans have been banned from within a one-mile radius of our schools, so that if a child—especially those in secondary schools—wishes to partake in fast food outlets, at least they have to walk a distance to get there and back.

The early years offer the best opportunity to put in place healthy behaviours around food and physical activity, which will hopefully be sustained into adulthood. Central to that is the involvement of families. Encouragement must start within families to adopt a healthy lifestyle and eat healthier foods. Today, 15 out of every 100 primary school children in Scotland aged between four and a half and five and a half are dangerously overweight. Diabetes is a serious condition that causes heart disease, stroke, amputations, kidney failure and blindness, and more deaths than breast and prostate cancer combined.

Almost a quarter of a million people in Scotland have diabetes. New statistics in the annual Scottish diabetes survey show that the number of people with the condition has continued to increase alarmingly by about 10,000 a year. The majority of those people will have type 2 diabetes, a form of the disease that can be caused by an unhealthy lifestyle and can be so easily prevented. Across all four nations in the UK, we have seen a huge rise in childhood obesity.

We know that losing weight is about more than just altering your diet, but people are different. There are burners and storers. Storers find it difficult to lose weight, but love food—and love the wrong food—and do not take to exercise too keenly. Those additional factors lead to their heading in the wrong direction with their weight, and that can subsequently lead to diabetes. Let us not assume, however, that all is well with the thin people whom we meet, because poor diet can cause problems. We clearly need an approach that combines diet, exercise, the education of children—and, crucially, the education of parents—and psychological support. We need to increase physical activity at primary school and carry that on into secondary school. We need to encourage leisure activities for children to get them involved in sports and away from their computers and TV screens.

[Ms Abbott]

Does my hon. Friend agree that, while all the things he said are important, it is also important that children take an intelligent interest in what they are eating? In that respect, Martha, the young woman in Scotland who photographed and blogged about her school lunch, is an example of a young person who is engaged in food quality.

[Mr McKenzie]

I absolutely agree with my hon. Friend and I will give her an example. During my time in local government, I took the opportunity of taking a few school meals with the kids. Was the message getting across? Yes, because they told the teacher that I had only two pieces of fruit and had not taken my five pieces of fruit. The message gets across if it is emphasised time and again.

As I said, we need to increase physical activity at primary school and carry that on into secondary school. The competition for young people’s leisure time has never been greater. Many prefer to play a sport on the Wii than try it for real. The issue is not only with the young, but with the elderly. A unique group called the Globetrotters has recently been set up in my area. It encourages the elderly to be more active and its members have, in their actions—their steps are counted and their trips are mapped out— walked to the moon and are on their way back. “Walking to the moon and back” is the group’s most ambitious trip to date. The Globetrotters is a fantastic example of what can be done from a perspective of physical exercise not needing to be that challenging.

The food industry, as we have heard, needs to take responsibility for the fizzy drinks and sweet foods targeted at children. Healthy eating patterns, as we know, are formed in childhood and taken into adulthood, and new research has warned that suffering obesity as a child may take a bigger toll on health in adulthood than was previously thought. If we do not put in place a varied approach to tackling obesity, a major and irreversible time bomb will be ticking away at our children’s and our nation’s health. Obesity will cost the NHS billions. Obesity-related illnesses already cost the NHS an estimated £5.1 billion a year. If we are to get to grips with it, we need to do a lot more together, starting right now, before the problem becomes worse and the NHS can no longer cope.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to take part in the debate. I have several things in common with the right hon. Member for Leicester East (Keith Vaz), not least that we support the same football team. I have done so since 1969, and I hope we shall be in the premier league next year. The second thing is that we are type 2 diabetics, as a result of our lifestyle—from about the same time, as I became a diabetic some five years ago.

I acknowledge that I am a diabetic because of the lifestyle I had. Hon. Members may know the experience of being offered a well man check by the doctor, who always says there is good news and bad news; we say, “Tell me the bad news first.” The doctor five years ago told me, “The bad news is you are diabetic. The good news is you can manage it if you really want to.” That was the thrust of it. He said “You can ignore this, and shortly you will be on tablets, and then on injections.” He was not scaremongering, but just wanted me to know exactly what the condition meant. He said, “Your diabetes will not kill you, but what will kill you will be all the things that come from it: your blood pressure and heart, or amputations and stress levels.” I know fine rightly that I became a diabetic because of my lifestyle five years ago. The fact is I love Chinese food; five days a week I had a sweet and sour pork and two bottles of Coke. It never changed—I like it, and so that was what happened. As well as that there was all the stress of the job—previously I was an Assembly Member in Northern Ireland, and a councillor. I love long hours, and they do not bother me at all—and that probably applies to every other hon. Member; the hours were not an issue, but the stress is.

Clearly I had to make changes. Looking back into my ancestry, no one—not my mother, father or grandparents—had diabetes. I was the first in my family, so the cause was clearly my lifestyle. I make that point because of the question of heredity and the hope that I would not pass on my difficulties to my children or my wee granddaughter, four-year-old Katie-Lee. The question is how to instil in children and grandchildren the necessary control, so that they eat the right food, in the right way. I was on diet control in January, and am now on two Metformin tablets in the morning, and two at night; there is nothing graceful about growing old. We may need tablets to keep us going, and probably most of us in the Chamber are of that ilk. The question for me is what I can do as a grandfather, and as an MP, to protect my granddaughter and children, and everyone else, from becoming diabetic.

The UK has the fifth highest rate in the world for type 1 diabetes in children. That can lead to serious health problems such as blindness and strokes, to name but two. Some 24.5 children in every 100,000 aged 14 and under are diagnosed with the condition every year in the UK. Statistics are real to those of us who are focused on the disease and how to deal with it. The UK’s rate is about twice as high as the rate in Spain, which is 13 in every 100,000, and in France, which is 12.2 in every 100,000. The league table covers only 88 countries where the rate of incidence of type 1 diabetes is recorded. There are around 1,038 children under the age of 17 living with type 1 diabetes in Northern Ireland, and almost one in four of those reached diabetic ketoacidosis before a diagnosis was made. DKA can develop quickly and occurs when a lack of insulin upsets the body’s normal chemical balance and causes it to produce poisonous chemicals known as ketones. If undetected, those ketones can result in serious illness, coma and death. We all know people who have come through that, and I am aware of people who have succumbed to diabetes.

The number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland during the last five years; that is the largest increase in the United Kingdom, compared with 25% in England, 20% in Wales and 18% in Scotland. The total number of adults with diabetes—those aged 17 and over—registered with GPs in our small part of the UK is just shy of 76,000, and 1,038 young people under 17 are known to have type 1 diabetes, which is another significant rise. Prevalence in the Northern Ireland population is now more than 4%. Some 10,000 people have diabetes without having been diagnosed with the condition. It is scary stuff, when we realise what is happening in our region. I had occasion to speak about that with the right hon. Member for Leicester East before the debate.

Through my colleague, the Northern Ireland Health Minister, I encouraged the purchase of insulin pumps for type 1 diabetics, which was done last year; we have also encouraged the provision of training for family members, guardians and health staff in the use of the pumps. When a Minister is committed to the issue, things can happen.

I have every confidence in the Minister who is present for the debate. In my short time here I have witnessed her contribution in her role, and her commitment to change and to taking hard decisions. I do not agree with everything that she does, but I admire her commitment to the job, and many things that she has done have not gone unnoticed.

Approximately 90% of the 3.7 million people in the UK diagnosed with diabetes have type 2. I have brought that issue to the attention of the Northern Ireland Health Minister, as I am very aware of the ticking time bomb that diabetes is, and the key initiatives in operation in Northern Ireland. He is clearly doing a great job, including setting aside funding to employ additional diabetes staff—specialists, nurses, dieticians and podiatrists: all help that a diabetic needs, but perhaps not enough. All the hon. Members who have spoken have done so with honesty; if we put all the ideas together in a big pot, perhaps we will find a way forward. We need to instil good eating habits in children that will not lead to diabetes later in life.

Rates of obesity—because that is the twin thrust of the debate—tend to rise with increasing disadvantage across developed countries, particularly among women. In 2006 in Northern Ireland, 18% of children aged between two and 15 years were reported to be obese. In 2008-09, the child health system reported that 5.3% of primary 1 children surveyed were obese. The hon. Member for Southport (John Pugh) said that when we were young, many years ago, for someone to be of a certain size was unusual. It is not any more. In the survey I mentioned, 22.5% of the children were described as overweight or obese. That is a massive number.

We need to educate parents on what they are teaching their children through their lunches and dinners. Some schools in my area implemented a healthy snack policy, where twice a week children were not allowed to bring in crisps or chocolate, but had to bring in fruit or a healthy option. That is fantastic, and it is good that it happens, but some parents pointed out how much more expensive it was. We should consider how to make healthy food more affordable for young families in the present economic difficulties.

[Mr McKenzie]

On that issue, is the hon. Gentleman concerned, as I am, about supermarkets that employ the tactic of making their fruit ripen as early as possible, so that families have to make several trips to purchase healthy options for their child’s lunch box?

[Jim Shannon]

Many parents have made me aware of that. There is a key role for supermarkets and how they do things. When we go to the supermarket—let us be honest—we can always find a multipack of crisps or chocolate. By the way, there is nothing wrong with that as long as it is done, like anything in this world, in moderation. Children love a treat, and why should they not have one if it does them no harm?

Unfortunately, it is more difficult to find a multipack of fruit juice, or bags of fruit on offer or sliced up. It is much handier for parents to pick up a bag of crisps for their child’s break than to take the time to cut up fruit when they cannot afford to buy the pre-cut fruit that they want. I believe that we need to change that by encouraging supermarkets to put regular offers on healthy options, and perhaps by looking at tax incentives to make such options a realistic lifestyle choice, and not just a fad to go for for a wee while.

One of the community groups in my area, the East End residents association, has put on a cooking class for its ladies group, which showed them how to cook healthily for the family in a quick and cheap way. Women of all ages learned how they could cook on a budget, but still provide a healthy and satisfying meal. That is also key, and I suggest that funding might be set aside for community groups and churches to put on such classes, which could make real lifestyle changes to entire households.

Unfortunately, at the moment there are few homes that can afford to have only one parent in work, with the mother at home cooking and cleaning—that now has to be fitted around another job—but we must educate people and teach them that short cuts can be made so that healthy meals and snacks for families are still provided. Will the Minister kindly address that and explain what can be done to educate and help those who simply do not know how to do the best for their families? A surprising number of families cannot do so, so we should try to achieve that if we can.

In conclusion, it is clear that something needs to be done. If there is one message from every speaker, it is that we all agree that something needs to be done; the question is how best to deliver that. Many children and adults will not be able to live a healthy life because of something that they could have made small changes to prevent. I congratulate the right hon. Member for Leicester East on bringing this matter to the Chamber. Many more hon. Members would like to make a contribution, but I can say one thing—every one of us, as elected representatives, has constituents for whom this issue is key. We look forward to hearing the response from the Minister, as well as the speech from the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott).