Eye Health and Macular Disease

Jim Shannon Excerpts

Tuesday 11th January 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current Government guidance and that of the House of Commons Commission. I also remind you all that you should have a covid lateral flow test before coming on to the parliamentary estate, and give one another plenty of room when entering and leaving the Chamber. I call Jim Shannon to move the motion.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of eye health and macular disease.

Thank you, Ms Nokes. This is a very important issue. I suppose all issues are important, but this one is very important, as I shall illustrate in my speech. I place on the record my thanks to the Backbench Business Committee, as always, for agreeing to schedule this debate, and to the Macular Society, which is working with Fight for Sight and Roche pharmaceuticals in the Eyes Have It campaign group—we say “The Ayes have it” in the House many times, and the eyes have it literally this time—for its support in securing the debate.

I thank all the hon. Members who are here for taking the time to discuss this important issue. I have spoken to some of them, and they will all bring their individual comments and contributions to the debate. I am very pleased, as always, to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place, and it is a particular pleasure for me and for all of us to see the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) in her place. We look forward to her response as well.

As someone who had glasses from a young age—eight years old—and who has had diabetes for the last 15 years, I can say that eye health is a matter of great personal import, as well as a constituency issue that affects a huge swathe of my constituents. Every day, 250 people start to lose their sight. At least half of all sight loss is avoidable. That is the key issue in this debate, because if sight loss is avoidable, the question is what steps we take to ensure that people do not lose their sight. With that in mind, I look forward very much to the Minister’s response.

More than 2 million people have sight loss, and 350,000 people are registered blind or partially sighted. Age-related macular degeneration is the leading cause of blindness in adults, leading to 50% of blindness. The hon. Member for Great Grimsby (Lia Nici), when we spoke last night, told me that she herself has this. Therefore the contribution from the hon. Lady, out of everyone in the House, will be particularly poignant and relevant to the debate.

I was shocked to learn that more people in the UK are living with macular disease than with dementia. We hear lots of stories—I am not saying we should not, by the way—about dementia, but just to give an idea of the magnitude of the subject of this debate and its importance, there are more people with macular disease than there are with dementia. Macular disease is a particular risk for the nearly 4 million people in the UK who, like me, are living with diabetes. I have long been instructed that poor control of blood sugar and insulin levels can damage the blood vessels of the eye, causing fluid retention in a condition called diabetic macular oedema. About one in every 14 people with diabetes develops DMO, which will result in a noticeable loss of vision.

Why should this topic be flagged as urgent for every Member of the House? Well, the issue is not just the physical health problems but the financial costs. The cost of eye conditions to the UK economy has been estimated at £25.2 billion per year, and without action, that is forecast to rise to £33.5 billion per year by 2050, so there is clearly a financial equation to this issue. It is about prevention and about reducing the costs for the health service as well. But cost is not the only important factor. The fact is that it is an awful thing to lose one’s sight and—for many people—one’s independence. Members across the House will know—perhaps through their own experiences or those of a loved one, or perhaps through the stories shared by their constituents, which we see in our constituency offices each and every day—the impact that sight loss can have. Loss of vision can have an impact on quality of life by undermining patients’ ability to live and work independently. For example, I recently met a member of the Macular Society, Bryan, who was diagnosed with age-related macular degeneration in 2012 and told me that something as simple as catching a bus can become very challenging.

Sight loss can also have a profound impact on emotional wellbeing. Sight is considered by many people to be the most important sense. Patients with macular disease, who are at risk of losing their sight, report feelings of isolation, shock, anger, anxiety and hopelessness. Those feelings may grow as individual sight deteriorates, with patients increasingly cut off from the world as they had previously experienced it. Losing one’s eyesight makes one particularly lonely; those who lose their eyesight do not know what is happening around them. I often think that, of all the senses that one could lose, eyesight is—with no disrespect to those who have lost other senses—the most important.

At the same time, macular disease can put pressure on the family members, friends or neighbours who act as carers for people with macular disease. This means that, although macular disease is more common among older people, its effects can be felt across the working-age population as well. Such feelings are understandable.

Without treatment, sight loss can be rapid. For example, wet age-related macular degeneration—wet AMD, where blood or fluid from abnormal blood vessels leaks into the macula, causing scarring—can cause significant sight loss within a matter of weeks. That is why this is so urgent. It is vital that patients are diagnosed and treated as quickly as possible. Can the Minister tell us what has been done to achieve the early diagnosis of AMD? It is so important that sight loss is addressed urgently. Other hon. Members in the debate will reiterate what I am saying shortly.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

In 2018, the Royal College of Ophthalmologists found that there was a need for an extra 230 consultants and 204 staff and associate specialists over two years. Does the hon. Gentleman agree that recruiting and retaining staff in the ophthalmology workforce needs to be a primary consideration?

[Jim Shannon]

I certainly do, and I thank the hon. Lady for that intervention. That was one of my points; the Minister has heard it said there, and I will not repeat it. The importance of having the staff in place, to which the hon. Lady referred, is one of the asks in this debate. How can we address that? If we have the staff in place, we can address the issue of eyesight loss earlier.

We are all aware of the demand for NHS eye-care services over recent years. Ophthalmology is now the busiest outpatient specialty in the NHS, with some 7.9 million attendances in 2019-20. That gives one an idea of the magnitude of the issue. That is why this debate is important, and why today we need to look to take things forward. Waiting times have been made worse by the covid-19 pandemic—we understand that. The pandemic has meant that some patients faced a waiting time of up to six months to access care. We know that the wait can be a matter of weeks, but if patients have to wait six months for a diagnosis and medical response, their eyesight can deteriorate significantly in that time. Up to 22 people a month may suffer severe or permanent sight loss as a result of delays to follow-up care. Can the Minister tell us what we can do to address those issues, and what has been done to catch up on that in the pandemic?

[Paul Howell (Sedgefield) (Con)]

Does the hon. Gentleman agree that we have seen massive innovation in the NHS during the covid pandemic? It has been able to deliver huge treatment gains. Does he agree that it is also important that the science of things like macular deterioration is picked up and taken forward? A company called PolyPhotonix, in my constituency, has developed an amazing solution that needs to be driven through to end state. I encourage the Minister to visit the company, because we are very close to making a major difference to treatment both in and out of hospital.

[Jim Shannon]

The hon. Gentleman has, I think, passed on that information to the Minister. It is important that we see where innovation has moved forward. PolyPhotonix, the firm to which the hon. Gentleman referred, can bring beneficial and positive changes to those with eye issues. I thank him for that intervention, and I look forward to the Minister being able to visit the company.

Care for patients with diabetic macular oedema was deprioritised during the pandemic, and delays have led to a doubling in the number of patient with DMO losing between one and three lines of vision. It is very important that that issue is addressed. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to staff shortages, and again I look to the Minister to see how we can address that issue.

We know that, as with other areas of healthcare, there are inequalities in eye care. Some parts of the population are not accessing regular sight tests, even if they might be eligible for them for free on the NHS. Can the Minister tell us what can be done to ensure that people are accessing that care? I know that the pandemic has changed many lives, but how do we address that? It is about solutions, not about negativity, but we have to say these things in the introduction to the speech so that we can look to the changes that we wish to see.

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

I congratulate my hon. Friend on securing the debate. We are coming up to the winter Olympics, and if there was a ski slalom for getting Westminster Hall debates, my hon. Friend would win the gold medal every single year. Given the localised comments that he has very appropriately made about the need for people to get their testing done, it is often the case that when the reminders come through for an ophthalmology appointment, they are overlooked. It is important that people take them up and any problems are identified very early on.

[Jim Shannon]

How pertinent that intervention is. I will give a couple of examples now that I was going to give later because they are pertinent to this. The opticians and ophthalmologists in Strangford and Newtownards town have told me of two occasions in 2021 when people who went for their test were sent straight away to the Ulster hospital in Dundonald because they had a tumour. They had no other ailments, but their ophthalmologist or optician spotted something early on. They say the eyes tell the health of the whole body, and I think they do. In that case, two lives were saved, and there are probably many others.

[Margaret Ferrier]

Following that point, it is really important to use the available data effectively in understanding the level of serious eye issues experienced across the UK. Does the hon. Gentleman agree that streamlining data sharing across all health care providers should be mandated?

[Jim Shannon]

It is always important to have the data on health issues. The Minister, the shadow Minister and hon. Members will know that. If you have the data, you can respond to where the problems are. The hon. Lady is right; we need to have that data in place.

In 2018, the APPG on eye health and visual impairment took evidence from the charity SeeAbility. People with learning disabilities, including children in special schools, are much more likely to have a sight problem, but much less likely to access NHS sight tests. Last night, in a different debate on the welfare cap, the right hon. Member for Hayes and Harlington (John McDonnell) referred to those who will feel the pain of the welfare cap, but those with disabilities will feel it more. That is very real when it comes to health issues and it is why this issue is so important.

With that in mind, the APPG and SeeAbility asked for sight testing and glasses dispensing facilities in all special schools, which has now been taken forward by NHS England. That is excellent news and it shows that sometimes—hopefully all the time—APPGs and their partners can bring about changes. This will reach around 130,000 children and help to address and prevent avoidable sight issues and reduce the need to use hospital eye clinics.

The commitment by NHS England to reform must continue as these children have an equal right to sight. We will all follow matters closely, and I would like to see the rest of the UK following Northern Ireland. The excellent work by the Ulster University Centre for Optometry and Vision Science in special schools has also shown the same need. When we see that issue being addressed, it is good news. Let us all look at the opportunity for reform in England and in the devolved nations and seek to improve sight testing for adults with learning disabilities in the community too.

There are targeted schemes with optical practices in every area. Unfortunately, Minister, at the moment we see a patchwork across the UK. In some areas the service is good and in other areas it is not. We need to act across the board in all postcode areas to see the level of care and attention that we seek in today’s debate.

The health inequalities experienced by people with learning difficulties justify more attention. People with learning disabilities are dying of avoidable health issues at least two decades before their peers. We cannot have people living without good sight and even going avoidably blind because national health services overlook their needs. That cannot happen and should not be allowed to happen.

I have outlined the issues, but I want now to look at the good news; the positive, glass-half-full news about how we make the changes to address those issues, including improving the quality of life for people with macular disease and the pressure on family and friends that inevitably comes with that.

With rapid and appropriate treatments, whether those are pharmaceutical treatments, laser treatments or surgery, we can do the job better, working alongside opticians. They are keen to be involved, and to address these issues. As my hon. Friend the Member for East Londonderry (Mr Campbell) said, when a person gets an appointment from their optician, they should go to it: it is so important that they do so, and we want to make sure that people do that. So many cases of sight loss could be either treatable or preventable.

As the UK builds back from the covid-19 pandemic, there is an opportunity to transform eye care services, increasing capacity to deliver rapid and appropriate treatment for macular disease and other causes of sight loss. NHS planning guidance for 2022 focuses on tackling elective care backlogs. Minister, what has been done to address those backlogs? I understand that there are many backlogs—we know them all too well. We need to deliver 110% of pre-pandemic elective activity, but we must also support the NHS to transform services for the long term, to ensure there is enough capacity to treat patients who start to experience sight loss. Improved integration of eye care services must also be a priority for integrated care systems as they move towards implementation. That should include supporting lower-risk patients to be treated in the community, freeing up specialist service capacity for those patients who need it most. At the same time, as the hon. Member for Rutherglen and Hamilton West said, data sharing needs to be improved, for example through the electronic eye care referral system. That is just one example of what could be done to ensure that everyone has the information they need to improve the quality and timeliness of care.

We must also ensure that the NHS is making use of the most innovative treatments—the hon. Member for Sedgefield (Paul Howell) has referred to one of them—especially those treatments that help people living with sight loss to manage their condition as independently as possible, with less frequent need for hospital visits. If we can reduce hospital visits and improve care, we will reduce costs and improve long-term health. We must invest in the workforce we need to deliver current and future eye care. I am very pleased to note that the Government have already confirmed that the process to appoint a new national clinical director for eye care has begun. I hope that this role will provide much-needed leadership and drive forward a transformation of NHS eye care services, including improved integration, better use of data and expansion of the workforce, which I believe is essential to provide the high-quality care that will, in turn, deliver better outcomes for patients. That national clinical director should therefore be appointed as a matter of urgently, and I look to the Minister and to Government to give us a clear timetable for making that appointment.

To ensure accountability and transparency, the national clinical director for eye care should report to a single Minister with responsibility for eye care services across primary, secondary and community care. The role of that individual is critically important for outlining a strategy and moving forward. Sight loss is widespread, and its implications are significant for the NHS. The cost of sight loss to the public purse cannot be ignored, but it is most important for the patients whose lives will be irrevocably altered by a diagnosis such as macular disease. Timely access to appropriate treatment could quite simply be the difference between someone losing and keeping their sight. We want to ensure that people can keep their sight, so it is vital that we do all we can to ensure that every patient can get the treatment they need, when they need it—the earlier the better. When it comes to sight, every day matters. Every appointment is essential, and that principle must underpin our approach to the necessary changes to macular eye health in this post-covid world.

I thank the Minister again for offering her time. People will say, “Well, that’s her job”, but she comes here with a passion and an interest in this issue. It makes it much more pleasurable for me introducing this debate, and for other Members as well, that we have a Minister who can respond positively. I welcome the opportunity to continue these discussions following today’s debate—I know that the Minister is always agreeable to doing so. In anticipation of their speeches, I also thank all of my colleagues, right hon. and hon. Friends and Members, in this Chamber. Working together, we can and will achieve.

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[Ms Lyn Brown (West Ham) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.

I thank the hon. Member for Strangford (Jim Shannon) for securing the debate on this neglected topic. Not for the first time, my comments will echo those of my right hon. Friend the Member for Hayes and Harlington (John McDonnell), because today I will focus on the damage that refractive eye surgeries can do to health. In particular, I would like to talk about my constituent, Darren Clixby.

Like many of us, Darren had lived much of his life needing glasses or contact lenses for short sight. As many people have, he heard the messages about laser eye surgery, and its promise to make life easier and better. He also heard the statistics that are bandied about regarding the rarity of serious complications, so he paid his money and went for it in January 2009, but I am sorry to say that the damage immediately after the surgery was awful.

Darren was in tremendous pain. He could not open his eyes at all until the following day and, when he did, his vision was unrecognisable. It was filled with sunbursts coming from light sources, with halos arounds them, with images that overlapped and with many floaters, which are small objects that persistently stay in the vision no matter where someone looks; I have loads of them in my eyes.

Having such damaged vision was distracting, disorientating and very distressing. Darren could not function. He had been told that this was merely a temporary effect and that it would go away after surgery, so he took sick leave and he persevered in that hope. The weeks passed, then the months, and the problems with his vision simply did not go away. Understandably, Darren became increasingly distraught, anxious and depressed. At check-ups, he was told time and again that it was temporary. He was fobbed off with steroid eye drops, which did nothing.

He was then offered another procedure with the same company, using an alternative refractive surgery technique, then another, via a private referral to Moorfields Eye Hospital, and then another. Darren has now had five separate refractive eye surgeries, four of which were to correct the damage of the first. None of these operations have helped. In fact, Darren believes they have just made things worse.

All of this time, Darren’s mental health was deteriorating. He found his work as a solicitor increasingly impossible because of the psychological damage that resulted in a diagnosis of severe depression and anxiety, which remains 13 years on. He resigned from his job and endured 18 months out of work. Even now, after getting a new legal role, he has found it difficult to continue and he had to resign 18 months after starting that job. Eventually, in 2012, Darren had to stop the process of repeated surgeries, and disengage to protect what was left of his mental health. It has taken him many years to come to terms with what has been done.

[Jim Shannon]

I thank the hon. Lady for sharing what surgery can be like. I have a diabetic constituent who asked a consultant if laser surgery would be appropriate. Unfortunately, as a result of that surgery he lost his eyesight in its entirety. Today, he has no sight in either eye. When it comes to surgery, the hon. Lady is absolutely right and I thank her for the reminder that it does not always work. People need to be careful and aware of that.

[Ms Lyn Brown]

Darren now believes that there is nothing that can be done significantly to repair the damage to his sight. He has uncomfortable, dry eyes every day of his life, which become far worse after reading or concentrating for long periods. He cannot see clearly in low-light conditions or drive after dark. Even crossing the road can be dangerous because it is hard to judge the distance between cars.

Darren believes that he was not fully informed about the risks before his surgery. He has no trust in what little regulation or self-regulation exists via the General Optical Council and the General Medical Council. This was a private, elective procedure that Darren paid for. Surely to heavens, the company that performed the surgery should be responsible for the best possible aftercare, and for making it right. In 2017, Darren again contacted the company responsible for the original surgery. It was made absolutely clear that it would offer him nothing. Effectively, it told him to go away, to stop being a nuisance and to stop getting in the way, frankly, of it making more money.

As always, the NHS has been left to pick up the pieces after poorly regulated private medicine has failed. I ask the Minister how much is this costing the NHS across the country? It would be good to know. Does she have any information to hand on that? We need to create a system where patients are genuinely informed about the real risks; a system where there is proper recourse to a regulator when things go wrong, and where private companies are held responsible for their failings and the cost.

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[Steven Bonnar]

That is so surprising. This Prime Minister is known for his consideration of others.

I put my thanks to Tuite Opticians on the record, not only for having me, but for its tremendous commitment to the wider community of Coatbridge for over 30 years.

[Jim Shannon]

I thank the hon. Gentleman for his positive contribution to this debate. The other good thing about going to an optician, is that if he has any concerns, he can refer the patient on—it does not necessarily have to go through the GP. I did that when I went to my optician in the Cathedral Quarter in Belfast to get all the tests necessary and ultimately was given the all-clear. An optician can put someone’s mind at ease.

[Steven Bonnar]

I thank the hon. Member for his intervention. He is absolutely right. The optician can highlight so many things. We know the burdens across the NHS, particularly on our GPs and this can lighten the load. However, as he correctly outlined, unfortunately, in England, Wales and Northern Ireland, the situation can sometimes be difficult. Optical practices are not so fortunate in that there is no governmental support and provision for free eye tests for the general public.

In England, a typical eye examination costs between £20 and £25 for all, except children, the elderly or people registered as partially sighted or blind. Having a monetary value attached to an eye examination would undoubtedly deter those unable to afford the crucial health test and endanger their long-term health and hamper the early prevention tactics that so evidently work. This in a country where health care should be free at the point of need is unacceptable. I believe it is unacceptable to administer a charge. The rest of the UK should follow suit. We have heard repeated calls for a national strategy—the example set by Edinburgh should be followed. Scottish citizens do not have to pay to have their eyes examined. Seeing is a privilege that so many of us will struggle to appreciate, but ensuring that there is universal access to eye tests means that those who require them do not have to think of any cost ramifications.

Scotland not only leads the way in the universal accessibility of eye tests but is the first country in the UK to enable access to important treatments for macular disease. Treatment depends on the type of AMD. Dry AMD accounts for 80% or 90% of cases. There is no treatment, but vision aids can help reduce the effects on day-to-day life. Wet AMD, which affects 10% to 20% of sufferers, may require regular eye injections and, very occasionally, as we heard from the hon. Member for Great Grimsby, a light treatment called photodynamic therapy, to stop vision getting any worse.

The other nations of the UK are missing a trick not only in determining new treatment methods for macular disease, but when it comes to understanding the importance of addressing such issues in terms of the impact on the wider health and social care system.

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

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking the hon. Member for Strangford (Jim Shannon) for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend the Member for Darlington (Peter Gibson), who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend the Member for Great Grimsby (Lia Nici). We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from the hon. Member for East Londonderry (Mr Campbell), we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

[Jim Shannon]

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

[Maria Caulfield]

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend the Member for Sedgefield (Paul Howell) about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend the Member for Hendon (Dr Offord) asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by the hon. Member for West Ham (Ms Brown) about her constituent, Darren, and those raised by the right hon. Member for Hayes and Harlington (John McDonnell). I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

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[Jim Shannon]

First, I thank each and every one of the right hon. and hon. Gentlemen and Ladies who have made a contribution. The hon. Member for Sedgefield (Paul Howell) referred to the innovative company in his constituency, which I think can help. The hon. Member for Darlington (Peter Gibson) clearly outlined the issues for those who are blind when it comes to obstacles such as street furniture, e-scooters and so on. He also referred to the strategy in his constituency.

I thank the hon. Member for West Ham (Ms Brown) so much for what she said. It was a reminder to us all that corrective surgery, unfortunately, does not always work. She referred to its being regulated. The hon. Member for Hendon (Dr Offord) referred to his own personal experience and to how he has better vision today because of the steps that were taken. He also referred to the eye strategy for the United Kingdom. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to the data. Data is critical to all health issues. My hon. Friend the Member for East Londonderry (Mr Campbell) referred to the fact that people must attend their optician appointment. The right hon. Member for Hayes and Harlington (John McDonnell), in a significant contribution, referred to the longer-term investment that is needed. He also said, “Listen to clinical and medical advice and don’t listen to the salesperson.”

I think every one of us was moved by the contribution from the hon. Member for Great Grimsby (Lia Nici). It was a real step-by-step story of the hon. Lady’s situation, and we thank her for all that she said. She referred to modern technology, buy-in by employers and computer advances.

The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), in a significant contribution, referred to what is done in Scotland. I wish that we in Northern Ireland perhaps had something similar to Scotland. That is something for us to look at as well. The hon. Member for Gillingham and Rainham (Rehman Chishti) referred to a public campaign being needed. The hon. Member for Denton and Reddish (Andrew Gwynne), in a very good contribution, referred to some people waiting more than a year for treatment. He pointed out that all ages are affected, and it is good to remember that it is not just people of a certain generation; it is younger people as well. Waiting times have soared, and people have been let down.

The Minister, in her response, has been incredibly helpful, as she always is. She understands the issues and understands the concerns of each and every one of us here. We said to the Minister—I think the right hon. Member for Hayes and Harlington also spoke about this—that if we could have a meeting with her, we would certainly do that. In relation to AMD, diabetes and glaucoma, a national eye care director is being put in place. There are certainly significant programmes. The issue is to ensure that those programmes are available across the whole United Kingdom, in every postcode. The Minister is committed and certainly very positive, and we look forward to working with her, all of us together.

Question put and agreed to.

Resolved,

That this House has considered the matter of eye health and macular disease.

Surgical Fires in the NHS

Jim Shannon Excerpts

Thursday 16th December 2021 Westminster Hall

[Christina Rees (in the Chair)]

I remind Members that they are expected to wear face coverings when not speaking in the debate. That is in line with Government and House of Commons Commission guidance. I also remind Members that they are asked by the House of Commons to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre on the estate or at home. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of preventing surgical fires in the NHS.

It is a joy to see you in the Chair, Ms Rees, for the third time this week, and to be here myself to make a contribution to the debate. I am pleased that other hon. Members are present: the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar); the shadow Minister, the hon. Member for Ilford North (Wes Streeting); and the Minister. It is no secret that I am very fond of the Minister. She and I have worked together in the House on many health issues, and I very much look forward to her response. This topic is of significant importance, so I am glad to see other Members in the Chamber to make what I am convinced will be significant contributions.

As Members are aware, health has been my portfolio in this House for quite some time—almost 10 years—which means I have been exposed to some of the more challenging issues to face the healthcare system across the United Kingdom. Today’s discussion is about one of those: surgical fires in operating theatres. It is certainly one of the most concerning issues that I have come across in my time in this House. Did I know much about it? I probably did not, but once it was brought to my attention in this place and back home in Northern Ireland, where it is a devolved matter and the responsibility of a Minister in the Assembly, I became aware of it.

I spoke to the Minister present before the debate, and she has some of the questions in my speech from my staff and others. I very much look forward to her response to the questions that I will pose today. First, however, I pay tribute to the work of the expert working group on the prevention of surgical fires, who brought the matter to my attention and whose report on the prevention and management of surgical fires I recommend to the Minister and all Members of the House. It is a thorough and detailed report, which encapsulates the issues that we will discuss in the debate and gives the Minister and her Department the opportunity to respond, I hope in a positive way.

I had the pleasure of chairing the parliamentary launch of the working group’s report in November last year. I am sure that their report and campaign will feed into much of the debate—it certainly will through my comments, and I am pretty sure it will through those of other hon. Members as well.

I want to underline what we mean by surgical fires and the serious dangers they pose to patients and clinicians alike. A surgical fire is a self-descriptive name: it is a fire that occurs during surgery in an operating theatre. In order for a surgical fire to occur, three elements must be present: the ignition source, the fuel and the oxidiser. Ignition sources include electrosurgical units, fibre-optic light sources and lasers. The fuels regularly include alcohol-based skin prepping agents that have been used in excess or applied inappropriately. The oxidiser is simply an oxygen-rich environment in which nitrous oxide is present, alongside the oxygen. Those are the three ingredients, or the three elements that are the reason for surgical fires. I do not believe that it is impossible to address the issue, through the Department and the Minister’s response, so that we can ensure that such fires do not happen.

The statistics, which the people working in the background have gained from across the whole United Kingdom, highlight just how worrying this matter is. The report states:

“Injuries caused by a surgical fire most commonly occur on the head, face, neck and upper chest.”

By and large, that is where operations focus on, and a fire can leave victims with debilitating pain and lifelong physical and psychological scarring—I will later give the example of someone whom I met in this House at a presentation that we did some time ago. A surgical fire can also cause harm to operating theatre staff, who are exposed to similar risks. It can affect not just the patient on the table who is having the operation, but the staff, so there is a dual responsibility for safety—obviously for the patient, but also for the staff.

Like so many members of the public and those of us present for the debate, I had absolutely no idea that surgical fires posed a threat to patients across the United Kingdom, and I was unaware of the extent of the injuries that they can cause, so I am extremely pleased that this subject is being debated, even though we are in the graveyard slot. We are going into recess after today, so most Members have probably left. That is unfortunate, because others had wished to participate but could not stay. The omicron variant has also been part of the problem, and that is perhaps the case for the shadow Minister who was originally going to participate in the debate but could not do so. We are ever mindful that although we may be small in number, the debate is none the less important, and we want to put that on the record.

Today’s debate is about raising awareness about the seriousness of surgical fires and pushing for the next steps to ensure that they no longer happen. Ultimately, that is the goal of the debate—to ensure that precautions are taken so that surgical fires do not happen. What I will outline in my contribution will helpfully enable the Minister and her Department to take the necessary action.

I am sure that many Members will be asking the same question that I did when this issue was first brought to my attention: how common are surgical fires? That is a question that many of us ask. The reality is that nobody knows entirely, but the expert working group sent out a freedom of information request to trusts, health boards and relevant bodies across the United Kingdom. Although there were significant discrepancies across all organisations, the NHS England acute trusts and Welsh health boards stated that they recorded some 96 surgical fires between 2010 and 2018. The report states:

“A search of the National Reporting and Learning System (NRLS) data from between 2004 and 2011 identified just 13 reported surgical fires.”

The important point is that, by comparison,

“NHS Resolution claim to have been notified of 631 clinical negligence claims relating to surgical burns to patients”

between 2009 and 2019. NHS Resolution also claims to have paid out £13.9 million

“in damages and legal costs on behalf of NHS organisations.”

The data that some of the trusts and health boards hold as their evidential base indicate to me that the issue is bigger than many people thought. The fact that some £13.9 million has been paid out in damages and legal costs emphasises that point with a strong evidential base. I am sure that the figure is still a stark underestimate of the scale of the problem, and not all incidents will have been recorded. I suspect the number of claims could be bigger than 631, and that does not even account for all the near-misses that may have occurred in operating theatres across the United Kingdom.

According to a survey by the Association for Perioperative Practice, which is one of the largest membership organisations for operating theatre staff, almost half of its members have personally witnessed a surgical fire—again, an evidential base to prove that this issue is like picking at a scab, because the evidential base and examples are far-reaching and quantitative. There is no question but that there is a clear and obvious discrepancy in how surgical fires are reported, which raises questions about the true number of such incidents.

One of the key questions is what reason is behind the large discrepancy in reporting and why the number of surgical fire incidents that occur each year cannot be accurately quantified. The answer is quite simple: it is not mandatory for trusts to report these events when they take place. I am astounded that that is the case. There is evidence to show that £13.9 million was spent in pay outs for damages and legal costs, and that there were 631 fires. How can it be possible that it is not mandatory to report when someone is set alight during surgery? It is bound to be a fairly dramatic situation. These figures do not even cover the near-misses that must occur on a regular basis.

As the Minister may know, over the past year I have tabled a few parliamentary questions, asking the Government to provide an answer about the number of surgical fires that occur every year, but each time they have been unable to do that. I find it concerning that the Government accept that surgical fires are an issue within the NHS but they still do not know the true scale of the problem. Such is the magnitude and severity of this issue that I would have thought the Government might respond. I say that very respectfully, which is my way of doing things, Ms Rees; when I ask questions, I ask them both to get the answer and to improve the situation. That is probably why I always see the glass as half full, rather half empty. I look to the Minister for a response on that.

The Government are still not monitoring or reporting issues that threaten the safety of patients in the UK. This is also a structural problem that requires proper education and training, and puts in place the necessary protocols to mitigate and reduce the risk as much as possible. One would assume that trusts across the country all have protocols in place to prevent such fires from occurring, but I am sad to report that that is not the case.

According to research by the expert working group, which examined specific protocols and training programmes addressing surgical fires in local NHS trusts, only a limited number of trusts across the UK actually have surgical fire protocols. I think it is vital that they should have them, but many rely on general fire safety guidelines, where there is often no mention of surgical fire risk and prevention processes. Again, I look forward to the Minister’s response about what protocols and safety measures can be put in place.

According to a survey by the Association for Perioperative Practice, over half the respondents reported not having surgical fire protocols to date, while almost two thirds reported that their organisation did not provide training courses or education for operating theatre healthcare professionals on preventing surgical fires. Again, there has to be a clear change of focus among healthcare professionals to ensure that this issue is addressed.

A third of respondents reported receiving training and education, and that training included both high-risk management courses and more generic fire safety training, which was more reactive than preventative. I am a great believer in early diagnosis and preventative measures, rather than reactive measures, so I hope that as a result of this debate we will have measures put in place to address those issues. The training is clearly not adequate for the seriousness of the danger at the moment. The lack of prevention and management protocol is completely unacceptable and represents a clear and present danger to all patients who undergo surgery in the NHS.

It is truly astonishing that surgical fires are already recognised as a safety concern in other countries. I will give examples of those, because if other countries can see the risk, difficulty, impact and severity of this, then I know that our NHS, which we all treasure and love, can deal with the issue equally well, if not better. Yet there is insufficient guidance about how to prevent and manage surgical fires in the UK.

In the United States, the Food and Drug Administration already provides a list of specific recommendations on reducing the incidence of surgical fires. These include conducting a fire risk assessment at the beginning of each surgical procedure, which seems to be logical. Again, maybe the Minister can give us some indication of whether that is a procedure that the NHS will adopt. Those recommendations also include additional safety procedures such as planning and practice on how to manage a surgical fire, including how to use carbon dioxide fire extinguishers. Are those things available in the NHS? They should be, so if not, is there an intention to put them in place? As a result of introducing the necessary protocols, educational tools and reporting systems, the number of surgical fires in the United States has dropped by 71% since 2004. By putting the right strategy and safety measures in place, we reduce the threat. That is my goal today, and that is the approach we should be trying to emulate within the NHS.

The expert working group’s report made a number of recommendations on the prevention and management of surgical fires. I do not intend to read out the entire report—even though I have three hours, I do not want to put people to sleep when they want to go home—but I want to highlight four of its key recommendations. First, professional associations should explore the value of a national awareness campaign for healthcare professionals. Secondly, education on surgical fire prevention should be mandated in the surgical and perioperative education and training syllabus. Thirdly, NHS England should explore how to evolve the procurement process for sanitation products, in order to reduce surgical fire risk and encourage procurement of proven surgical fire-safe technologies. Fourthly, NHS England should explore the development of a standardised patient safety alert system that aligns the processes and outputs of all bodies and teams, and ensure that they set out clear and effective actions for providers to take on safety-critical issues. If I were to ask for nothing else today, I would ask for those four recommendations to be acted on, because that would be a massive step forward.

It is clear to me, as I hope it is clear to other Members, that effective education and training are the primary means of preventing the incidence of surgical fires. Despite some form of fire safety training being mandatory for all NHS staff during their induction and ongoing employment, that training does not address the unique features involved in preventing or extinguishing a surgical fire. The response to different kinds of surgical fires can differ, as can an individual’s role, depending on who is present at the time. I know that the past year and a half—almost two years—have been extremely difficult due to covid, and that the NHS, the Minister and the Government have other priorities, but this is about prevention. It is about making sure that surgical fires do not happen again, and it is logical to try to do so: it would have stopped that £13.9 million from being paid out in damages and legal fees. Meanwhile, preventative measures and effective management strategies require additional education and training, and the absence of such training currently acts as a barrier to eliminating incidents of surgical fire and ensuring an appropriate response.

As I have highlighted, providing detailed guidance and encouraging the individuals who constitute the perioperative team to consider their role in surgical fire prevention has led to a statistically significant decline in the incidence of such fires in the United States. Their incidence has fallen by 71%—wow! I did not do the mathematics, but if we brought that 631 down by 71%, it would be approximately three quarters of that number. It is clear to me that surgical fire training should be made mandatory across the NHS and the private sector, and should be updated at least every two years. Again, I refer to those four asks: we need to make sure that those matters are taken on board, so that we have a proper system in place for the future as well.

Despite education being an essential method of preventing surgical fires, it is no use if it is not mandated, and if we still fail to tackle the institutional failure to truly record the scale of the problem. Following discussions with the expert working group and others, I call on the Minister to instruct the Centre for Perioperative Care to investigate the possibility of making surgical fires a never event, meaning that they never happen again. We would like to see surgical fires made a never event as part of the CPC’s work on redeveloping the national safety standards for invasive procedures to ensure they remain fit for purpose.

Classifying surgical fires as a never event would require mandatory reporting of incidents or near misses, while also mandating essential education for surgeons and other perioperative staff across all NHS trusts. Even without knowing the details of surgical fires, the name itself suggests they should be a never event. The concept of a surgical fire is terrifying enough that if we asked a lay person whether it should be classified as a never event, they would likely agree that it should never happen—indeed, they would probably be astounded that it even did. Only by classifying surgical fires as a never event can the national safety standards continue to be fit for purpose.

I have been paying keen attention to some of the Government’s responses to my questions about surgical fires over the past year. I realise that the Government have previously stated that they have no plans to classify surgical fires as a never event. Again, I urge the Minister, in the light of the evidential base we now have, to do just that. I note in the latest response to me that the Minister says that it is not possible to make surgical fires a never event because

“there is currently no national guidance or safety recommendations to prevent surgical fires in operating theatres”.

I say respectfully that we need to do that. If we can do that, we can move forward.

I have good news for the Minister—I always try to bring good news, and not just because it is Christmas. The expert working group has already developed national guidelines. Its report made safety recommendations for perioperative staff, and the group is waiting for them to be adopted. What the expert working group has done could be a template for exactly what the NHS needs to do. It has informed me that it is more than willing to pass on its hard work directly to Government. If the Minister is agreeable, I would be happy to have a meeting to exchange those views, and those papers as well, with the Centre for Perioperative Care expediting the process. I believe there is now no reason not to classify surgical fires as a never event.

We should not forget the most important impact of surgical fires: the human impact. As I mentioned earlier, I had the pleasure of chairing the launch of the report last year. During the event, I also had the pleasure and the privilege of listening to a patient who had experienced a surgical fire. He explained to us the impact that the incident had on his life. What happened to this gentleman is quite tragic. I will quote his story, but I will not name him, and I will be careful what I say in relation to him.

He told the group that he had visited the hospital for a routine procedure, but that when he woke up the staff informed him that his body had been set alight during surgery. He told us how he had been burnt on the left side of his chest and upper arm, and of the impact that this trauma had on him. He was not aware of the fire because he was under anaesthetic having an operation. He went on to explain how it had prevented him from continuing his career in social care, which he had been in since the age of 16, because he was disabled as a result of the incident. He explained how it had left him physically and psychologically drained, and how it had left him in pain, unable to carry out simple household tasks such as making a cup of tea—he did not have the stretch or lift in his arm any more. He told us of the impact that the fire had on his family. His partner became his carer and he could no longer spend time with his granddaughter. Having five grandchildren—three girls and two boys—I know how much I enjoy spending time with my grandchildren.

That is a jarring story—one that is all the more shocking and disturbing the more details that are revealed. I am not going to name him because there are legal discussions going on with the trusts involved and because he has nothing but praise for the nurses who have cared for him since the incident. He understands that nobody set out for it to happen, but it happened, and it happened because the precautions were not in place, because there was no safety measures and no training. The so-called never event happened.

He is a very kind man—a gentleman. However, no matter how good the nurses have been to him, it would be remiss of me not to mention how inadequately his situation was addressed. To cause severe harm to a patient is beyond the pale; it is against every medical principle that exists. The NHS and all its staff are tasked with saving life, and that is what they do to the best of their ability. We must not forget the impact on the operating theatre staff, who may also experience a psychological cost from these experiences. It is equally essential that surgeons learn how to give both physical and emotional support to the victims of surgical fires. They are the ones who have suffered most, and surgeons must be empathetic to them and their needs.

What is also concerning is that, despite this serious incident taking place, the hospital appears not to have made the appropriate changes to its systems and protocols. We all learn lessons—every day of my life, I learn lessons; I am not so proud that I do not learn from all those around me and those who I speak to. The patient required follow-up treatment in the same hospital and, on inquiring what had been done to prevent the incident from happening again, was told that nothing had changed; there had been no updates. How disappointing.

As I mentioned, I cannot name the patient, but I pay tribute to his bravery and his determination to prevent this from happening to another person. That is one of the reasons why he told us his story. He wanted to provide us with the evidential basis for what had taken place and to ensure that it did not happen to somebody else. He is truly an admirable person. I thank both him and his partner for sharing their story with me and, ultimately, with everyone in the House and Westminster Hall and with the Minister and her Department.

I am coming to the end of my speech, Ms Rees. I will begin summing up, so that we can also hear from others. I look forward to hearing some thoughtful and insightful contributions from the shadow Ministers and, specifically, the Minister. As I have stated, I hope this debate will bring greater attention to the issue of surgical fires and shine a spotlight on this danger. It is clear to me, from reading the expert working group’s report and patients’ testimonies and from listening to expert guidance, that more needs to be done to prevent surgical fires. That is why I am so pleased to play my part in today’s debate in support the aims of the expert working group.

I hope that in the short time—it feels like a long time perhaps, Ms Rees—that we have been making the case today that it is clear that we are supporting the aims of the expert working group. There needs to be mandatory reporting of both surgical fires and near misses, because until we can effectively quantify the scale of the problem, we cannot effectively address it. Similarly, we need to introduce effective and mandatory education for all surgeons and perioperative practitioners in order to prevent surgical fires from occurring and to ensure that they are effectively managed when they do occur. This can also be done by classifying surgical fires as a never event. NHS operating staff are already aware of the threat of surgical fires, but they have not received the proper support and guidance to ensure that these incidents are prevented.

I therefore hope that our actions today will start the necessary change. Whether we are talking about simple steps such as introducing a checklist to ensure the taking of appropriate preventive measures, such as using the correct antiseptic skin solution, or ensuring the presence of the appropriate tools and equipment for the management of fires, which we should have as a precautionary measure in all operating theatres, these are all necessary steps to ensure the safety of patients and operating theatre staff alike. This is about the patient; it is about the staff; it is about getting it right. If we do not, we will have to confront the reality that many more people will be harmed by our failure to act. Classifying surgical fires as a never event is, I believe, the only way to effectively prevent patients and NHS staff from coming to harm.

I thank hon. Members for attending the debate and ask them to consider the reaction of their constituents if they were asked about surgical fires. If a Member here were asked about this matter, what would he or she want done in relation to it? They would surely all agree that such fires should never be allowed to happen. Making them a never event is the common-sense option, and I hope that others will join me in urging that that rational action be taken on this issue.

The people to whom I have referred, including the gentleman who made his own personal submission, are real human beings. They are people who have gone through operations and been confronted with the reality of this issue. We know about 631 of them in the United Kingdom, and we believe there are more. Addressing this issue would put an end to the need for the £13.9 million of damages and legal charges. We live in an age in which we must also be careful with the money we spend. If we are not, things may happen that cost the NHS money. People have been affected by this issue, and people will continue to be at risk until we act. I therefore invite the Minister and other hon. Members to join me in what I believe is a very worthwhile campaign to make surgical fires a thing of the past—as I said before, a never event.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing this hugely important debate. While he is right that we may be small in number this afternoon, it is the quality not the quantity of the Members that counts.

Health is a devolved matter, so I can really only respond on behalf of the NHS in England to the issues the hon. Gentleman raised, but, as the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), said, surgical fires are a priority area of concern in all the devolved nations. Patient safety is our absolute focus. We want to provide the public with the safest care possible. As the hon. Member for Strangford said, a fire affects not only patients but the NHS staff working in those units. We traditionally think of surgical fires as taking place in hospital-based settings such as theatres, but more and more minor surgery is taking place in community facilities such as primary care facilities. This issue is expanding to other areas of the NHS, so it is important that lessons learned in hospital trusts are learned in the community as well.

Supporting a culture of safety in the NHS is critical, and we have put in place a number of measures aimed at supporting the NHS. The key is learning from incidents. Where there have been surgical fires in the past, it is important to identify their causes and how they could be prevented in the future. It is also important to hear from staff, who will sometimes not be surprised when an incident occurs or who may have flagged issues a number of times before attention is taken.

We are taking a number of initiatives to improve patient safety across the board. The first is establishing the health safety investigation branch, which conducts independent reviews and investigations into any patient safety concerns, including surgical fires. We are also introducing a statutory duty of candour to ensure that NHS organisations are open and honest towards patients. If a surgical fire happens, as in the hon. Gentleman’s tragic example, a patient who may have been asleep at the time should be made aware of that and receive an apology and support afterwards. Sometimes the fires are quite minor and the patient is not affected, but it is important that they know that an incident happened. We are also setting out in legislation the first ever patient safety commissioner, which will be for England only. They will be a champion for patients in relation to medicines and medical devices and will certainly look at the issue of surgical fires.

Regrettably, despite some of the progress and some of the measures we are putting in place, and despite the high quality of care provided by NHS staff, incidents happen that cause harm to patients and put staff at risk. If a surgical fire is extensive enough to take a theatre out of service for a time, that has a knock-on effect for other patients on surgical waiting lists, who may be delayed as a result. Minimising the risk of surgical fires is an area we take very seriously, and although rare, when they do occur in or around the operating table, they can cause extensive damage and put patients and staff at risk.

The issue is how to best minimise the risk of fires in the first place. As has been pointed out, work is going on into this area. NHS England’s national patient safety team has been involved with the expert working group on the prevention of surgical fires, which the hon. Gentleman referred to and which is chaired by the chief executive of the Association for Perioperative Practice. We will continue to support the development of its guidance. I am happy to meet the hon. Gentleman to follow this up, because as highlighted by the shadow Minister the working group published a report in September last year on the prevention and management of fires and made a number of recommendations. It is the view of the national patient safety team that further work on surgical fire prevention following the report is best developed alongside the wider national safety standards for invasive procedures. Those standards were created to support all aspects of patient safety in the surgical environment and are currently being led by the Centre for Perioperative Care, which is responsible for ensuring that national safety standards for invasive procedures continue to be fit for purpose.

[Jim Shannon]

I am very encouraged by the Minister’s response. I referred to four key recommendations, which she referred to. She also referred to the fact that there are ongoing negotiations and discussions with the expert group. Has there been an opportunity to push for those four key recommendations as part of the change that is needed?

[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) for his contribution. He developed the debate in the way we hoped he would, referring to the strong evidential base, the urgent need and the update on progress, as well as patient safety and preventive action.

I am pleased to see the shadow Minister, the hon. Member for Ilford North (Wes Streeting), in his place. I wish him well in his new role—I should have done that at the beginning, and I apologise for not doing it. Being the true MP that he is, he took the opportunity to make a mark for his constituency, as we all would, by the way—none of us misses that opportunity. I thank him for a very constructive contribution, in which he referred to the training that is needed now, the national guidelines and the never event. Incidents can be prevented—I think that is the thrust of the debate. I thank him for that and wish him well for the future in his new role.

I want to say a big thank you to the Minister, who clearly responded on the key issues. The first one, which is important in relation to the example I gave, was that if we get it wrong, we apologise and we change the system. That is a key issue. It is never hard to do, but sometimes difficulties seem to arise. I thank her for her comments on that. She also referred to the four key recommendations and the data to be collated. I thank her for agreeing to a meeting—we will do that.

On staff training, this is not just about patient safety; it is about the staff as well. On the never event, I think that that will be really important when the expert working group meets the Minister and her officials. For patients and staff, work continues to progress, and I very much thank the Minister for her constructive response to all three of us here today.

I take this opportunity to wish a merry Christmas and a happy new year to you, Ms Rees, to my colleagues the hon. Members for Coatbridge, Chryston and Bellshill and for Ilford North, and especially to the Minister and her Department. The Minister and I have worked together on many things, and we will work on many more if God spares us to the new year. Her Department, her Parliamentary Private Secretary—the hon. Member for Grantham and Stamford (Gareth Davies)—and all the officials certainly make our jobs easier. We could not do this job without them.

I am a very simple person when it comes to these things. I wish to make progress and to do that alongside people. I never want to score a point—that is not my form. I think that we have made progress today and that we will make progress on other things in the new year, which I am looking forward to. Once again, I wish a merry Christmas and a happy new year to all of you and your families. I hope that we will see each other here on 5 January 2022.

Abortion Services Commissioning: Northern Ireland

Jim Shannon Excerpts

Tuesday 14th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate on an issue that is very close to my heart. I will replicate the opinions of my colleagues and of the hon. Member for Congleton (Fiona Bruce). I am my party’s health spokesperson. As a Northern Ireland MP—I was born and bred there and I still live there—I have listened to the views of those around me: of women and men; of young and old; of those who are affected by the meddling of this House in one area and cry out for help in other areas, only to be told that the issues are devolved. There is no justification for interference in the devolved settlement in Northern Ireland in this matter.

The Abortion (Northern Ireland) Regulations 2021 conferred egregiously wide powers on the Secretary of State to

“direct a Northern Ireland Minister, a Northern Ireland department, the Health and Social Care Board and the Public Health Agency to take any action capable of being taken that is required for the purpose of implementing the recommendations in paragraphs 85 and 86”

of the CEDAW report. The regulations note that the Secretary of State will have powers to direct any “relevant person” to take any action that they are capable of for the purpose implementing the recommendations in paragraphs 85 and 86 of the CEDAW report. It is not clear that Parliament intended to allow such wide-ranging powers to be created, given the obligations voted on in section 9 of the Northern Ireland (Executive Formation etc) Act 2019, which outlines such powers as applying to Ministers and Northern Ireland Departments only, while the 2021 regulations extend these powers to direct public health organisations.

That sets a dangerous precedent for commissioning on a devolved issue. There is no clear limit to the sweeping powers granted to the Secretary of State; they are potentially indefinite. The Northern Ireland Office states that

“the statutory duty imposed on the Secretary of State by section 9 of the NIEF Act is such that until all of the recommendations in the CEDAW Report are implemented in Northern Ireland, he will not have complied with his statutory duties in full.”

That is very concerning and very worrying. These are wide-ranging powers across a spectrum of issues that extends well beyond abortion. The list under paragraph 86 of the CEDAW report, for example, also includes sex education. The powers taken by the Secretary of State in the 2021 regulations allow the UK Government to override Stormont on devolved issues on an ongoing basis, even though the Assembly is functioning. We may not like all the things happening at the Assembly, but it is a functioning Assembly and it has a cross-section of political support in Northern Ireland.

Notably, consent for constitutional change is one of the fundamental principles of the 2005 St Andrews agreement, which restored the political institutions of Northern Ireland in July 2006. The radical abortion amendment to the 2019 Act has not received the consent of the Northern Ireland Assembly. Repeatedly laying these statutory instruments glosses over the deeper issues related to devolution and that abortion is devolved to Northern Ireland, but seemingly now in name only.

Abortion is an immensely sensitive issue in Northern Ireland, a place where both lives matter—both the life of the pregnant woman and the life of the unborn child, the baby yet to be born. It is an issue that crosses the bounds of political persuasion, class or creed. At the walk for life at Stormont, which I was happy to attend with my hon. Friend the Member for Upper Bann (Carla Lockhart), I stood shoulder to shoulder with nationalists, Alliance voters and Unionists alike. We rose above the politics because life matters, including the life of the unborn baby. I was thankful for the thousands and thousands who came out to respectfully plead that we did not implement the most liberal abortion laws in Europe, to no avail.

I respect the hon. Member for Pontypridd (Alex Davies-Jones)—she knows that, I spoke to her beforehand—and I want to be respectful to everyone because it is my nature to be so. With that in mind, I say this. The hon. Lady referred to consensus. First, back on 2 June 2020, 75 of the 90 Members of the Legislative Assembly demonstrated cross-community opposition to the imposition of abortion legislation that discriminated against those with non-fatal disabilities, including Down’s syndrome, and an absolute majority voted specifically against the imposition of abortion regulations that allow disability discrimination, as the 2021 regulations have done. Secondly, I am aware of a poll earlier this year that indicated that 60% of the people of Northern Ireland were against abortion on demand for any purpose. Those are two reasons why the consensus that the hon. Lady referred to does not hold up.

Thirdly, a poll by the University of Liverpool and Britain’s Economic and Social Research Council showed that only 5% of the public in Northern Ireland support introducing abortion up to 24 weeks, which is what the UK Government implemented through their regulations. Fourthly—my hon. Friend the Member for Upper Bann made this point, but it is important that I put on the record that I feel the same; it has never been contradicted, and indeed has been enhanced—it has been reported that an estimated 100,000 people would likely not be alive today had Northern Ireland been subject to the same drastic expansion of abortion legislation as the rest of the UK has experienced since the Abortion Act 1967. With abortion on demand, those people would not have jobs and would not be contributing to society. I thought that was a very salient tale of just how important that is.

In effect, it seems that abortion in Northern Ireland has become a reserved matter, predicated on the consent of Westminster, and by extension, the CEDAW recommendations, rather than a devolved matter of full legislative control as before 2019. In the last two days, from my constituents in Strangford, I have been contacted with some 400 emails on this issue—I say that honestly. How many emails have I had in favour of abortion in the last six months? Three. Three in favour of abortion, and 400 in the last few days. Indeed, in those six months, thousands spoke against it.

I want to reflect the opinion of those in Strangford and across Northern Ireland. I am very proud to represent everyone on this issue, and people do take the time to come and tell me their views. I have had nationalists come to my office who pleaded with me to stand firm against this most liberal abortion regime in the world. The case is clear. The majority are against abortion.

One of my constituents tells me that she emailed one Member of the House who has spoken out passionately, telling this House that she spoke for the women of Northern Ireland. I will not shame anybody, because that is not what I do, but my constituent, who wrote to that Member and asked her to represent her, is still waiting for a reply. There is a pick-and-choose when it comes to Northern Ireland that goes from Government right down to individual Members. I am not picking and choosing. I can speak with authority and say with certainty that the overwhelming majority of those who have contacted me are appalled at this legislation. They are appalled that the wishes of a cross-section of the Assembly have been ignored by the Government. They are appalled that the legislation means that a reason for taking a life at 27 weeks can be a cleft lip. Does anyone really think that that reason could be condoned legislatively or in any other way?

My hon. Friend the Member for Upper Bann speaks with passion, compassion and sense, and I commend her for that. My voice should not carry any less weight because I am a man. I speak for my constituents—male and female, young and old. I represent them very well, I believe, and I am fervently urging Members to consider what they are asking to be implemented expressly against the democratic will of the people of the Province.

There is coming a day shortly when the day-to-day business of Northern Ireland could well be the responsibility of this House, and all decisions could be made here, but not now and not at this time. Today is not that day. It is the place of the Northern Ireland Assembly to make a decision on abortion. It should be up to Assembly Members to respect them. They should be respecting the thousands upon thousands of my constituents who say that they do not want abortion on demand, that they want to speak up for the unborn and, above all, to respect life. The life of the unborn baby is so important to all of us.

Sickle Cell Treatment

Jim Shannon Excerpts

Wednesday 8th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mrs Miller, for giving me the opportunity to speak on this issue. I am my party’s health spokesperson and it is always a pleasure to speak on any health issue.

I was talking to a colleague about Stephen Pound, the former Member for Ealing North, who told me about this disease. He and I had a good, friendly relationship. I went to an all-party group event on sickle cell, and through Stephen’s introduction I perhaps gained some small knowledge of the disease. I want to speak today on behalf of those people who have sickle cell. We do not have it in Northern Ireland; thank the Lord we do not have it in Northern Ireland—[Interruption.]

[Mrs Maria Miller (in the Chair)]

Order.

[Jim Shannon]

I was just getting started.

[Mrs Maria Miller (in the Chair)]

There is a Division in the House. I am going to suspend the sitting for 15 minutes, and for 10 minutes for each subsequent vote, but may I encourage Members to return to this Chamber as soon as possible so that we can resume the debate and ensure that as many Members as possible can participate? Thank you.

--- Later in debate ---

[Mrs Maria Miller (in the Chair)]

Order. If the next break is 15 minutes long, and we have just one break, we should complete this debate at around 5 o’clock. Can Members bear that in mind?

[Jim Shannon]

I will not repeat what I have already said; I will not take more than four or five minutes, and then I will give other Members a chance to speak. I was referring to Stephen Pound, the former Member for Ealing North, who introduced me to sickle cell and understanding that process. This happened around the time that the daughter of one of my staff members had taken ill—she lives over here. I am not smarter than anyone else when it comes to health issues, but I just happened to say to my staff member, “I hope she hasn’t got that sickle cell.” From what I understand, she could not have had it. However, she did have primary biliary cholangitis; this is a lifetime health issue—a forever illness. It was just because at that time, I had been made aware of sickle cell, and I wondered if there was any connection.

Sickle cell can affect anyone, although it is more common in people from African and Caribbean backgrounds. The National Institute for Health and Care Excellence estimates that there are currently 12,500 to 15,000 people with sickle cell disease in England, while data from NHS Digital shows that there were almost 25,000 hospital admissions in England in 2020-21 where the primary diagnosis was sickle cell disorders. It is very clear that there is a significant issue when it comes to sickle cell. I commend the right hon. Member for Wolverhampton South East (Mr McFadden) for introducing the debate and raising awareness of the condition—I should have done so at the beginning; apologies for not doing so—and I support all the other speakers who are here today.

A stem cell or bone marrow transplant is currently the only cure for sickle cell disease. Neither are commonly undertaken in sickle cell patients. The US National Heart, Lung and Blood Institute notes that a

“well- matched donor is needed for a patient to have the best chance for a successful transplant”.

In the introduction to sickle cell given to me by Stephen Pound, that was one of the things that we looked at in relation to transplant issues. However, most patients who have sickle cell disease are either too old for transplants, since the risks associated with transplants become greater as a person gets older—and the older someone gets, the less they may want to receive one—or they do not have a relative who is a good enough genetic match to be a donor.

There are many issues that need to be resolved. After reading the APPG on sickle cell and thalassaemia report into the quality of care received by sickle cell patients, “No One’s Listening”, my heart went out to those people who quite simply feel abandoned—many people do. How do we improve that? The Minister and I are good friends, and I know that, when asked for help with this issue, she will come back with a response that the right hon. Member for Wolverhampton South East, and others, will be happy with.

The key findings of the report are a true indictment of the current state of play for sickle cell sufferers. Evidence of substandard care for sickle cell patients, either in a general ward or attending an accident and emergency department, including a widespread lack of adherence to national care standards, is unacceptable, as is the fact that there is clearly a low awareness of sickle cell among health care professionals. There are examples of inadequate training and insufficient investment in sickle cell care. In the Minister’s response, can she give some indication of how that can be improved, so that awareness can be raised and sickness levels addressed?

Many sickle cell sufferers feel that they are not getting answers. That is not a criticism of Government, but if we indicate that there is a problem, as we are doing through this debate, and there is a way of curing that problem, let us do that. There is a clear breakdown that must addressed, not simply clinically, with treatments being made widely available, but further with the training of medical staff and teams to understand this disease and its other medical contraindications.

Those are the issues that we are looking to the Minister to address. I support the right hon. Member for Wolverhampton South East and his attempt to highlight this plight, as he and other speakers have done so well—that will continue in the following contributions. They have not simply highlighted the problem, but pushed the Government and the Minister for action to begin the steps to rectify our current approach.

--- Later in debate ---

[Bell Ribeiro-Addy (Streatham) (Lab)]

It is a pleasure to serve under your chairship, Mrs Miller. I congratulate my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) on securing this debate and on his sterling work as the chair of the sickle cell and thalassaemia all-party parliamentary group. I also commend my neighbour, my hon. Friend the Member for Vauxhall (Florence Eshalomi). She always speaks with such affection about her mother, and I hope that she knows that her mum would be so incredibly proud of her if she were alive today.

The APPG’s landmark report, which was triggered by the tragic and avoidable death of Evan Nathan Smith in North Middlesex hospital, reveals the terrible truth of sickle cell treatment: the substandard care, the stigmatisation and the lack of prioritisation of this condition. As an officer of the group, I was pleased not only that the report came out, but to be able to give evidence as somebody who cared for someone with sickle cell—as someone who lost a loved one, my friend Adjuah, to negligent care. I sat with her through many hospital admissions, and I witnessed mistakes and mistreatment. She said to me on more than one occasion, “One day this hospital is going to kill me,” and one day it actually did. I hope that the Minister has read the report, has taken into account its many recommendations and will outline what steps the Government will take to improve the treatment of sickle cell and the overall experience of sickle cell patients in our national health service.

I also hope that the Minister will touch on what steps the Government will take specifically to improve the treatment of black sickle cell patients. Unfortunately, for those of African and Caribbean heritage, the experience of sickle cell is made far worse by the prevalence of institutional racism. In several past debates and in various inquiries, reports and personal accounts, we have heard how racist attitudes have a negative impact on a patient’s healthcare and experience: lack of research, which is certainly a major issue with sickle cell; biased perceptions of pain tolerance, drug habits and medical knowledge; and experiences of overt racism. All of that makes the experience of living with any condition difficult, but it makes living with sickle cell even harder.

When we talk about institutional racism in the NHS, we are sometimes met with Conservative Members saying, “Why are you calling our NHS staff racist?”. We are not calling NHS staff racist; we value our NHS staff. We are recognising that the institution of the NHS, which is governed by the Government, has issues when it comes to race, and that the policies and practices create biases that cause us problems. We want to know what the Government are doing about that.

Sickle cell is often referred to as an invisible illness, because of how the pain is experienced—often it is invisible to others. However, there is also a distinct lack of education and public awareness of the condition and the symptoms. I point specifically to the issue of education. I studied biomedical sciences and specialised in cellular pathology as an undergraduate. Because of the amount I knew about sickle cell before I went to university, I was struck by just how much it was used as an example but just how little those teaching me knew about its practical aspects. If we do not improve the education of those who treat people, we are never going to improve the outcomes. That definitely needs to be looked at.

The recent removal of discriminatory blood donation restrictions on black donors was a massive step in the right direction, which I really welcome. The largest beneficiaries of the change will be those patients who are often treated through blood transfusions and need rare blood subgroups, such as Ro, that are more common in black people. I have that blood group, so I give blood. Blood donations have gone down rapidly during the pandemic, but they are needed no less at the moment. I encourage all people from the black community, and from all communities, to give blood. I would love to see a blood donation stand in Parliament one day; there are so many of us here, and we should all be able to roll up our sleeves and give a pint or two.

[Jim Shannon]

I think that the Government have been keen to have blood donations, and the hon. Lady has very kindly volunteered and has been donating. She could perhaps be a poster lady for the campaign. Maybe the Minister will take that on board.

[Bell Ribeiro-Addy]

I thank the hon. Gentleman for his contribution, and look forward to seeing him roll up his sleeve as well.

Maintaining those discriminatory blood donation rules for so long was really poor. They were based on outdated HIV science and denied thousands of black sickle cell patients the treatment that they needed, but not only that; the legacy of those rules resulted in a reluctance among the black community to come forward to donate blood. The restrictions have resulted in a shortage of black blood donors and have had a severe effect on the willingness of the black community to donate overall. We have to undo that damage.

I call on the Minister to promise all of us here, and those who are keenly watching the debate, that the Government will act to improve the quality of care and treatment of sickle cell patients. Words are good, but action is better. My hon. Friends have touched on prescriptions and the barriers to receiving proper care. We want action on that. Those watching the debate at home do so in eager anticipation of something that will give them hope of better treatment. I sincerely hope that the Minister will not let them down.

Covid-19 Update

Jim Shannon Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

I am sure that my hon. Friend will agree that the best support we could provide for the transport sector right now is to remove these recent restrictions. I am confident that, as we learn more about this variant and if, as is expected, over time it becomes the dominant variant, we can start removing those restrictions very quickly.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement, and I believe his response reflects the seriousness of the current covid disease levels. Has there been any opportunity to speak directly to the Health Minister in the Northern Ireland Assembly to ensure that the regulations put in place here in Westminster may be considered for Northern Ireland, so that all regions of the United Kingdom of Great Britain and Northern Ireland can together combat and defeat the latest omicron variant?

[Sajid Javid]

We do work very closely together across the Union, and I have regular contact with my counterpart in Northern Ireland. I have not been able to discuss these particular measures with him today, but I know that we will do so shortly.

Antimicrobial Resistance

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

You are most kind, Sir Gary; thank you very much. I am not sure about the pure gold, but I will certainly do my best to make my contribution to the debate. I congratulate and thank the hon. Member for Thirsk and Malton (Kevin Hollinrake). He is not only an hon. Member but my friend, and has been for all the time we have been together in the House. We have spoken on many issues together, so I am pleased that he has brought this subject forward.

I have an interest in this issue, probably because of my constituency. I will start with a comment from back home. This is not only a UK-wide issue but a global issue. As Northern Ireland’s chief medical officer, Dr Michael McBride, said:

“As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.”

If that does not shock hon. Members or sound horrific, it should. If hon. Members thought the covid-19 pandemic was their worst nightmare, with all its repercussions and problems and horribleness, I suggest that this debate has the potential to be their even worse nightmare. Will I be here in 2050? It is highly unlikely, but many others will be, so we should ensure that what we do today will be sufficient to protect those of tomorrow—my children, my grandchildren and, whenever they come, my great-grandchildren.

The rise in antibiotic-resistant infections is of real concern: England saw 90,000 hospital admissions because of such infections in 2019-20 alone. There is a real problem, and we need to act now, as right hon. and hon. Members have said. There is a rising tide of antibiotic-resistant infections. We have to do something.

I declare an interest as a member of the Ulster Farmers’ Union. I have acknowledged on the record the need for investment in agriculture in the effort to tackle antimicrobial resistance from every angle. The Ulster Famers’ Union said:

“As a farming industry, we are committed to playing our part in reducing antibiotic usage and resistance. Significant progress has already been made in the pig and poultry sectors, which have seen their usage fall by over 50% and 80% respectively. Historically, those working with cattle are smaller users of antibiotics but there are improvements that can be made.”

I welcome that commitment from not only the Ulster Farmers’ Union but the National Farmers Union here on the mainland; it is a joint operation. We should support the clear commitment by the farmers unions to do these things and take this action.

[Kevin Hollinrake]

The hon. Gentleman is making a very good speech, and he makes a good point about the pig sector. I am sure he will be aware that the reduction in antibiotic use in the pig sector has not affected yields at all, which demonstrates that things can be done more sustainably, and can be better for the environment, without affecting the economics of farming.

[Jim Shannon]

The hon. Gentleman is absolutely right. The farmers unions welcome these things because, first, they are the right things to do, and secondly, because they do not affect the profitability of the sector or the industry. We need to try to reinforce that.

My constituency has only two or three pig units—one is fairly big, by the way—but a big poultry sector, which has made significant moves towards those things. I live right in the middle of a farm. All my neighbours are dairymen or have beef cattle or some sheep, and they told me that they are careful about what antibiotics they give their animals because that is the right thing to do. Who led the way on net zero targets from the farming sector? The National Farmers Union. It did not have to be coaxed to do that; it was happy to do it. Those are some good things.

It is clear that the farming community is stepping up to the mark and that we in this House need to do more. We need to get the message out that antibiotics are a last line of defence. We must allow our bodies to do their work against viral infections, which antibiotics cannot hope to address. I do not take antibiotics often, but I had to in 2019 because I got a bad infection, and those worked well to clear up my chest infection. Researchers at the University of Limerick found that GPs often felt pressurised into prescribing antibiotics, particularly for fee-paying patients in both in and out-of-hours situations, despite being aware that antibiotics were inappropriate for treating non-bacterial infections. Can the Minister provide an idea of what GPs and consultants do in relation to that and why it is important to get that right and not to be pressurised into giving those out?

GPs need our support and a clear message needs to be sent. We need to ensure that the message is simple: that it is a matter of life and death. Antibiotics are the last of our steps to take and only if we hold them as sacred will we ensure they can still work effectively and save lives. At the end of the day, that is all we want.

Asthma Outcomes

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Steve McCabe (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate. This is in line with current Government and House of Commons Commission guidance. Members are also asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered asthma outcomes.

Thank you very much for calling me to speak, Mr McCabe. This is an issue that is close to my heart and close to the hearts of others here. There are few families in the whole of the United Kingdom for whom asthma has not been a key issue; it has been an issue for my own, and I want to speak about that as well. I am grateful to the Backbench Business Committee for agreeing to have the debate. I am chair of the all-party parliamentary group for respiratory health, which recently completed an inquiry into this issue, so I am delighted to be able to raise the issue of improving asthma outcomes in the UK. I very much look forward to the response from the Minister. I am also very pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place, and I wish her well in her new role.

What does asthma mean to me? My second son, Ian, had asthma. He was born with very severe psoriasis, which meant that we had to apply cream to him three times a day when he was a wee boy. The doctor told us that the psoriasis would eventually go away, but that it would be replaced by asthma. I am not sure of the medical connection—I am not medically qualified to understand it—and I know only what the doctor told me and my wife. Ian has had asthma all his life now—he is 30 years old—and has used salbutamol, the wee blue inhaler, which is always there. It is very clear, from our family’s experience, that those salbutamol inhalers are really important. They are important for Ian. Asthma did not stop him participating in sports, but it meant that he always had to have that inhaler close by, should he at any time feel shortness of breath or need a wee helper.

In Ian’s class at school, there were many others who had asthma issues. As an elected representative, whenever I help constituents with benefit forms, whether for attendance allowance, personal independence payments or whatever, I always ask them about their medical circumstances. More often than not, asthma features among the ailments that they confirm they have—even for those of a different generation. They have often had it for many years. Asthma is an incredibly important issue.

I am pleased to see the Minister in his place. I always like dealing with him, because I always find his answers helpful. He has a passion for the health issues that we bring to his attention, and he always tries to give, and indeed succeeds in giving, the answers that one wishes to receive. Today, we are going to ask a number of questions, and we very much look forward to his responses. I am pleased to see hon. Members in their places. I had hoped that more Members would be able to attend, but I understand that last night was a late night for Members and that there are other pressing matters today.

I have always had a particular interest in respiratory health. This debate has arisen as a consequence of the APPG’s report, which we published last year: “Improving asthma outcomes in the UK”. We looked at the UK mainland, but we also had contributions from Scotland, Wales and Northern Ireland. Obviously, I bring the Northern Ireland perspective to any debate, wherever it may be about, and bring in Strangford too. I am my party’s health spokesperson in this place, and I work closely with my colleagues back home in the Northern Ireland Assembly, particularly with Pam Cameron, my party colleague. She and I work on many things together, including this topic.

Last year, the APPG produced a report investigating the reasons behind the UK’s poor asthma outcomes. We were pleased, honoured and humbled that recognised experts in fields relating to asthma responded to our invitation to take part. The experts ranged from clinical experts from primary, secondary and tertiary care to patient advocacy groups, national asthma champions and patients.

The inquiry was incredibly helpful and detailed. I thank Hugh McKinney of the APPG secretariat and his team for bringing together all the people who wanted to contribute. As a result of the inquiry and the report, many countries in the world now look towards us to learn about how we deal with asthma. They want to learn something from us here in the United Kingdom, and perhaps do things that wee bit better.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Member on securing today’s debate. As with most conditions, research and development is key to improving outcomes. Does he agree that funding into asthma research must be provided from a clearly defined central source and that there must be increased capacity for trials in hospitals?

[Jim Shannon]

I absolutely agree with the hon. Lady. No matter what the sphere of health, early diagnosis and attention is key. Indeed, my son is an example of that, as a child born with the ailment. There was early participation in his treatment by the doctors, including our own GP and those in the hospital. It is clear to me that that helped him on the pathway to better health. The hon. Lady is absolutely right and I thank her.

We received a large number of written submissions, including evidence from across the numerous asthma disciplines. We were encouraged that there was such a high level of interest. The APPG tries to do a catch-up once a month with stakeholders and those with medical expertise. Each month, we aim to hear from between 16 and 20 people who have an interest in the subject. They bring all their information to us, which we are pleased to have. We were incredibly encouraged that there was such a high level of interest, and I thank every one of them for their help and expert advice.

Let us consider the impact of asthma on people in the UK. The number of people affected by asthma in the UK is among the highest in the world, with some 5.4 million people sufferers. I had never done an interview with GB News until yesterday morning, but they were interested in this debate and a former colleague in this House was the interviewer. It was nice to catch up with Gloria de Piero again in her new job, and it was a platform and an opportunity to raise awareness and the questions were clear. That figure of 5.4 million people suffering from asthma came up early on in that interview.

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

I congratulate my hon. Friend on securing the debate. On raising awareness, will he join me in congratulating and commending so many of the voluntary groups, particularly those working with issues around chronic obstructive pulmonary disease? I can think of one such group in my constituency, in the Causeway area, that highlights these matters and draws attention to them in the wider community, in order that there is greater awareness across society to try and help people cope with that debilitating condition.

[Jim Shannon]

I thank my hon. Friend and colleague for that point. He is right that there many charities and volunteers, as well as many people who have the disease. A great number of people have expertise, interest and keenness to help and assist them. COPD is one of the most debilitating diseases that I have ever seen. I never realised just how many people in my constituency suffer from COPD, but there seem to be a large number, some of whom are in the advanced stages of a deterioration in health. I have a very good friend who is an artist; we have been friends for many years. He is interested in rural and country sports, as I am, which is where our friendship came from. Today, he is completely dependent on oxygen 24/7 and rarely leaves the house. For a man who was active and fit, COPD has changed his life dramatically.

Some 65% of people with asthma do not receive a yearly review—I am keen for the Minister to respond to that—despite recommendations by the National Institute for Health and Care Excellence that they should. I respectfully ask the Minister, if they are not getting a review, why not? Asthma has an impact on every patient’s quality of life. A recent pilot study for Asthma UK showed that the impact can be considerable: 68% said asthma attacks hold them back from work in school; 71% said severe asthma affects their social life; 54% said it holds them back from going on holiday; and 66% said severe asthma has made them or their child anxious. When the child is anxious, the parent is anxious—we all worry about what happens. The study also found 55% said having severe asthma has made them or their child depressed. The issue of depression and mental health has come up during the difficulties we have had with covid over the past year and a half.

Asthma deaths in the UK have increased by one third over the last decade. Three people in the UK die from asthma every day, which is among the highest in Europe, yet studies show that more than two out of three asthma deaths could be prevented. Three people die every day and if we had the right things in place, we could save two of those three lives every day in the UK. I put that challenge to the Minister, who I hope will give us the confident and positive reply that we would like to see.

[Margaret Ferrier]

Air pollution can trigger asthma attacks, and it is believed that it is linked to the rise in childhood asthma. Does the hon. Member agree that tackling air pollution could also bring public health benefits?

[Jim Shannon]

I absolutely agree. The hon. Member is making points that we all agree with. I am glad she has brought that to my attention. I come to London to work and am aware of the air pollution and the steps that the Mayor of London and others that are taking to try to address that, by restricting the number and type of cars coming in. As the hon. Lady rightly said, people have died in London from air pollution and we must address that. In large metropolises and population clusters, where vehicles and the economy are concentrated, air pollution is important.

I am fortunate to have lived in the countryside all my life. It means that when I go out of my back door there are green fields and the neighbours are about half a mile away, so there is a distance between us as well. However, some 14,000 vehicles a day pass by us on the road—the A20 from Ards to Portaferry—which, by its very nature, shows where the problem is.

Asthma exacerbations lead to over 77,000 hospital admissions each year. It is estimated that asthma leads to a direct cost to the NHS of £1 billion and an indirect cost to society of £1.2 billion due to time off work and loss of productivity. This goes back to the intervention by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) when she referred to early diagnosis which can stop people losing work days and reduce the cost to the NHS. These factors cannot ignored be when it comes to addressing the health issues and helping to balance the books.

This year, the APPG’s intention was to produce a one-year-on report to highlight and emphasise the tremendous work that has been carried out by all those working in asthma. We intended to highlight the progress that has taken place in the past year, the actions of the Government, and any further areas that needed to be reconsidered. Our job will be to continue to note the progress—it may not be the progress we would like to see—and speak to the Minister to see how we can change that. However, covid changed everything. It changed our thinking dramatically. It has had a devastating effect on many lives and has impacted on asthma care. It affected the scope of our latest report, as well as concentrating on asthma outcomes one year on. We have also looked carefully at the impact of covid on respiratory health and asthma in particular.

I have the greatest admiration and respect for all those working in the NHS during these difficult times, especially those in respiratory health, which has been the hardest hit. They are all heroes—that word is used often, but it is true here—and a credit to the profession and the NHS. We are grateful and thankful to them all.

In the past year, covid has had an impact on those with asthma, COPD and the complex health needs that can sometimes be exacerbated by covid, leading to further difficulties. The past year has been difficult for every one of us. We have probably all lost loved ones to covid. In October last year, we lost my mother-in-law, who had complex needs. Covid took her, and we still miss her.

Today, I want to concentrate on the three critical issues identified by the clinical advisers who addressed our inquiry and shared their expertise and evidence. The first issue is the overuse of salbutamol reliever inhalers. We are not saying that people should not have them. That is not what the inquiry said or what the APPG is saying. We are looking at the potential overuse of those inhalers. The second issue is the new unified asthma guidelines. Thirdly, we need better use of biologics.

Prior to the covid pandemic, responders to our inquiry last year identified the overuse of salbutamol inhalers—the blue, not brown, inhalers—and oral corticosteroids as the biggest area of concern and the most important cause of exacerbation and unnecessary asthma deaths. In our report, the APPG also cited numerous studies that have shown that over-reliance on salbutamol may lead to the reduced use of preventer inhalers and to a greater risk of preventable attacks. Regular overuse has also been shown to increase the risk of asthma attacks, hospitalisations and deaths. The Department of Health and Social Care needs to look at the overuse of medications and whether that may do more harm. The evidence in this case seems to show that this is one of those situations.

A recent study by the SABA use in asthma global programme—the SABINA programme—found that high use of such inhalers was frequent among UK patients and

“was associated with a significant increase in exacerbations”

and in reliance on asthma-related healthcare. It stated the need to align SABA inhaler prescription practices with current treatment recommendations.

Some 22.5 million of these inhalers are dispensed to asthma patients each year, an average of five per diagnosed patient. Way back in 2019, before covid, and during one of the few times in my life I have had health issues, there was a week when I could not even come to Westminster, because the doctor told me it would not be safe to travel. My chest and breathing were at a level where he advised me not to travel. At that time, I was on the blue inhalers. I think I had three over that 11 or 12-week period. I may have had a wee bit too much, although I did not realise that at the time. That is one of the issues highlighted by the inquiry.

Patients using excessive numbers of inhalers should be flagged, identified and immediately seen by an asthma-trained clinician. I bring it to the Minister’s attention that we think it is time to rethink asthma treatment and get this right for patients and constituents across the United Kingdom of Great Britain and Northern Ireland. There are innovative approaches that demonstrate SABA-reduction.

A 2018 study in The Lancet suggested a maintenance and reliever treatment, with a combination steroid and long-acting beta-agonist, which would allow SABA-free treatment. That could be an effective way to reduce SABA overuse among patients, where clinically appropriate. As ever, it must always be done in consultation with and under the guidance of your doctor and those with health expertise.

The Sentinel project undertaken in Hull and East Yorkshire improved outcomes for adult asthma patients by identifying SABA over-reliance and appropriate implementation of a MART strategy. There is a pilot scheme, which could be the marker, the guide, the standard, the level for the rest of the United Kingdom. Data from that pilot Sentinel study demonstrated that MART can substantially reduce the SABA prescribing.

To ensure that that happens, it is important to restore the asthma reviews, which were hit badly by covid. It is time, ever mindful that covid is our priority, to look at the other issues in the United Kingdom, and asthma is one of them. Asthma UK’s latest annual survey showed that 66% of people with asthma are not receiving basic care for their condition, and that that level has fallen, for the first time in eight years. Minister, what has been done to address that fall? How can we do it better?

An annual asthma review is an important component of addressing that. I should be grateful if the Minister would update us on the progress that has been made on restoring the annual reviews. When we are responding to health issues in the United Kingdom we often need data, so it is important to have that in place.

We also suggested in our APPG report that primary care incentives might be necessary to drive the reduction of SABA use. We stated that the QOF—quality and outcomes framework—or the investment and impact fund have the potential to help with that. The patient pathway is also an important method to reduce SABA use, which brings me to my second point—the new unified guidelines.

Last year, in our inquiry, we analysed the challenges faced by clinicians in treating severe asthma. We found that almost all the experts identified the existence of multiple asthma guidelines as confusing, unnecessary and a cause for concern. If they are confusing to experts, and therefore for our constituents and patients too, we need to have a singular approach. Again, I look to the Minister for a response.

The Royal College of Physicians told us in its submission that

“national audit data collected from England, Scotland and Wales indicates that the standard of care against national guidelines (NICE and BTS) and recommendations from NRAD are variable and on the whole substandard.”

There is a need to get things right and singular. As a consequence, the APPG strongly welcomed the commitment to and the ongoing work to produce unified guidelines as a necessary step forward to improve asthma outcomes. We felt that it was especially important for our time-stretched clinicians that all guidelines on asthma should be in one place.

The unified guidelines were delayed due to covid, but are due in 2023. Our main concern, however, is that we understand that the draft scope for the new unified guidelines does not include severe asthma. I bring that to the Minister’s attention, because we feel it should. Perhaps the Minister will give us some indication of what will be done to address that, because that appears to me to be a serious omission, and others will agree.

It is unclear how any guidelines could be described as “unified” when the most serious type of asthma is not included. I have a concern, a question mark in mind, about that. It is especially puzzling when we consider that the existing NICE, British Thoracic Society/Scottish Intercollegiate Guidelines Network, Global Initiative for Asthma and NRAD—national review of asthma deaths—guidelines all give similar criteria for referring a patient for severe asthma.

If severe asthma is excluded from the scope of the unified guidelines, the concern is that newer treatment options will not be addressed properly, which takes us back to the intervention by the hon. Member for Rutherglen and Hamilton West. This is about early diagnosis and treatment at an early stage. If we do not get that right, we will have complications and problems later.

Those newer treatment options include the use of biologic treatments and the latest best practice in phenotyping, which were strongly recommended by both clinicians and severe asthma patients in our inquiry. The long-term plan states:

“We will do more to support those with respiratory disease to receive and use the right medication”,

but without severe asthma included in the unified guidelines, that is unlikely to happen. How can we make that happen, rather than being unlikely? Will the Minister therefore give me, the House and those in and outside this Chamber the thinking behind that omission? What is the possibility of adding severe asthma back into the discussion? If we can retrieve that and bring it back in, I will be pleased. I also wonder what can be done while we wait for the new guidelines. Four sets of guidelines are confusing for clinicians. Surely it would be preferable not to wait until 2023 for clarity. We need to act today—for the three people who die every day due to asthma. That is the imperative. Is there any way that the Minister can reflect on that and give consideration to updated living guidelines to reflect current best practice and treatment?

Unified or updated guidelines can materially affect my third point on biologic therapies. They are life-saving treatments for people with certain types of severe asthma and asthma that is difficult to control. They can reduce asthma attacks in severe asthma, reduce the need for steroids and improve symptoms. At present, they are only offered to patients through the specialist asthma clinics. There was strong support in our report last year for the appropriate use of biologic treatments and we supported the extension of prescribing to secondary care clinicians for severe asthma patients. Many clinicians viewed the use of biologics as a better alternative to traditional oral corticosteroid treatment for severe asthma and we received evidence that a large majority of patients who are eligible still do not have access to them.

Asthma UK suggests that

“82% of difficult and severe asthma patients are often not being referred at the right time, or sometimes, not at all.”

That is hard to believe. Asthma UK and BLF also told us that the current NHS asthma care pathway does not take full account of the availability of the new treatments. So most people with severe asthma are still reliant on OCS. According to Asthma UK, three in four people eligible for biologic treatment are still not accessing it and thousands of patients are having to endure treatments that are considered inadequate and suffer unnecessary side effects.

That is linked to the Government’s five highest health gains programme, which introduced a commitment by the UK to match or surpass comparative nations in the access to new and innovative medicines in five clinical areas, one of which is severe asthma biologics. The scheme committed to the objective of

“reaching the upper quartile of uptake for 5 highest health gain categories”

during the course of the first half of the scheme, by mid-2021. We applaud the Government’s initiative and action on that to date, but the deadline has clearly been missed. New data commissioned by NHS England has shown that the UK is far from the upper quartile and confirms that we are currently ninth out of 10 with regard to comparator countries. We must improve that. We must get better and do that for our patients. We also recommended extending the Accelerated Access Collaborative’s severe asthma programme, and increasing resources to increase capacity for prescribing biologics will be important for achieving that. Will the Minister give a renewed commitment to achieving upper quartile access and set a new, clearly defined target for when and how that will be achieved?

In October 2021 the Government announced 40 new community diagnostic centres, which are set to open across England in a range of settings, from local shopping centres to football stadiums, to offer new and earlier diagnostic tests closer to patients’ homes. I want to put on record my thanks to the Government and the Minister for that commitment. It is clearly there and we thank him for that. However, we cannot make it a postcode lottery. If it can happen here in London, it should happen in Cardiff, Newcastle, Liverpool and everywhere else. Nowhere should be any different, so I would like to see that happening.

The Government have stated that the new centres will be backed by a substantial amount of money—a £350 million investment—and will provide around 2.8 million scans in the first full year of operation. They are designed to assist with earlier diagnosis through faster and easier access to diagnostic tests for symptoms in areas including breathlessness, cancer and ophthalmology. In the Budget, the Chancellor announced an additional £5.9 billion to tackle the backlog of general diagnostic tests to deliver more checks, more scans and more treatment. The intention is to increase the number of diagnostic centres to at least 100 and I understand that each one will include a multidisciplinary team of staff, including nurses and radiographers, and will be open seven days a week. The Government and the Minister are to be commended for that, and I warmly welcome it and the funding that will be allocated. I hope they can help address the covid-imposed inequalities that we have seen across the country in asthma care and treatment. Will the centres be fully staffed, will they have trained staff and will they be in place?

I also welcome the breathlessness diagnostics, which will be included in the centres. It is essential that they should be equipped to diagnose any cause of breathlessness, whether cardiovascular, lung cancer, asthma or chronic obstructive pulmonary disease, which my hon. Friend the Member for East Londonderry (Mr Campbell) mentioned. It is also important to establish an appropriate referral system from the centres, should further investigation be warranted. Will the Minister confirm that the FeNO and spirometry tests will be included in all centres, to allow for fuller asthma assessments?

I look forward to the contributions from other Members, and I thank those who intervened on my speech. I very much look forward to the Front-Bench contributions, particularly from the Minister.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

[Jim Shannon]

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

[Edward Argar]

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their immense contributions and incredibly helpful comments. I think we all spoke with a united voice, from all parties and all parts of the Chamber. I believe we got an excellent response from the Minister and a commitment—even though asthma is not in his direct portfolio.

My hon. Friend the Member for East Londonderry (Mr Campbell) referred to volunteers and charity groups. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to air pollution, as others did. The hon. Member for Loughborough (Jane Hunt)—also a Leicester City supporter, though we lost on Saturday, but that is by the way—referred to prescription charges. The firm that she mentioned contacted me as well, and I am pleased that the Minister was able to respond to her questions. The hon. Member for Blaydon (Liz Twist) brings a vast amount of knowledge of and interest in this subject. She referred to quality of life, mental health issues and how biologic therapy is needed.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), a friend and the SNP spokesperson, spoke about her personal experience of asthma. It is also pleasing to have so many Members present to support the shadow Minister taking her place for the Labour party, the hon. Member for Enfield North (Feryal Clark). Certainly; she has had an exceptional debut as the shadow Minister in Westminster Hall. I was pleased with her contribution, which encompassed all our thoughts and ideas, notably the effect of air pollution and how treatment for severe asthmatics is not in place.

I thank the Minister so much for his response. He gave us the details and told us about the 2023 target, but we will try to do better. He referred, too, to consideration of the annual review and to the unified or joint guidelines to be agreed. There is much to be encouraged by in his response. With that in mind, I thank all hon. Members for their contributions. Here is a battle to be fought; we are about to fight it.

Question put and agreed to.

Resolved,

That this House has considered asthma outcomes.

Adult Social Care

Jim Shannon Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Of course I am trying not to be too disappointed by the reactions of Opposition Members; I did not really expect an awful lot more.

Areas such as Sutton Coldfield and Surrey are expensive to live in, and we need to recognise that. Most of us, when asked about our future care arrangements, would say that we would like to stay in our own homes, and we want to make that possible. There is a great deal of technology that will help, but it is also important to adapt more supported housing and to work with local groups to deliver the right approach for the right areas, and that will include local hospitals as well.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her statement, and for the progress that she is clearly trying to achieve.

Workforce availability for care homes is vital. Today a representative of a care home bordering my constituency rang to say that a quarter of its staff are off work owing to close covid contacts, although they are now treble-jabbed, and it has no more staff and a lack of agency staff to employ. What can be done through this strategy, Minister, to ensure that the recruitment and retention of care workers are improved?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I cannot believe that the hon. Gentleman said “Minister” again. I thought that he was beginning to get it, and that he would not make me unhappy any more!

[Jim Shannon]

I should have said “the hon. Lady”.

[Madam Deputy Speaker]

I thank the hon. Gentleman very much for that. I can say “Minister”; it is the hon. Gentleman who cannot. Minister!

Public Health

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

I reiterate that I cannot speak for other people. I am setting out the measures today that we implemented this morning in a timely fashion, and it is those measures that we are considering. From the Government’s point of view, that is the legislation that we are implementing.

[Jim Shannon (Strangford) (DUP)]

I support what the Minister is putting forward. What happens here will happen in Northern Ireland, as the Minister in Northern Ireland has said that he will follow the instructions and guidelines from Westminster. We are aware of the variant and we are aware at this stage that our vaccinations may be enough to combat it. If we hand wash, distance and wear a mark, surely we cannot do anything other than support the measure. Does she agree that other hon. Members should adopt the same attitude?

[Maggie Throup]

I speak for myself in saying that I have changed my habits with regard to hand washing since the pandemic began, much to the detriment of my skin. We can take simple measures that have been put in place that have no impact on other people but help to protect us and others indirectly.

NICE-Approved Products: Patient Access

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I rise to address the challenging issue of access for patients to medicines and medical devices. We all believe absolutely passionately that we should have access to doctors and nurses, good hospitals and operating theatres, but I think the pandemic has shown beyond question that access to medicines and medical devices goes hand in hand, and without that we do not have the NHS that I think we all believe everyone deserves.

What is the problem? The problem, I shall explain, is as follows. When a medicine is approved, it goes through two processes: first, with the Medicines and Healthcare products Regulatory Agency, which checks whether or not a drug is actually safe and does effectively what it says on the tin; and then it goes to a separate process run by the National Institute for Health and Care Excellence, which looks at cost-effectiveness and value for money. The theory goes that, once those two hurdles have been passed, the medicine is then accessible to anyone. It is very clear in the NHS constitution, which explains that there is a legal right for people to have NHS NICE-approved drugs if it is right for their particular circumstances. Indeed, the NICE guidelines say that there should be automatic adoption, if clinically appropriate and relevant, within 90 days of approval. So where is the problem?

The problem is partly in the system and partly in the words. The words in the constitution are effectively caveated: people can have a medicine if it is right for their particular circumstances. Likewise, according to the NICE guidelines, it will be automatically adopted if clinically appropriate and relevant. The challenge is that, in the current system, NICE will approve medicines for the condition for which they are most cost-effective, so in this country we do not have the ability to approve a medicine for multiple conditions—multiple indications, in the jargon. It is what is most cost-effective that gets approved, and others do not, and there is not a system, either than paying privately, to ensure that the medicine that has been approved for the condition for which it is most cost-effective is available to those with other conditions, but that medicine may in fact still be the only possible solution.

Assuming we get over that hurdle, there is a second hurdle, because not only must NICE have approved the drug, but it has to go on the approved list of drugs locally in the local health authorities—now integrated care systems. The problem is that to get on those formularies, somebody has to put it on those formularies. Currently, while in theory under the NHS NICE guidelines there is a system, it does not actually happen. There is currently a drug for multiple sclerosis, and research shows that people are still waiting after 150 days for it to go on the formularies in something like 25% of the local health systems across the country. So the system, fundamentally, does not work.

What does this result in? It results in a postcode lottery. If someone has type 1 diabetes, it is absolutely crucial that they monitor their condition. There is a device, a flash monitor, that is state of the art, and research shows that the uptake across the country varies between 16% and 65%. What is most worrying is that those parts of the country with the greatest levels of deprivation have the lowest levels of uptake. We all think we have access to medicines for cancer given that we now have the highly innovative and very welcome cancer drugs fund. However, that drugs fund is only relevant when the particular drug is approved for a particular type of cancer. So there will be some drugs—Avastin, for example—which those with the appropriate cancer can get through the CDF, but those with a different type of cancer or who do not fit the profile again have to pay for it privately, costing £252 to £1,088 per cycle, which is every three months.

Sadly, NICE does not approve much for those with skin conditions. For those with mastocytosis—blotches on the skin and boils causing vomiting and diarrhoea—the only solution is usually NICE-approved food allergy drugs, but they are approved for NICE allergies not skin conditions so they have to be paid for privately. For cystinosis, the accumulation of amino acids, which gives rise to kidney problems and kidney damage, the drug Procysbi has been approved by NICE but, bizarrely, there seems to be no uptake of that to date at all. That is important because that drug is, unlike the existing drug, a slow-release drug and therefore mums and dads do not have to keep waking up their kids in the middle of the night to give them the next dose, which, as we can imagine, takes a real toll on family life.

For those with an obesity problem there is a good solution in Saxenda, but that is approved for diabetes. So those whose obesity does not give rise to diabetes will not get access except by case-by-case approval. I am pleased to say that Imperial has finally accepted and approved.

How are we going to resolve some of these issues to make sure there is no longer a postcode lottery? First, let us look at the simple case of those drugs that are deemed to give the most health benefit and are therefore in theory approved and people can get hold of them. What can we do to make sure they do actually finally appear on those formularies and how can we then make sure the system for take-up is actually in place? One of the problems is that there is nobody sitting in these health bodies who monitors NICE drugs coming up, and therefore no one who looks to see whether in their health community they may be of benefit.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing a debate on this topic. As she says, this is about NICE-approved products as well as drugs. One of those products is cognitive rehabilitation therapy, an important intervention for those with dementia, enabling them to live independently for longer. However, despite being listed in the NICE recommendations there is a barrier to delivery. Occupational therapists and other staff in memory clinics do not have the capacity to deliver programmes that are National Institute for Health Research and Alzheimer’s Society-funded. Does the hon. Lady agree that the NICE recommendations must address not just drugs but also products?

[Anne Marie Morris]

I could not agree more. It is crucial to realise we are talking not just about medicines and drugs but also devices and, as the hon. Gentleman says, the processes, which are often the connection between the medicine, the device and the patient.

Within these health bodies, there is no training and nobody specifically focused on monitoring innovation, and there is no obligation to prescribe. Even more peculiarly, for these drugs there is an agreement between the industry and the NHS, the voluntary payment scheme or VPAS, under which manufacturers that are members of the scheme effectively agree with Government when the medicine or device is approved that it will be supplied at a well-discounted price. In addition, there is an agreement that sets a cap so that if, as it happens, more prescriptions are written for that particular drug, it is agreed that the extra cost that the NHS has incurred will be reimbursed by the manufacturer.

So if there is excessive prescribing—we assume that is why there is an attempt to limit how much goes on to formularies—why is that a problem when we have the VPAS scheme? It is a problem because the scheme does not the pass the benefit, other than the reduced price, down to the local health authority. The money is put into a separate pot, and that pot is then used generally to support the NHS writ broadly; it is not ringfenced, either for medicines or to be used, as it could be, to support local health authorities—integrated care systems—when their budgets are put under pressure, which is why they do not want too many things on their formularies. This would help them pay the price.

It seems to me, Minister, that there are some solutions here. You will be aware that I raised three of them in proceedings on the Health and Care Bill. To deal with the imperfections of the current arrangements, if those drugs that were approved by NICE—we are talking about the most cost-effective drugs—were mandated to be on formularies within 28 days automatically, so no one had to decide whether they went on or not, that would be a good system. It would also ensure that the decision was in the hands of the clinician and not of the bureaucracy of the health authority.

It seems to me, Minister, that the second suggestion I made—