Hospice Funding

Jane Hunt Excerpts

Monday 22nd April 2024 Commons Chamber

[Jane Hunt (Loughborough) (Con)]

I welcome today’s debate on this very important issue. I congratulate my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) on securing this excellent debate.

Everyone should receive appropriate and dignified care, personalised to their individual needs, as they approach the end of their life. Hospices are central to delivering that care, including LOROS hospice for adults, based in Leicester West, which provides care to my terminally ill adult constituents, and the fantastic Rainbows hospice for babies, children and young people, located in my Loughborough constituency.

Since becoming an MP, I have visited Rainbows hospice on a number of occasions and seen at first hand the professionalism and dedication of its staff, who provide the highest levels of care to around 300 of the estimated 1,739 children and young people with life-limiting conditions in Leicester, Leicestershire, and Rutland, as well as their families. Rainbows also cares for hundreds more babies, children and young people with serious and terminal conditions across the wider east midlands area, providing support at its hospice in Loughborough, as well as in local hospitals and at home.

Rainbows is particularly concerned about the access of children and families to round-the-clock end of life care at home, provided by nurses and supported by advice from consultant paediatricians specially trained in paediatric palliative medicine. I am told that only a third of local areas in England are meeting the required standards in this area. Rainbows has informed me that in Leicester, Leicestershire and Rutland there is no 24-hour end of life care available at home, other than that based on goodwill provision from the Diana team. Therefore, in October 2023 Rainbows launched its hospice at home service, which it provides jointly with community nursing teams. However, there are no paediatric palliative consultants across the east midlands and no funding available to support this essential service. As such, Rainbows is currently paying for remote support from a consultant in another region.

Rainbows also funds two clinical nursing specialists working at the Leicester Royal Infirmary. In addition, it provides paediatric palliative care single point of contact, which is a pilot and is currently funded by the Paediatric Palliative Care Network, although the future of this funding is not guaranteed. Furthermore, Rainbows provides end of life care, symptom control and short breaks at its hospice in Loughborough. Its therapists offer support in the hospital, and provide ongoing bereavement support to families.

I am told that in 2024-25 it will cost Rainbows £12.1 million to provide its services. Over the same period it will receive roughly £1.7 million in statutory funding, which works out to be around 14% of its costs—enough to keep it open for only seven weeks. It will also receive £99,000 from Leicester, Leicestershire and Rutland integrated care board and £1.4 million from the children’s hospice grant for all five counties. This income totals £3.2 million, leaving a shortfall of £8.9 million, which Rainbows has to try to find itself.

Furthermore, although Rainbows has been told that it will receive the children’s hospice grant for 2024-25, the ICB has still not confirmed whether it will receive the funding in subsequent years. Together for Short Lives has also highlighted that, while ICBs and hospices are now clearer about their process for distributing the grant—thanks to the confirmation from the Government —it still remains unclear when and how hospices will receive the funding from ICBs and to what extent NHS England will hold ICBs to account in ensuring that the money is paid out. As a result, at the moment hospices do not have the reassurance of a long-term NHS funding plan, so I seek clarification from the Minister on those points.

Although Rainbows is fantastic at fundraising, its current position is simply not sustainable, particularly given that the number of children with life-limiting or life-threatening conditions is increasing. If we restrict the services that existing hospices provide by not supporting them with adequate funding, the provision will have to be found elsewhere, and responsibility will likely fall on the state. I therefore encourage the Government and NHS England to accept Together for Short Lives’ recommendation to review children’s palliative care funding going forward and to fill the £295 million annual gap in NHS spending on children’s palliative care in 2024-25. This should either be met centrally by maintaining ringfenced NHS England funding beyond 2024-25, or by setting out a framework under which ICBs are required to provide sustainable funding.

If urgent action is not taken, I share Rainbows’ concerns that more seriously ill children and their families will be denied choice and control over their palliative and end of life care.

In conclusion, I ask the Minister not to change a single atom of LOROS hospice or Rainbows children’s hospice, because they both provide excellent care. However, I urge her please to work alongside them as much she can and to get the ICBs, in particular, to deliver on the funding that was mentioned earlier in the debate.

NHS Dentistry

Jane Hunt Excerpts

Thursday 20th October 2022 Commons Chamber

[Jane Hunt (Loughborough) (Con)]

I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing what is clearly an important debate.

I take this opportunity to thank those in the dental profession in Loughborough and across Leicestershire for everything they have done over the past few years and particularly for the way they adapted to implement the huge changes needed to ensure the safety of their patients throughout the covid-19 pandemic. This year I have met with nearly all the dentists in my constituency, who have highlighted a number of issues they face and the impact they have on the profession and the patient experience more broadly.

[Richard Graham]

The points my hon. Friend is making are particularly important to constituencies such as hers, which have towns but are also rural.

[Jane Hunt]

I thank my hon. Friend, who is a true hero in every way.

One concern is about the UDA system, with the recurring message being that the system in its current form is not fit for purpose. I welcome the package of initial reforms to the NHS dental contract announced in July, in particular the introduction of enhanced UDAs to support higher-needs patients.

However, the reforms do not address my local dentists’ concerns that the current system is based on rewarding reactive treatment, rather than preventive, meaning that dentists are driven to do the minimum necessary to meet the terms of the target. That is a source of frustration for some, who have expressed their preference for being remunerated for using their initiative and working in the best interests of their patients.

Furthermore, while it is welcome that a minimum indicative UDA value of £23 has been introduced, UDA payments are not rising in line with increasing overhead costs, which is devaluing contracts and, in some cases, leaving dentists out of pocket. That was highlighted recently during a conversation I had with Bupa in Loughborough. Bupa expressed that that is compounded by the fact that UDA payments vary geographically, so that a UDA is worth £36 in its Sheffield practices but only £24 in its Loughborough one. Finally, the reforms do not address the issue of dentists not being given leeway under their contracts for last-minute cancellations and no-shows, even though they can lead to missed targets. I ask that this be urgently reviewed, so that we do not punish dentists for trying their hardest to continue to provide the care needed.

It is clear that there is still a way to go to make NHS dental contracts more attractive, both in terms of the nature of the dentistry performed and the level of financial reimbursement received for services performed. I fear that if the Government do not continue to work at speed, we will lose even more NHS dentists through early retirement, a reduction in time spent completing NHS work, or a full move into private practice. That would be detrimental to patient care and the availability of NHS appointments. I know that the former Minister of State for Health, my hon. Friend the Member for Lewes (Maria Caulfield), was working hard to review UDA contracts, and I would welcome confirmation from her successor that they will continue that hard work.

As well as difficulties retaining dentists, I have been informed that locally, we are having difficulties recruiting them. One reason for that is that there is no dentistry school in the east midlands, our nearest being in Sheffield and Birmingham, and students are choosing to enter into the workplace close to where they study. That is causing supply issues in the NHS service, and has created a gap in the market that is being filled by private dentists with a focus on cosmetics. We therefore need to ensure we are training up enough dentists and providing them with incentives to move away from where they are studying to areas with greater demand. Bupa has also advocated for putting dental practitioners on the shortage occupation list in order to increase overseas recruitment and fill shortages, then upskilling those practitioners via short courses to meet UK standards. Could the Minister please comment on the actions being taken to increase the number of dentists from overseas?

I am very concerned that NHS England has proposed closing the intermediate minor oral surgery service in Loughborough, meaning that local residents will have to go as far as Leicester for treatment. That city is some considerable way away, and there has been a recent cut in bus services, the No. 2 bus service in particular. Loughborough is effectively Leicestershire’s county town, so there is more than enough demand there for that service. Closing the centre will only increase pressures on the Leicester centre, extending waiting times and further impacting on patient care. That centralisation of services does not meet the needs of the patient, and I ask that the Minister look with some urgency at local services’ availability throughout the country, especially throughout Leicestershire.

Having listened to the whole of today’s debate, it has been very interesting: there are a small number of points that need to be addressed, which have been made by Members from all across the Chamber and all over the country. I do not think this is an insurmountable problem to solve, and I feel sure that the Minister will be able to address it.

Oral Answers to Questions

Jane Hunt Excerpts

Tuesday 1st March 2022 Commons Chamber

[Sajid Javid]

Yes.

[Jane Hunt (Loughborough) (Con)]

A dental practice in Shepshed has informed me that its NHS contract has changed little since 2006. Can the contracts and value of units of dental activity for treatment be increased to focus on prevention, rather than treatment alone?

[Maria Caulfield]

I absolutely agree; my hon. Friend hits the nail on the head of why we are seeing such problems in dentistry. We have started negotiations on the dental contract and are working with the British Dental Association. The UDA has to be reformed as part of that: it is a perverse disincentive that turns dentists away from providing NHS services. I will keep her updated on our progress.

Asthma Outcomes

Jane Hunt Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jane Hunt (Loughborough) (Con)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I am delighted to follow the hon. Member for Strangford (Jim Shannon), and I congratulate him on securing this excellent debate. I thank him very much for what he has said. My speech will be less wide-ranging than his, but I want to deal with two particular aspects. First, I should declare an interest, in that my brother works in this industry. Having said that, we never talk about work, so that is literally as much as I can say about what he does. However, I have had several meetings with representatives of Kindeva, a company that deals in the asthma industry, and visited its site. It is based in my constituency, so I will refer to the company in some detail. I will first discuss the change in drug delivery that is proposed by DHSC, before talking about prescription charges.

Asthma can be an incredibly dangerous condition. As Asthma UK data show, there are around 75,000 asthma-related emergency admissions to hospital every year in the UK and, sadly, asthma causes the death of around 1,200 people every year. Thankfully, however, although there is no cure, there are simple and, importantly, accessible treatments that can help keep the symptoms under control, including inhalers. That being said, the fact that people are still dying from this condition shows that more work needs to be done, and I was encouraged by the response from the Minister for Care and Mental Health to the debate on access to salbutamol inhalers last week, during which she set out the steps that the Government and NHS are taking to improve asthma outcomes. I was particularly encouraged to learn that the NHS long-term plan includes respiratory disease as a national clinical priority and sets out a number of respiratory interventions, including plans for early and accurate diagnosis of respiratory conditions. I would welcome reassurance from the Minister that the Government will work with the NHS to achieve the aims set out in the long-term plan.

I want to take the opportunity to mention an issue that has been raised with me by Kindeva, a pharmaceutical contract development and manufacturing organisation, when I visited its state-of-the-art research, development and manufacturing facilities at Charnwood Campus in my constituency, which is the very first life sciences opportunity zone that is based in the UK. During my visit, I saw the production of pressurised metred-dose inhalers, or PMDIs, and I heard about Kindeva’s work to transition to green propellants. I am delighted that as part of this, Kindeva and Loughborough University formed a knowledge transfer partnership to proactively address the inhalation drug delivery industry’s move to develop PMDI propellants with lower global warming potential, or GWP, than exists currently in marketed propellants. That is a fantastic example of universities and businesses working together to turn a cutting-edge idea into a marketable product, and it reflects the success of Charnwood Campus.

That being said, I understand that the NHS’s current target to reduce the carbon impact of inhalers by 50% by 2028—by switching patients from PMDIs to dry powder inhalers—coupled with the Government’s review on the use of fluorinated gases, is creating uncertainty for the industry. Specifically, I have been informed that the NHS switchover policy is shrinking the size of the UK PMDI market, and that Department for Environment, Food and Rural Affairs’ proposals to remove the essential medical use exemption of F gases in PMDIs would put considerable pressure on the market before green propellant alternatives are widely available.

Although I fully support the Government’s net zero strategy and their commitment to build back greener from the pandemic and level up all areas of the country in the process, if we are to achieve these aims, we must work with industry to ensure that we do not unintentionally drive innovation out of the country, along with opportunities for inward investment and long-term, highly skilled jobs, particularly in the east midlands and, from my point of view, most particularly in Loughborough. We have a fantastic opportunity to be a world leader on green propellants, and we have the willingness of industry to make the necessary changes. I therefore ask the Minister and the NHS to work with the industry and, most importantly, afford it the time needed to transition to greener propellants, by delivering the current NHS emissions reduction targets over a longer timeframe, and maintaining the current medical use exemption for F-gases until 2030.

Consider the situation, imagine the scene, of struggling for breath. Constituents have that problem across the country every day. They need consistency of treatment to enable them to trust the medication and have it delivered quickly and accurately. When they need the medication, it is very often an emergency. They need the drug delivery to be accurate and timely. Let us take that into consideration when looking for net zero outcomes in medications and treatment.

Asthma UK called for a suspension of prescription charges for asthma medications and for them to be added to the medical exemptions list. I think we would all agree, particularly in the case of the son of the hon. Member for Strangford, who was born with the condition, that this is not something that can be avoided. Therefore, why should patients pay for those prescriptions?

--- Later in debate ---

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr McCabe, in what is an extremely important and timely debate. I thank the hon. Member for Strangford (Jim Shannon) for securing it, and I know that the issue is very close to his heart. He exerts such energy, enthusiasm and dedication through his work with the all-party parliamentary group on respiratory health, and the issue also has a very personal resonance for him, as we heard, given that his son has been diagnosed with asthma. The hon. Gentleman has first-hand experience of asthma’s impact on a young person and a family, of the concerns that it brings to the whole family and of the need for improved, ongoing care for everybody affected.

The hon. Gentleman set the scene extremely well, and in a detailed manner. He raised with the Minister the issues that clearly need to be addressed, and ensured that we are all aware that we should be speaking more about asthma and its implications, given its impact on so many people across the United Kingdom. He gave some startling figures, including that three people a day die as a result of this treatable disease. We should be doing far more to ensure that those deaths do not happen and that the interventions required are delivered in a timely manner. Those who need additional support must get access to the trained nurse clinicians and the annual reviews that they so desperately need.

I also thank the hon. Member for Loughborough (Jane Hunt). I do not believe I have had the pleasure of speaking to her personally in this place yet, because of our absence during the covid pandemic. I look forward to speaking with her about her particular interest in health. I say that as a clinician, as the chair of the all-party parliamentary health group and as someone with an interest in taking these issues forward. She raised such important matters, including the move towards climate change-friendly, net-zero alternatives. She said that the move must be staged so as not to be too quick for the people who desperately need the medication to catch up, and that it must be done in a very pragmatic way so that it does not impact on those UK organisations that she spoke about, including in her own constituency. Those organisations are working so hard to ensure that science is at the forefront and that, while we achieve net zero, we put patient health at the forefront of all of the decisions that are made in this context. She spoke extremely well on that matter.

The hon. Member for Blaydon (Liz Twist) always speaks eloquently on health-related matters, and I very much welcomed her person-centred approach to the debate. She detailed the impact of asthma on people’s lives, and contributed that first-hand information to the debate. Asthma has a devastating impact on individuals, and people must have access to the biologic treatments that she described. Where there is innovation and excellence in our NHS, it must be available to everybody who needs treatment. That is why, importantly, she told the Minister that individuals must have access to community hubs for diagnosis, linked with early prevention and prescribing. There should be no postcode lottery; no matter where people live in the United Kingdom, they should have access to the treatment that they so desperately need.

While I think about hon. Members’ contributions, I will also briefly mention prescription charges, which the hon. Member for Loughborough also discussed and are extremely important. The Scottish Government abolished prescription charges in 2011, but in England the current charge is £9.35 per item. Since 2011, those suffering from asthma in Scotland have had access to free inhalers, meaning that no person is ever left without an inhaler because of cost. A recent survey conducted by Asthma UK found that three quarters of people living with asthma in England had struggled to pay for their prescriptions and that individuals had often turned to skipping doses of their inhaler to cut costs—again, the impact of poverty and deprivation causing detriment to those who have asthma.

[Jane Hunt]

I thank the hon. Lady for letting me intervene. I understand her point about Scotland, but there is available an annual prescription charge, which is far less. However, my point was really about the fact that asthma sufferers cannot help it, essentially. Is there something we could do there?

[Dr Cameron]

Absolutely, and the hon. Lady makes an excellent point. While the choice in Scotland has been to abolish prescription charges, I note that she did not suggest that to the Minister. However, she did suggest—perhaps because we know that asthma often starts in childhood and is not something that people have much control over—that an exemption could be applied. Following that recommendation from the hon. Lady, I would be interested to hear the Minister’s thoughts on the matter.

Cost itself should not mean that someone cannot access healthcare, and in a developed country such as the United Kingdom, there should be no prohibition owing to charges and costs, particularly for something for which people often need daily medication. We have heard from Asthma UK that that is happening—people are skipping doses and many are struggling to pay for their prescriptions in England.

In 2021, the Scottish Government published their respiratory care plan, which is a care plan covering 2021 to 2026. It includes a workstream specifically on asthma, and I am pleased that that is being taken forward at that level. We know that asthma attacks across the UK, including Scotland, have increased by a third over the last decade, and the number of people affected in the UK is among the highest in the world, with about 5.4 million receiving treatment for asthma. That is equivalent to one adult in every 12, and one child in every 11, so we know that asthma is widespread and that it needs to be a priority for Government action.

Asthma affects people of all ages, as we have heard, and often starts in childhood. I must declare that I have been diagnosed with asthma and have had asthma since childhood. I say to the Minister that there is absolutely nothing worse than the feeling of struggling for breath. I have found wearing a mask difficult at times, but I have continued to do so, and there are exemptions for people with severe health conditions. However, asthma comes upon people suddenly and can leave them with a feeling of such a lack of control, so it is important to have specialist advice from the nursing staff, which the hon. Member for Strangford spoke of.

I do not believe that I received such advice when I was younger; I think I was given an inhaler, told to go off home to practice and learn to use it myself. I wonder whether the issue that the hon. Gentleman raised—people overusing their inhaler medication—is down to there not being enough early intervention and education on how to use an inhaler properly.

I say to the Minister that although the recommendations have been raised on the Floor of this debating Chamber, we need meaningful data. We need to know about overuse, and the rationales and reasons for that overuse. Do people need more education and intervention from clinical nursing staff in the community hubs? Does the cost mean that people in poverty struggle to access treatment, and is that contributing to the death toll? That data is crucial.

As has also been widely mentioned, Asthma UK has indicated that NICE should develop comprehensive guidance on severe asthma. Can we also make sure that the newer treatment options—the biologic treatments—are widely available to everyone who needs them?

I thank everyone who has taken part in this debate, which has been an extremely positive one. I particularly thank the hon. Member for Strangford, because this issue is so important to so many people in the United Kingdom, and I look forward to hearing the Minister’s response.

Covid-19 Update

Jane Hunt Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

This year alone, we have provided an additional £34 billion of support to the NHS and the social care system. All the extra funding is in place in each of the areas that the hon. Gentleman has just mentioned—whether it is the winter access fund for GPs or the support for the ambulance trusts, which I think have had more than £55 million for the winter pressures—and it is making a real difference.

[Jane Hunt (Loughborough) (Con)]

Having received my booster vaccination yesterday, I would like to thank the Leicestershire and Rutland vaccination service, and particularly Rachel and Abbie, for their excellent work. Does my right hon. Friend agree that it is vital that constituents take up their vaccinations, including their booster, to help us all through the winter period?

[Sajid Javid]

Yes, I do. The vaccines remain our primary line of defence and I congratulate my hon. Friend on getting her booster shot yesterday. I wholeheartedly agree that everyone who is eligible should come forward, to protect themselves and their loved ones.

Oral Answers to Questions

Jane Hunt Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

That is an important point, which is why the Government have listened to it. The hon. Gentleman will know that a lot of consultation was done before the Bill that he refers to was presented. In terms of voices around the table in the ICB, we have deliberately set up a permissive system that allows those local voices to be catered for, and for local decisions to be made. While there are minimum requirements, there are no maximum requirements.

[Jane Hunt (Loughborough) (Con)]

Humphrey Perkins School in my constituency had carried out all the necessary preparations ahead of its anticipated roll-out of the vaccine prior to the autumn half-term. However, the day before, the school was informed that the roll-out would be postponed until 30 November. Please can my right hon. Friend set out the reasons for this delay, and will he confirm that this date will not be pushed back again, as that could have an impact on transmission between local adults, among which cases have increased recently?

[Mr Speaker]

Unfortunately, that question is not relevant to Question 1. We will come back to it as a substantive question later.

--- Later in debate ---

[Maria Caulfield]

As I have said, this Government are leading the way in England in the way community pharmacies are transforming services in primary care. That is why we have the new medicines service, where patients with conditions such as asthma and high blood pressure or who are on blood-thinning medication are able to go and see their pharmacist as a first port of call in managing their medication. We will be expanding those services and are in discussion with community pharmacists about how we take that forward.

[Jane Hunt (Loughborough) (Con)]

8. What steps his Department is taking to roll out the covid-19 vaccination to 12 to 15-year-olds.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

We have vaccinated more than 1.1 million 12 to 15-year-olds since roll-out began. Vaccine clinics have been held at around 3,500 schools, with 800 more to be visited next week, and there are more than 240 out-of-school vaccine sites in operation. To bolster the roll-out, since 22 October vaccination bookings for any 12 to 15-year-old in England can be made through the national booking service to attend a vaccination site outside school hours. I take this opportunity to thank everybody involved in making this programme so successful.

[Jane Hunt]

Humphrey Perkins School in my constituency had carried out all the necessary preparations ahead of its anticipated roll-out of the vaccine prior to the autumn half-term, but on the day before, it was informed that the roll-out would be postponed until 30 November. Please could my hon. Friend set out the reasons for this delay, and can she confirm that this date will not be pushed back again as this could have an impact on transmission between local adults, among whom cases have increased recently?

[Maggie Throup]

In late September, the Leicestershire Partnership NHS Trust school age immunisation service devised an updated schedule for covid-19 and flu vaccinations comprising the remaining schools to be visited. This was to address some operational challenges, reduce the need to postpone sessions at short notice and offer the best experience to the young people receiving vaccinations. All affected schools were notified as soon as possible. As my hon. Friend said, the service will be attending Humphrey Perkins on 30 November, when eligible students with consent will be offered both the flu and the covid-19 vaccines. West Leicestershire clinical commissioning group has confirmed to me that this date will not be moved.

Covid-19 Update

Jane Hunt Excerpts

Tuesday 14th September 2021 Commons Chamber

[Sajid Javid]

I believe we have been very clear on this issue.

[Jane Hunt (Loughborough) (Con)]

Last Friday, Leicestershire MPs met NHS officials locally. We were told that around three quarters of all those in hospital with covid were not vaccinated. Does my right hon. Friend agree that if we do not want to be in lockdown this winter, all who can get the vaccine should get it, especially in Leicester, where I now understand from the shadow Secretary of State’s comments that take-up is only 61%?

[Sajid Javid]

I agree with my hon. Friend. Some 6 million adults throughout the UK remain unvaccinated, and we should all do that we can to at least encourage them to think about taking the vaccine, not only to protect themselves but to protect their loved ones.

Injectable Vitamin B12

Jane Hunt Excerpts

Wednesday 26th May 2021 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Well, only one Member is here physically, so I do not think that I need to read all of this out. If everyone present here in the Boothroyd Room could clean their spaces before using them and before leaving the room, that would be great. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall—apart from by me in the Chair, as I may need to speak at any second.

[Jane Hunt (Loughborough) (Con)]

I beg to move,

That this House has considered proposals to remove classification of prescription-only medicine from injectable B12 vitamin.

It is a pleasure to serve under your chairmanship, Dr Huq. First, I thank my constituent Tracey Witty who, since being diagnosed with B12 deficiency in 2012, has worked tirelessly to support others to secure the treatment that they have desperately needed and campaigned for, and to increase public awareness of vitamin B12 deficiency as well as the issues surrounding access to treatment. It is clear that she is making a real difference to the lives of people across the country; and much of the information that I will share today has come from her extensive investigation and research into this disorder.

Vitamin B12 deficiency is a progressive neurological disorder with a wide range of symptoms that affect all body systems and, importantly, people of all ages. Statistics from the National Institute for Health and Care Excellence show that, in the UK, 6% of people below 60 years of age are deficient in B12, and the figure rises to 20% in people aged over 60 years. That means that hundreds of thousands of people are struggling with the symptoms of B12 deficiency, which can have a devastating impact on both physical and mental health, leaving sufferers unable to contribute to either family life or society.

Crucially, and in part because of the wide range of symptoms associated with the disorder, sufferers often struggle to receive the correct diagnosis. They are commonly misdiagnosed with conditions such as Alzheimer’s disease, bipolar disorder, multiple sclerosis, chronic fatigue syndrome, autism, ADHD—attention deficit hyperactivity disorder—and fibromyalgia. That means that they do not receive proper treatment and, in the long term, that can lead to significant complications, including permanent neurological damage.

Over the years, many people have contacted my constituent, Tracey, to discuss their experiences of living with B12 deficiency and the difficulties that they have faced in getting the right diagnosis. I would like to share a couple of their stories The first is of a mother, with three young children, whose serum B12 level first indicated a deficiency nearly a decade ago. Sadly, however, that was overlooked and, despite being unable to physically function because of her disorder, the woman was repeatedly denied access to B12 injectables by GPs. After spending a number of years being passed from pillar to post— seeing a psychologist, endocrinologist, haematologist and gastroenterologist, attending a pain clinic and chronic fatigue clinic, and being sent for a brain scan—the woman felt that she had no choice but to resort to sourcing injectable B12 online. Thankfully, she is now fully functioning, but can she be certain of having a trusted source of injections through the internet?

The second story is of a woman who, following four unsuccessful attempts at IVF decided to explore B12 deficiency as a possible cause of her fertility problems, as she also had a myriad of severe neurological symptoms and a known family history of B12 deficiency. More than a year ago, she found out that she was indeed deficient when her serum B12 test result was flagged as abnormal. However, along with the test result was a note stating that no action was to be taken and so, instead of being treated for a clear B12 deficiency, she was advised to take oral supplements and was referred to a chronic fatigue clinic. This woman is only just starting B12 injections with her GP this week, after repeatedly supplying evidence to them of the need for correct treatment. It is understood that oral vitamin B12 cannot be absorbed when the patient is B12 deficient; it requires an injection to be effective. Even when patients are correctly diagnosed, they often face an uphill battle to access the treatment they need when they need it. As the NHS website states:

“The treatment for vitamin B12 or folate deficiency anaemia depends on what's causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins.”

It goes on to state that, “At first”, patients will

“have these injections every other day for 2 weeks or until…symptoms have started improving…After this initial period,”

if a patient’s B12 deficiency is not caused by a lack of the vitamin in their diet, they will

“usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of”

their life.

Sadly, however, for many people that maintenance dose is not enough, leaving them to deal with debilitating symptoms while trying to juggle the stresses of everyday life. That was the case for another woman who has been in contact with Tracey in recent months. During lockdown, that woman who had previously been diagnosed with pernicious anaemia, which is one cause of vitamin B12 deficiency, was exhausted, constantly nauseated, stumbling, struggling with brain fog and unable to function properly. She therefore asked her GP whether she could have her B12 injections more regularly than the eight-weekly regime she was on.

Subsequently, however, that woman had her regime reduced to just four injections per year, after her GP took advice from a professor of haematology who it seems incorrectly stated: “A typical dose survives in the body for up to two years and once the patient has the first few injections, there is no ongoing deficiency. We can be confident that these fluctuating symptoms are not related in any way to B12.” That statement is at odds with NICE guidance, which is clear:

“Treatment of B12 deficiency in people with neurologic involvement should include”

injections

“on alternate days until there is no further improvement”.

A single mother who was trying to cope with the additional stresses of home schooling two autistic children due to covid-19 restrictions was left with no other choice but to purchase B12 online from a pharmacy abroad in order to function properly.

It is because of such cases that I presented a petition in the Chamber calling for the classification of prescription- only medicine to be removed from injectable B12, so that those who have been diagnosed with B12 deficiency may access treatment over the counter at pharmacies when they need it. As the petition mentioned, that would bring the UK’s

“approach in line with that of other countries, affording those with B12 deficiency the same dignity and control over their own health as a diabetic using insulin, and reducing the workload and financial burden on GP practices, District Nurses and other NHS services”.—[Official Report, 23 September 2020; Vol. 680, c. 1077.]

The latter point has become increasingly important given that covid-19 has placed significant pressure on NHS services and, in recent months, intensified demand for GP services.

It is also worth noting that, since I presented the petition, Tracey’s Change.org petition on that very subject has garnered more than 96,300 signatures, reflecting the public interest in the matter. I am grateful for the Government’s response to the petition that I presented. However, it raised a number of new issues, which I will put to the Minister now.

The Government’s response stated:

“Clinically urgent treatment must always be provided, with the patient's clinical needs being paramount. Any patient who wishes to discuss their need for vitamin B12 injections can request a review with their GP or other responsible clinician.”—[Official Report, 2 November 2020; Vol. 683, c. 6P.]

In Tracey’s experience, however, and as evidenced by the stories I shared earlier, clinically urgent treatment is frequently denied to those with B12 deficiency. That situation has been worsened by the covid-19 restrictions, when many people with the disorder and pernicious anaemia were told by their GP that they no longer needed B12 injections and could instead take a B12 tablets. Tracey heard how some of the GP practices came to that conclusion after taking blood to check B12 levels. That is despite NICE guidance and The BMJ stating that no testing should be carried out once a patient is on vitamin B12 injections, as there is no indication of what is happening at a cellular level.

The Government’s response also stated:

“Vitamin B12 could not legally be classified as a medicine that can be made available for sale without prescription in pharmacies because it is an injection and because the condition it is licensed to treat, pernicious anaemia, needs a clinician to diagnose it, and monitor its treatment.”—[Official Report, 2 November 2020; Vol. 683, c. 5P.]

It is important to make a distinction here because, as I mentioned, pernicious anaemia is only one cause of vitamin B12 deficiency. B12 injectables are also required by those who are B12 deficient for other reasons. Tracey feels that there is a widespread lack of understanding of this subject among clinicians, which is compounded by the inaccuracy of B12 testing.

As the NHS website acknowledges,

“the current widely used blood test only measures the total amount of vitamin B12”

in a patient’s body, rather than what form the B12 takes. This means that a blood test may show that a patient has normal B12 levels, even though their body cannot use much of it, leaving many patients without access to help or treatment. I would welcome the Minister’s comments on whether the Government will be working with the NHS to further clinicians’ understanding of B12 deficiency, in particular the limitations of testing, to ensure that those who are deficient receive better care.

Finally, I will pick up on the wider point in the Government’s response about the classification of B12 injectables. The response stated:

“Before a medicine can be switched from a prescription only medicine (POM) to a pharmacy (P) medicine, Ministers must be satisfied that it would be safe to allow it to be supplied without a prescription. This means that it is a medicine which no longer meets any of the criteria for a POM.”

The response went on to imply that, as B12 injectables are normally prescribed by a doctor for parenteral administration, they cannot be considered safe to be supplied without a prescription.

That position seems to be at odds with the fact that private clinics are able to provide the very same injectables to clients, provided they advertise them using such terms as wellness, boost or supplement, and do not market them as treatments for B12 deficiency or make any medical claims. That is because the Medicines and Healthcare Products Regulatory Agency does not consider vitamin B12 injectables to be medicines in this instance. Indeed, in a statement to Tracey, the MHRA said:

“Our current advice to private clinics administering vitamin B12 injections which are not licensed medicinal products intravenously for non-medicinal purposes is that we do not regard these to be medicines and that they fall outside of the remit of the MHRA. It must be absolutely clear in the advertising of such products that they do not have a medical purpose.”

Furthermore, staff at private clinics do not need any medical training to administer B12 injectables to clients. The implication of this is that B12 injectables are simultaneously licensed medicinal products, which are not safe to be administered by someone without medical training, and non-medicinal products, which are safe to be administered by someone without medical training. Moreover, unlike with insulin, the risk of toxicity or overdose with injectable B12 is considered to be extremely low, and so would be relatively safe for those with a deficiency to self-administer. I would welcome the Minister’s comments on those points.

That being said, as the Government’s response to the petition rightly highlighted, self-administration would not be suitable for everyone, so it would be only right that patients retain the ability to receive their injection at a GP practice. Tracey has also expressed that pharmacists who are already trained to administer vaccinations should be allowed to administer injections to those with a prescription. That would allow pharmacists to play a greater role in community healthcare, relieving pressures on GP services.

Here is another email I received directly from a constituent: “I suffer from B12 deficiency. At present I require an injection every other day to keep serious neurological decline at bay. I was diagnosed last summer and rapidly declined, to the point of almost being in a wheelchair. I was helped by the GP initially, but would not expect them to continue my intensive treatment owing to resources. However, if they could train us and supply the details, it would be better than as now, when many of us are forced to research this ourselves.

“I currently have to purchase ampules of hydroxocobalamin online from Germany, which I am sure you will agree is an expensive, lengthy and unnecessary process when they could easily be bought over the counter in the UK. The injections have enabled me to regain my peripheral vision, resume driving, function normally in a busy household and even get a new part- time job. I cannot overstate the impact they have had on me, especially since the doctor suggested I might have terminal neurological decline. Please, please state the case for hundreds or possibly thousands of us in the same position, and for those who have not yet been diagnosed and are struggling with poor mental and physical health for the sake of a low-cost vitamin.”

I hope that the overriding message the Minister takes away with her is the desperate situation in which those whose stories I have shared have found themselves—so much so that they have had to source their own injections just to be able to function as she and I can. The debate has been advertised on the “B12 Deficincy.info” Facebook page and, this morning, one lady left the following comment:

“Fingers are crossed. This would be life changing for me and so many others, no more battling with my doctors. I can only dream of what it’s like to feel alive.”

I ask the Government please to reconsider their position urgently.

Covid-19: Dental Services

Jane Hunt Excerpts

Thursday 14th January 2021 Commons Chamber

[Jane Hunt (Loughborough) (Con) [V]]

May I take this opportunity to thank all in the dental profession for all they have done and, in particular, for how they have adapted to implement the huge changes needed to be covid-secure? I have direct experience of this, having received urgent care both during the first lockdown and yesterday. I know that I am not alone in thanking them, as several of my constituents have told me of their own experiences. On behalf of all of us, I thank them very much for what they are doing during these trying times.

At the beginning of the pandemic, dental practices across the country were instructed to close. This meant that dentists took a huge financial hit, which was compounded by the fact that many were ineligible for the Government’s financial support package. This was particularly true of private dentists. We rely on these practices as much as NHS ones to meet local demand, and that should be considered going forward.

NHS dentists have recently been asked to fulfil their contractual obligations in the last quarter of the financial year. However, in order to meet additional safety guidelines, they now see fewer patients. Indeed, 64% of practices surveyed by the British Dental Association last year estimated that they could only treat less than half the patients they saw before the pandemic. Practices also have to cater for the self-isolation of staff and patients, the general fear of older residents leaving their home for any reason and cancellations at short notice for all of the above.

I emphasise that dental practices are safe and continue to be so. I am grateful to the Leicestershire and Rutland Local Dental Committee, which allowed me to attend its Zoom meeting last night and hear the concerns of 112 local dentists. In an online vote, 80% of those dentists said they would not be able to hit the target for quarter 4. The added dimension is that should dentists miss the target by as little as 1%, they receive considerably less revenue for the work they have already carried out. Dentists are also given no leeway for last-minute cancellations and no-shows in their contracts, even though that may lead to those missed targets. I therefore ask that that be urgently reviewed, so that dentists are not punished for trying their hardest to continue to provide the care needed.

I can fully understand why the target was set when it was put in place just before Christmas. At that time, little was known about the new variant of covid and the case rate was dropping at a rapid rate. If it had remained in that arena, I certainly would have been clamouring for tier 2 in Loughborough and fighting to get as many businesses and facilities open as possible. Unfortunately, the new variant has put paid to that idea and a national lockdown has ensued. I ask that the target for dentists be reviewed in light of the current situation.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Scott Mann.

Covid-19 Update and Hospitality Curfew

Jane Hunt Excerpts

Thursday 1st October 2020 Commons Chamber

[Matt Hancock]

Yes, the £190 billion of extra funding has been there to support jobs, and of course we keep that, as with all these things, under review.

[Jane Hunt (Loughborough) (Con)]

I refer colleagues to my entry in the Register of Members’ Financial Interests.

I understand and support the measures taken to reduce deaths from this terrible disease, and thank Ministers for all they have done to stem the tide of the virus. Please could my right hon. Friend consider allowing pubs, cafés, restaurants and casinos to extend their closing time when customers are still in the process of eating a hot meal? That would allow time for a second sitting of those venues without disturbing the safety elements of table service and social distancing. It would also mean a staggered time of exit from those venues, allowing better social distancing in the local community.

[Matt Hancock]

Of course, as we keep this under review, we will consider all the options. The clarity of the rule that was brought in was one of the reasons that it commends itself, but I would be happy to talk to my hon. Friend about the future.