Universal Health Coverage

Jim Shannon Excerpts

Thursday 5th July 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the role of universal health coverage in tackling preventable and treatable diseases.

I would first like to thank the Backbench Business Committee for granting this debate. I have been lobbied fairly heavily on the subject and a number of organisations asked me to approach the Committee and request a debate. I am pleased to see the Minister in his place. He and I have discussed the matter before. It is probably one of those issues that involves not only the Department of Health but perhaps the Department for International Development. He once told me that he took part in a debate that covered five different Departments—I suppose he is a man of many talents—so he will be able to answer wisely for the Departments covered in this debate. I thank hon. Members for coming along to Westminster Hall on such a warm day, and given the almost end-of-season approach we seem to have to matters now.

I wish to begin, as we approach the 70th anniversary of our NHS, by thanking all those who have made that institution all that it is. I have said that in other places, but I wanted to say it publicly now in Westminster Hall. Many political parties have had the opportunity to be part of the creation of our great NHS, and many of us have had the opportunity to be cared for by it, both surgically—in operations—and through the care that nurses provide in hospitals, which I personally have had on three occasions over the past year. I am thankful to every person involved in the NHS, from the porter to the paediatric consultant, from the occupational therapist to the oncologist, from the scrub nurse to the surgeon, from the auxiliary nurse to the audiology clinician, and all people in between. I thank them all very much for all that they do for us as patients, but also for us as a nation. I want to put that on the record.

I thank NHS staff for making the NHS work in situations that often seem unworkable, due to stress and pressure. As the Democratic Unionist party’s spokesperson on health, I am frequently contacted by those who need more than the service has to offer. A great many times we focus on the problems of the NHS and where we are—that is the way life is—but we also need to reflect on how good it is and how much we owe it.

People often come to us with their problems; they do not necessarily come to us to tell us how good a job we are doing. Perhaps half a dozen people will call in a week to say what a good a job we are doing, but hundreds of others will come to us with their complaints. That is the nature of the job. It is not about complaining; it is part of the job. I believe that I must highlight where we are going wrong, or perhaps where we can do things better. We must see if we can do things along those lines.

Today it is my desire to thank all those who work in the NHS so tirelessly, who do not always get the recognition they deserve. The NHS is our nation’s greatest asset. A Member said in the main Chamber today during business questions that the NHS was probably our nation’s greatest accomplishment. I tend to agree, as I am sure would many others. The NHS embodies our British values of compassion and fairness. It represents our nation’s strong sense of justice and the desire to help those in need. With its quality of care and pioneering scientific research, it is a world-leading institution.

Across the whole of the United Kingdom of Great Britain and Northern Ireland, the NHS works in partnership with many universities and private companies on research and development for drugs that can help save lives. Queen’s University Belfast is one of those universities, and I know that because it is one of the institutions that I would call in on. Indeed, just three months ago I visited its cancer research team to see the scientific work they are doing. They were over here this week, along with staff from breast cancer charities, in the Attlee suite in Portcullis House, and we had a chance to catch up. What they are doing to try to find cures for cancer at all levels is incredible. There is also the complexity of breast cancer treatment to consider, because many people have different variations, so the drugs they take must be just as varied.

The NHS is the type of British export that can help underpin the UK’s global Britain vision, which I believe we lead the world on and which we can be the forerunners for. Health for all, which is the bedrock of this most beloved institution, is a principle that the UK originated in 1948, when it first embarked on the altruistic duty of creating a national health system to provide care to everyone, everywhere, without their having to experience financial hardship.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

I agree with everything the hon. Gentleman has said so far about the NHS. I saw its merits at first hand when I had a baby two years ago. However, I wish to make a point about the current shortage in the NHS of the BCG vaccine, which is used to treat tuberculosis. My constituent, Hussein, is 11 months old. He was born in Lebanon but is a British citizen. His parents have told me that their GP said that Hussein cannot have the BCG vaccine on the NHS because he was born outside the UK. Does the hon. Gentleman agree that although our NHS has a fantastic track record in tackling diseases and providing care, in order for it to have a successful future every British citizen must be entitled to the preventive medicines on offer?

[Jim Shannon]

I thank the hon. Lady for that intervention. I know that the Minister, like me, listened carefully to what she said. If there is clearly the anomaly that she outlines, the NHS should reply and make the vaccine available. I am quite incredulous that someone who is a citizen of the United Kingdom of Great Britain and Northern Ireland cannot have it. That is almost impossible to understand. I am sure that the hon. Lady will receive a response from the Minister in whatever time is left at the end of the debate.

The NHS is the purest and simplest definition of universal health coverage, and it is the world’s oldest and most successful model. The World Health Organisation estimates that half the world’s population lack access to essential healthcare services and that 100 million people are pushed into extreme poverty by healthcare expenses. We have problems as well. I get frustrated sometimes when constituents come to me. I am referring to Northern Ireland, where health is a devolved matter and therefore not the Minister’s responsibility, but I believe that these cases illustrate some of the issues. A constituent told me this week that a consultant had said to them, “Well, you’re going to have to wait maybe 53 weeks for an operation.” If people want to have an operation through private healthcare, however, they are told that it could maybe be done before the end of the month. As always, if someone can pay for something, they can have it done. We have these problems within the NHS in Northern Ireland and, I suspect, across the rest of the United Kingdom.

As I said, the World Health Organisation estimates that half the world’s population lack access to essential healthcare services and that some 100 million people are pushed into extreme poverty by healthcare expenses. Behind these horrifying statistics are tragic human stories of unnecessary loss and suffering. My parliamentary aide, who does a lot of speech writing and research for me, has travelled to Africa to work every summer, usually in Swaziland but also in Zimbabwe over the past couple of years. That is through Elim Missions, which is a church group in my constituency. She used to visit Africa every summer, during the recess, but she now has two young girls and has not been for a few years. When she came home each year, the tales she would tell about the hospitals she visited would break your heart.

Let me tie together these two stories: first, our NHS; and secondly—perhaps this is for DFID—the responsibility that I believe we have to reach out and help other countries. I referred to that in my earlier discussion with the Minister. My aide’s stories would really have broken your heart. The children’s ward was full of the cast-offs from hospitals in the UK. I do not mean that disrespectfully, because we do that in Northern Ireland—Elim Missions and many other groups do it. We fill containers with second-hand hospital apparatus that might need repairs and we send it out to Zimbabwe, Swaziland and other countries around the world. The equipment can still be used, but sometimes it is worse for wear. We would not put our children anywhere near some of those conditions, but the staff we met made use of all that apparatus and all those materials.

Children in orphanages went without basic medical care until nurses from the UK gave up years of their lives to provide medical training to local communities, for example on the importance of sterilisation. Sometimes the issues can be small, but necessary, such as the simple effect of drops. The hon. Member for Stafford (Jeremy Lefroy) and I were talking this morning about some other things. He said that when he was in Africa his son was taken very ill with pneumonia at eight months old. They did not have the small antibiotic drops that were needed, but once his son got them he became much better and got over the illness. That shows how small things can make a difference and how important it is that we do them.

The Luke Commission is a charity that has been operating since 2005. It takes free healthcare and hope to the most isolated populations in Swaziland. Mobile hospital outreach sites are set up in the remotest parts of that small country. The population is scattered and dispersed. Patients are tested, counselled and linked to treatment for HIV/AIDS. Swaziland has some of the highest levels of HIV in the whole world, and the whole of Africa in particular. Those suspected of having TB are X-rayed and started on medication. Voluntary male circumcisions are performed in an on-site 11-bed operating room, as studies have shown that the rate of HIV transmission is cut by 60% in circumcised males. Those are practical actions that can be taken to change things. More and more evidence indicates that lack of male circumcision is one of the primary reasons why the HIV prevalence rate is so high. These actions can reduce that. Nurses travel back to rural communities to check on newly circumcised men to ensure that they are healing, to answer questions and to provide HIV prevention education.

At the mobile hospital sites, schoolchildren are treated for skin and intestinal problems. Young people are fitted with new shoes. Those are practical, small things that can make a difference. I put on record my thanks to the Elim church charity and to the many other charities and churches across my constituency that gather products, whether clothes, shoes, medication or hospital apparatus—whatever it may be—to help fit out some of these places in Swaziland, Zimbabwe and further afield.

Handicapped people are analysed by Luke Commission medical personnel and given bush wheelchairs—they need a wheelchair that is practical. Follow-up treatment for patients with HIV, chronic disease, complex medical disease and various cancers is offered. Those with poor eyesight receive vision services and glasses, if needed. There is an ophthalmic surgical programme primarily focused on the removal of cataracts, which are a serious issue in parts of Africa. Those practical changes can be made easily. They do not need a lot of money or investment, but they can change lives. Can you imagine, Mr McCabe, not having your eyesight? Of all the things in the world that you would never want to lose, it would be your eyesight. I say that as someone who has worn glasses since I was eight. I understand the importance.

Packets of medication are distributed by the thousands every day, each prescribed by a doctor with instructions on usage in the mother tongue so that they are understood. Psychosocial and grief counselling is available, too. The pain and the tears they have are no less than the pain and tears we have. Some of the things that happen to them happen because they do not have medical treatment available. The Luke Commission team of nearly 100 people treated more than 61,000 patients in 2015. We can do a lot more with small things, but how many more could we affect?

Most recently, a young lady from my constituency gave up her time during her summer to help the Luke Commission. So many others from the UK give up their time to make a difference. Would the Minister be so kind as to outline the initiatives that are in place? I understand his remit may not stretch to that, but it would be helpful if he could give us some idea. What initiatives are in place to encourage our knowledge and skills to be shared worldwide, like the schemes of Doctors Without Borders and the Luke Commission? How are the Government sharing and disseminating the expertise and learning generated from the NHS with Health Minsters in developing countries?

We have great partnerships and the wonderful NHS. We are celebrating the NHS’s 70 years of tremendous work, but we should be trying to show other countries what we can do. Will the Minister give us some idea of how we can help developing countries? I believe that is our duty, and I would like to better understand how we can fulfil it. We need to take up the mantle and do more in our constituencies. We are doing practical, physical and financial things through churches and other charities that directly help in Africa and other countries across the world.

Countries in the developing world are already showcasing their ingenuity and political will in delivering universal healthcare. For example, Bangladesh has achieved wonders in national health in the last 25 years. More than 95% of Bangladeshi children are now fully immunised—that is tremendous. There have been other massive improvements: breastfeeding is near universal, and the level of stunting in children under five declined from 51% in 2004 to 36% in 2014—a significant decrease, showing what we can do if we influence and help both physically and practically. Community outreach by a skilled cadre of female community workers was instrumental in achieving almost universal immunisation coverage, the world’s highest coverage of oral rehydration solution, greater uptake of family planning, and innovative solutions for community-based management of sick newborn babies and severe and acute malnutrition.

Bangladesh is a world leader in reducing child mortality, but pneumonia remains a major challenge for policy makers. Sadly, childhood pneumonia is prevalent across many countries. The stats are alarming: every minute of every day, including today, two young lives are lost to pneumonia; in 2016, it claimed nearly a million children under the age of five in developing countries—more than HIV, TB and malaria combined. If we had the antibiotics available, we could tackle a lot of those problems. Pneumonia is a killer that leaves children gasping for breath and fighting for their lives, but it is also a disease that we have the power to prevent, diagnose and treat. We can do that, so how can we do it better to save those million children’s lives?

We know that an accessible and free health system is the most effective way of treating pneumonia. A fully integrated universal healthcare model can care for a child from the moment they are born until they reach adulthood. That will prevent deaths from pneumonia, which is the biggest killer. We are here today to find out what more can be done to provide UHC in countries around the world, including those in Africa and the middle east, India, Pakistan, Bangladesh and other countries where these problems occur. Millions of people around the world are denied their most basic rights of access to healthcare. We have UHC in this country, and I would like to think that one day we will be able to make it available across the world. As beneficiaries of the NHS, everyone in this room must believe we want everyone to have what we have: a system that is fair and free. We must therefore take steps to change things.

Pneumonia is a prevalent issue within the Commonwealth, too. Save the Children has calculated that children under the age of five living in Commonwealth countries are two and a half times more likely to die from pneumonia than children living in non-Commonwealth countries. When we hear those stats, we realise how big the difference is that we have to try to reduce. Will the UK Government raise the subject at the next Commonwealth Health Ministers meeting? If the Minister is in a position to use that power, I ask him to do so. He should certainly contact the relevant Department to ensure that it happens. What leadership role can the UK Government play, given that the UK is the chair of the Commonwealth for the next two years? I would like to think we can use that influential role. I know we will, but perhaps we should be reminded that we have that opportunity. We should try hard to make things happen.

I am incredibly pleased to have one of the world’s foremost research and medical centres in the wonderful Queen’s University. The steps taken in improving healthcare worldwide have been tremendous, including the most recent breakthrough regarding the targeting of antibiotics for pneumonia using groundbreaking cancer treatment technology. I mentioned Queen’s at the beginning of my speech, but I mention it again, because it is at the coalface of breakthrough technology. I asked Queen’s for a little more in-depth information regarding the breakthrough. That information is certainly something to be proud of. The Queen’s research team indicated that our struggle against infectious diseases is far from over, but they, with other universities, research and development bodies and private companies, are doing their best to make things happen. Globalisation has increased the risk of pandemics, which we get regularly, reminding us that whenever we accomplish something, another disease and pandemic comes along, and sometimes existing drugs are useless.

Unsurprisingly, antimicrobial resistance—AMR—is included in the recently released UK Government national risk register of civil emergencies that may directly affect the UK over the next five years. Our Government have been instrumental in assisting and responding, and it is always good that they do that. More than 80,000 deaths in the UK are estimated if there is a widespread outbreak of a resistant microbe. Far from being an apocalyptic fantasy, a post-antibiotic era in which common infections and minor injuries can kill is a very real possibility for the 21st century. We can never rest on our laurels with what we have done. We need to step forward and be more aware of what we need to do in the time ahead. New diseases are always developing, and there is always a need to match them. We should pay respect and give credit to organisations that do that well.

The O’Neill review on AMR sets out the global threat by highlighting that drug-resistant infections already kill hundreds of thousands of people a year globally. By 2050, it could be as many as 10 million—one person every three seconds. If we needed a reminder of the importance of the issue, that would be the figure. I am not sure if anybody in the Chamber will be around in 2050—I certainly will not be—but those who are could well face one of the debilitating diseases that we need to research now.

Of particular concern is the mounting prevalence of infections caused by multi-drug-resistant gram-negative bacteria, in particular Klebsiella pneumoniae. That pathogen has been singled out as an urgent threat to human health by the UK Government, the US Centres for Disease Control and Prevention, and the World Health Organisation due to extremely drug-resistant strains. Notably, Klebsiella infections have increased by 12% in the UK alone over the last five years. That tells us how things are developing, and that we need to be prepared.

Professor Chris Scott, the interim director of the Centre for Cancer Research and Cell Biology, is an expert in nanotechnology. In June, he teamed up with Professor Jose Bengoechea, director of the Wellcome-Wolfson Institute for Experimental Medicine, who is a world expert on infections by multi-drug-resistant pathogens, chiefly Klebsiella pneumoniae. Professor Bengoechea’s team discovered that it is possible to use the nanotechnology approaches that Professor Scott is developing for cancer to try to treat the bacteria that reside inside human cells and combat that pathogen. We have to listen to the experts and ask them to take things forward in the right way.

Although there is clearly a need for new antibiotic drugs, which must be the Government’s main focus in tackling the potential tsunami of antimicrobial resistance that we face, Queen’s research shows that with effective delivery of antibiotics we will gain a better therapeutic effect against a main protagonist of pneumonia. The complex scientific work that Queen’s is doing should make a difference. Patients may need to take an inhaler of particles containing antibiotics, as opposed to a simple tablet, in the specific case of pneumonia. It is possible that an advanced formulation of drugs could slow resistance developing in some instances and generate better outcomes for patients. It may also mean that we could extend the useful lifespan of some of our current antibiotics. To take that to patients, we need to prepare clinical grade material, but advanced formulations such as nanomedicine are difficult to manufacture. Life is never straightforward, but when we are given a challenge we have to take it on.

Investment is needed in the UK to provide facilities that can advance these excellent therapeutic strategies before they can be tested on humans. We have a process to go through and we must walk along those lines. When we come to the end of the road, we want to ensure that the medication is appropriate and safe. Additional funding needs to be allocated to new approaches to treat infections. Again, the Minister may wish to tell us how the Government are working through the Department of Health and Social Care with universities, companies and research and development on how that process can work, and perhaps how it can work better.

By thinking outside the box, as exemplified by the Queen’s University Belfast research, we will find much-needed new therapeutics. Several projects at Queen’s University Belfast are reaching the pre-clinical stage and are being stalled by the lack of investment, since pharma are still not interested in supporting this essential work. There are ways of going forward, but we need a wee bit of security as well. The lady from Queen’s University who was here this week talking about breast cancer research was funded through one of the Government Departments in Northern Ireland. Queen’s University also gave her a position, which brought her a bit of income. That meant that she could do her research here in the UK, and we in the UK can get the advantage and try to advance that as well. Other UK Government schemes, such as those supported by Innovate UK, also fall short in supporting pre-clinical work because there is still no commitment from pharma. I ask the Minister to consider standing in the breach, if that is possible, and supplying the necessary support and funding for Queen’s and other research centres to help us to do better.

It is expected that by 2035 more than 500,000 people in the UK will be diagnosed with cancer each year. To ensure that our health service can meet future demand, action to prevent cancer and other diseases must be at the forefront of any approach. We have heard today some of the figures, certainly on the mainland in relation to cancer and some of the delays. There are many problems in the NHS, but we are here to help the Minister and to encourage him and the Department of Health to move forward.

The Government must train and employ more staff to diagnose and treat cancers earlier. We can be proud of what the UK Government—our Government—do on healthcare, but we strive to do more, and the Minister strives to do more. The Department of Health is already looking across the world to see how it can share expertise. The Department for International Development is helping countries to strengthen their healthcare systems. What else could we achieve if we joined up the dots and worked together more on implementing universal healthcare?

We should encourage countries to raise their own domestic resources for healthcare, which could have a transformative impact. DFID has been fantastic at supporting the health system to strengthen, but that is not always free, which leaves behind the poorest and most marginalised. I referred earlier to those who are unable to get their operation through the NHS, but are offered the opportunity to pay for it. I am very unhappy with that system; it suits some people, but not everyone. We have to be ever mindful that some of the poorest and most marginalised people in countries across the world are at the bottom rung of the healthcare ladder. We should share our expertise on domestic funding for the NHS with Governments around the world, encouraging Governments to spend more on healthcare.

From 2011 to 2015 there was a cross-Government strategy on global healthcare. An update strategy could include recommendations on domestic resource mobilisation. I understand that the Department of Health has a global health team. It would be helpful to know the remit of that team and how they co-ordinate with DFID on global health issues. What is the connection? Do they have any input to the policy, strategy and the way forward? Do they have regular meetings?

In February 2014, the world watched in horror as Ebola swept across many parts of Africa. We in this country did our bit immediately to respond. We sent our service personnel, our experts and our medication. We were not found wanting, and we never will be. The horror turned to pride as we saw that role that UK aid and our healthcare professionals played in stopping Ebola and saving lives. We should be immensely proud of what our people did, and what our Government did and continue to do. That was the UK Government at their best. They co-ordinated the response to a major global health crisis and supported a country’s health system. How well that was done! We owe thanks to those personnel and to our Government for leading the way. We would never wish for Ebola or something similar to return. What can be done to implement that sort of cross-Government approach to supporting health systems?

I thank hon. Members for coming along to support me, and the Minister for coming along to respond. I thank hon. Members for their time. How does the Minister believe we can excel, improve and achieve an even higher level of global care?

--- Later in debate ---

[Jim Shannon]

I certainly would, Mr McCabe. I thank you for chairing the debate so well. I also thank the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald)—my pronunciation is probably all wrong—and for Washington and Sunderland West (Mrs Hodgson), whose contributions were immense. The hon. Member for Hampstead and Kilburn (Tulip Siddiq) highlighted important issues with the BCG vaccine.

I thank the Minister for his comprehensive response. He always says that he is pleased to be in his position because he has a deep interest in the subject, and that was illustrated by his responses to everyone who spoke. He was right to say that we are celebrating the 70th anniversary of the NHS and its excellent work, and to focus on what we can do both here and around the world. I am glad he mentioned the importance of remembering, whenever we think about diseases and healthcare in this country, that we also have to prepare for the diseases that come into the country from outside. We have a joint approach, in which the NHS delivers great healthcare here and we share that healthcare around the world. For that, we are eternally grateful.

Question put and agreed to.

Resolved,

That this House has considered the role of universal health coverage in tackling preventable and treatable diseases.