Stroke: Aftercare

Jim Shannon Excerpts

Wednesday 21st April 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate, Sir Edward, and I congratulate the hon. Member for Bromley and Chislehurst (Sir Robert Neill) on securing it. I can remember when he requested the debate during business questions—I believe it was in January—so it is good to know that the system works. We have in place two of the participants in a Westminster Hall debate on heart valves, which I think was held on a Thursday in February. This Minister responded, and the shadow Minister also made a significant contribution. I do not want to pre-empt what the Minister will say, but I think the hon. Member for Bromley and Chislehurst will be pleased with the response, because she certainly gave me a good response to my debate on heart valves. We will take the Minister up on her invitation for the all-party parliamentary group to speak to her about these matters.

This is an issue that has become very real for me, although probably not as real as it is for the hon. Member for North Norfolk (Duncan Baker), and for people whom I know who have had a stroke. Over a period of time, I have been greatly encouraged by those who have improved. Some improve almost back to where they were—about 80% to 85%—and others not as well, which is probably to do with age and the severity of the stroke.

I want to make three quick points to the Minister, and I am quite sure that the reply will be positive and helpful. I believe there is a need to increase the availability of clot-removing treatment—thrombectomy—to enable all hospitals to carry out the procedure. We should have a target of delivering a tenfold increase in the proportion of patients who receive a clot-removing thrombectomy in order to end their strokes, so that 1,600 more people can be independent after a stroke each year. If we are to do that in reality, we have to address some of the reasons why strokes happen. Perhaps our health conditions have not been as good as they should have been, and it is about improving people’s health. Can the Minister tell us what has been done to deliver that across every region?

Back home in Northern Ireland—I presume it is the probably the same here—we have regular adverts. Chest, Heart & Stroke has an advert on UTV that tells people what to watch out for, and it is really helpful. Can the Minister confirm whether the mainland has the same number of adverts? They tell people what to look out for. To take up the point made by the hon. Member for North Norfolk, time is of the essence when someone has a stroke. It is what people do in those minutes afterwards, regardless of whether they have the qualifications or just want to do something that helps, because time is absolutely critical.

I recently watched something on TV. It was a clip of a darts match in which a player is having a stroke. His face distorts, and he loses all power in his arm. Seeing that take place in real time has shocked me, because it really brought home the issue that pertains to those who have had a stroke, as well as what can be done in that short time. We need to incorporate a greater awareness of the warning signs. Getting help quickly makes the difference between a fast recovery and a slow one. Can the Minister tell us what has been done to raise awareness among the general public?

I said that I know people who have had strokes and who have recovered quite well. Indeed, a friend of mine had one a while ago and is now back to almost 95%. It is incredible that someone can have a stroke and recover so quickly. In Northern Ireland, over a third of strokes happen to people over the age of 69, and 50% to people over the age of 60. However, it is not uncommon, unusual or unique for those under that age to have a stroke. What has been done among all those groups? Those who are most at risk must be aware of the signs and symptoms.

The hon. Member for Bromley and Chislehurst was absolutely right to refer to long-term personalised care. I am asking things that have perhaps been asked before, but I am quite sure that the Minister will be able to reiterate and to assure us on that, and on the national stroke programme and the lessons learned and the changes that can provide better protection, raise awareness and ensure that we improve health for everyone in this great United Kingdom of Great Britain and Northern Ireland. I know that the Minister has no responsibility for Northern Ireland, but I look to her, as always, for a response to the queries we have all put forward. It is important, not only for me, as my party’s spokesperson on health issues, but for all of us to know that we are improving long-term care and help following strokes for those who need it.

Elective Surgical Operations: Waiting Lists

Jim Shannon Excerpts

Tuesday 20th April 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate. I intend to make some constructive comments and look forward to the Minister’s response. I thank the hon. Member for Bootle (Peter Dowd) for setting the scene so very well and reflecting the opinion that we all have. The Minister does not have responsibility for health in Northern Ireland, but I will give him a couple of examples from Northern Ireland as they are replicated elsewhere.

As the hon. Member said, the figures, which we are all aware of, were clearly in the press last week. I had the opportunity to ask the Secretary of State about them yesterday. I did so because of the backlog of operations—I mentioned tonsillitis and children waiting for their adenoids to be removed—with waiting lists growing not just here in the mainland but indeed across the whole of the United Kingdom of Great Britain and Northern Ireland. Those who have spoken have mentioned the concerns and pressures that I have, and they will be reiterated by those who come after. The Secretary of State in replying said that £7 billion would be made available—the hon. Member for Twickenham (Munira Wilson) will be interested in that figure—and through the Barnett consequentials we in Northern Ireland will get some benefit.

The Secretary of State did acknowledge that there is an absolutely massive backlog, but I think that as we slowly get out of covid-19 through the vaccine roll-out—we put on record our thanks to the Minister and the Government for all they have done on that—we need a strategy in place that addresses the backlog of those waiting to be seen. From waiting lists to see consultants to surgery dates being pushed back, coronavirus has brought us from teetering on the brink of surgical collapse to being under the rubble. It is as serious as that, certainly in Northern Ireland, where the waiting lists are gross. The Secretary of State referred to how it is a problem not just in England but in every region in the United Kingdom. We welcome how he and the Government recognise the problems, but we look to the Minister, with no pressure whatsoever, to tell us what is going to happen and how the strategies will address the backlog.

The Secretary of State always tells me that he has regular contact with Health Ministers in the devolved Administrations. I know that he does, and I welcome that close contact, being on the phone every week—maybe two or three times a week—but I want to ensure that the strategy and the co-ordination are working across all the regions. I will give two examples to illustrate what the issues are.

One of those examples happens to be from one of my own staff, who has two wee girls. One of them is a five-year-old, Lily, who was choking on her food and her drink. After another bout, her mum looked into her throat and saw that her tonsils were the size of golf balls. Those are her words. For a wee girl of only five years old, one would panic right away. She rang the GP, was seen and got an urgent referral to ENT. She then paid to go private, which meant she had to borrow money. Not everybody can do that. She was told that the waiting list was over a year long just to get a consultation. She went to the consultant and was sent home with a sleep monitor, to see where the problems were, which would report back to the doctor. She gave back the monitor after three nights, as requested, and was contacted within two days to say that Lily needed urgent surgery, as her oxygen levels had dipped dangerously low during the night.

Lily’s mother rang the hospital and was told she would have to have surgery in the first urgent slot in April. We are more than two weeks in from the beginning of April, and it has not happened. Lily is still waiting for her surgery and her mother has installed a baby monitor, which speaks, with an on-and-off movement. What a way to live a life, heart in mouth, on eggshells over a five-year-old, listening to the baby monitor all through the night, almost afraid to sleep in case of missing something.

The stress to the family resonates across every one of them. Simple surgery would rectify that. Despite being first on the urgent list, Lily is still waiting. I know the Minister is not responsible for that. The hon. Member for Bootle, who set the scene and had lots of examples, did not go into them all. I suspect that he would have examples very similar to the one I am referring to. Lily’s mother has sleep-interrupted nights to ensure that her child is breathing. A simple procedure would be the solution but, for some unknown reason, the year has passed and we do not seem to be any further ahead.

My second example is a 42-year-old market trader who has worn kneecaps. His business employs 13 local people. He has told me that unless he gets his operation, he will have to close one of his shops, as he cannot physically load and unload the vehicles, and he is losing business. The impact of not getting an operation in time not only affects children but those involved in industry and the economy.

The hon. Member for Twickenham referred to cancer diagnosis. I know of people who had cancer in the past year and, unfortunately, because they did not have their operations, they are no longer here. That is a fact. When the hon Lady mentioned that, I could relate to it and understand, because I know people who are not here today because they were unable to get an operation. I understand that the Government have a responsibility to look after the covid situation, but the time is coming when we need to look beyond that. We need to have a strategy in place, and I look to the Minister for a response on that.

With regard to knee replacements, that 42-year-old market trader is an example of those who need it right now, not years in the future. I also make that point for cataract surgery. Lots of people are not just waiting for the surgery, they are waiting for the appointment to diagnose when it can be done, knowing that they are going blind. Simple cataract surgery can change their lives with real, dramatic and positive effect. We need to be on the ball with these things.

I understand the reference the hon. Member for Twickenham made to mental health. I have seen in my constituency the effect on the mental health of children, some as young as primary age. Schools are suffering tremendous mental health problems. This problem does not only affect Northern Ireland. Just under 4.7 million patients are waiting for hospital treatment in England, as of February 2021. That is the highest number since the referral for treatment data series started in 2007. Although a relatively sharp decrease in numbers waiting was observed from April to June 2020, the numbers have since increased to that record level of 4.7 million in February 2021. It seems likely that the dip from April to June 2020 was due to limited new referrals during the first wave of the coronavirus pandemic.

I always try to be positive when I come to debates. We get the background and examples to set the scene and show what the problems are, but everyone who has spoken so far has very honestly and admirably put forward solutions. I think we are all in the business of solutions. It is about the glass half full rather than half empty.

We need investment. We also need access to private clinics—at some time we will have to look to them—and facilities, and we need action now. With every day that passes, more people are in need; more are in pain and more are in fear, and we must get a hold on the situation. The lists continue to grow as more people’s names are added.

We need a clear strategy that prioritises the backlog of elective surgery. We need the £7 billion that the Secretary of State referred to in the Chamber, which is extra money for this particular purpose. We want to see how that pans out. We need to employ more staff, and extra surgeons as well. What do we have to do to do it? There must be a plan. We have a responsibility. As my party’s health spokesperson, I am very keen to see these matters addressed. I know the Government can do it. If they put their minds to the issue, they can make it happen, but each and every one of us in the House wants to see it sooner rather than later.

Covid-19 Update

Jim Shannon Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

I am delighted that my hon. Friend, along with my hon. Friend the Member for Harrow East (Bob Blackman), is among the 10 million who have had their second jab; that is really good to see. The hope and cheer that the vaccine brings links to the second part of her question, about the speed of the road map. The reason for the timing set out in the road map is that we want to see the impact of one step before we take the next step. We are but one week on since we took step 2. That is a significant reopening, as we have no doubt all seen in our constituencies and around the country. We want to see the impact of that on the data before taking the next step, so we can have confidence that this is an irreversible path—a one-way street, as I put it. That is the reason for the way that we have set this out, and that is how we are planning to proceed.

[Jim Shannon (Strangford) (DUP)]

Along with others, I welcome the roll-out of the vaccine, as that is very important, but few would deny that it is now time to look at waiting lists, and I shall put one on record. What steps have been taken to get routine operations such as hip replacements and tonsil operations back on the table to address the eye-wateringly long waiting lists? That is vastly concerning, especially when we hear, for instance, of children who were on waiting lists for tonsils and adenoids to be removed last year; due to dips in oxygen levels they were considered urgent at that time, but that now appears to be okay. That is very worrying.

[Matt Hancock]

The hon. Gentleman raises a very important point. The waiting list issue is very significant; it has built up because of covid, but we must tackle it and we are absolutely determined to do so. He, like me, will have seen the figures last week on the increase in the waiting list in England, but the waiting list has increased in all parts of the UK. We have put in extra funding, an extra £7 billion in total for next year in England and, through the Barnett consequentials, to the three devolved Administrations. That is there to make sure we can get through this backlog while also of course dealing with covid and the infection prevention and control needed to tackle covid. This is a vital task, the hon. Gentleman is right to raise it, and we are working very hard to address it.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 13th April 2021 Commons Chamber

[Jo Churchill]

I agree wholeheartedly that we should encourage all children to make sure that they can take part in sports and enjoy the outdoors. Regular physical exercise is important for the health and wellbeing of young people, and the local community has an important role to play in developing facilities. That is why the Government launched a £150 million community ownership fund, to ensure that communities across the UK can benefit from the local facilities and amenities that are most important to them. That includes community-owned sports clubs and sporting and leisure facilities that are at risk of being lost without community intervention, and I urge my hon. Friend to work with his community to ensure that he has those facilities locally.

[Jim Shannon (Strangford) (DUP)]

What plans the Government have to ensure an adequate number of nurses in the cancer workforce to deliver the targets for cancer set out in the NHS long-term plan.

[The Minister for Care (Helen Whately)]

Cancer diagnosis and treatment is a priority for this Government. I am working with the Minister for prevention and public health—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—to ensure that we have the necessary workforce to deliver improved cancer care. Overall, we are increasing the number of nurses in the NHS, with over 10,000 more nurses in the NHS this January than a year ago. We are training 250 more cancer nurses and 100 more specialist chemotherapy nurses.

[Jim Shannon]

I thank the Minister for that encouraging response, but will she outline what steps have been taken to ensure that Northern Ireland students educated in UK mainland nursing schemes can easily transition to fill the needs in our cancer wards both in the UK mainland and in Northern Ireland?

[Helen Whately]

I thank the hon. Gentleman for his question, and if he will allow me, I will look into that and write to him.

Cardiopulmonary Resuscitation in the Pandemic

Jim Shannon Excerpts

Tuesday 13th April 2021 Commons Chamber

[Danny Kruger (Devizes) (Con)]

I rise to speak about the use of “Do not attempt cardiopulmonary resuscitation” notices during the pandemic. Last year, the health service was hit by the worst crisis in its history. The whole country was told to stay at home for one simple reason: to save the NHS. That meant not overwhelming the system with too much demand—too many people needing care. We faced a real nightmare scenario of the NHS not being able to treat people who were sick and dying. The horrific idea emerged of doctors or local health managers or the NHS itself having to play God to decide who should live and who should die by deciding who should get treatment and who should not. Thankfully, the NHS was not overwhelmed. This, of course, was mostly due to the heroic work of frontline staff. It is also because every measure possible was put in place to reduce pressure on hospitals. That included people staying at home, building new hospitals at record speed and getting people out of hospital as fast as possible, including to care homes. This is where the occasion for the DNACPR notices came about.

Care homes found themselves under enormous pressure, too. Stories emerged last spring of blanket DNACPR policies being put in place in care settings. They were for people with certain characteristics—people with learning disabilities, people with certain complex needs, and people with life-limiting illnesses. This was done, the report said, without consultation with patients themselves or with families. All this was quite wrong and against all the guidance. Indeed, in April last year, the Care Quality Commission issued a joint statement with the British Medical Association, the Care Provider Alliance and the Royal College of GPs, reminding all providers that it is unacceptable for advanced care plans with or without DNAR notices to be applied to groups of people of any description. I am pleased that they did it. I am particularly pleased that the Department of Health and Social Care— I understand that the Minister herself was responsible—asked the CQC to investigate these reports and to review how DNAR orders were used during the pandemic. I will come to its findings in a moment.

I want to make it clear that DNACPR orders are an appropriate part of our health and care system and can be a right and proper part of an individual’s care plan. We need to distinguish between what might be called beneficial and futile uses of CPR. An obvious example of beneficial CPR is for young people with neuro-degenerative conditions. Respiratory arrest is common for these patients, but with CPR they have an almost 100% survival rate. For them, it is essential and necessary. If a patient’s other vital organs are shutting down—if they are dying—CPR can do little.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman and I share a very common cause, and I appreciate him bringing this debate forward. Does he not agree that for families such as mine who, last year, lost a loved one—my mother-in-law—we would like to believe that any and every measure was taken to save life. The stories that we have heard and that he has referred to are certainly heartbreaking. I very much share his concern.

NHS Pay

Jim Shannon Excerpts

Wednesday 24th March 2021 Westminster Hall

[Paula Barker (Liverpool, Wavertree) (Lab)]

I beg to move,

That this House has considered NHS pay.

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank my hon. Friends the Members for Luton South (Rachel Hopkins) and for Birkenhead (Mick Whitley) for co-sponsoring this debate. I am pleased to have been allocated such a generous amount of time for the debate. That is entirely justified given the importance of the subject at hand—NHS pay.

I thank all those who have taken the time to sign the following petitions: e-petition 300073, signed by more than 170,000 people and titled “Increase pay for NHS healthcare workers and recognise their work”; e-petition 316307, titled “Award all Nursing Staff in the NHS a pay rise of 10% backdated to 1 April 2020” and signed by more than 140,000 people; and e-petition 560253, which is titled “Recognise all members of NHS nursing profession by giving them a 12.5% pay rise”, has been signed by more than 19,000 people and does not close until 7 June.

[Jim Shannon (Strangford) (DUP)]

I sought before the debate the hon. Lady’s permission and your permission, Mr Hosie, to intervene. The petitions before us are an indication of the numbers of people across the whole United Kingdom who feel strongly about this issue. The people emailing me are not just NHS workers. They are families; they are people who have been recipients of the goodness of NHS workers. I believe that there is a moral obligation on us—I have said this to Government as well—to deliver a satisfactory pay increase for nurses. We need to give them a rose of appreciation in the springtime, not a dandelion.

[Paula Barker]

I completely concur with what the hon. Gentleman has said.

The figures that I have given lay bare the strength of feeling that people in our communities have for our incredible NHS staff as a whole. People who know me and have listened to any of my previous contributions on the public sector will know that I like to set the historical context, that context being the last decade and the political decisions taken by the Conservative party in office during that time, especially on matters of public spending and public sector pay—matters that are very close to my heart. During debates such as this, the Government may like to pretend that the pre-pandemic world does not exist. According to them, decisions that they take during the current economic crisis should be taken in the context of spiralling debt and deficits, as well as the looming prospect of inflation. But we have been here before, have we not, especially given that the last economic crisis was not too long ago? The Government are starting to sound like a broken record stuck on repeat, using the same smokescreens that they used in the early part of the last decade, which laid the pretext for an outright assault on public sector pay.

Public sector workers, and not least the brave women and men who staff our national health service, have long memories. What is it that I am referring to that existed at the front and centre of the NHS worker psyche going into this pandemic? It is the fact that nurses’ pay is down £840 in real terms since 2010. Further to that, the likes of the Health Foundation have stated that at the start of the pandemic, NHS wages were £600 lower per employee in real terms than in 2011-12. It is the fact that staff morale is at rock bottom, with many leaving certain NHS professions and the Government failing most spectacularly to fill the gap in staff shortages—nearly 50,000 combined vacancies exist across doctor and nursing professions. It is the fact that workers have had to endure rising demands on their work with less reward.

That is what NHS workers, who make up 4% of our entire labour market staff, have had to suck up since 2010 in order to pay for an economic crisis—a crisis in the casino economy that they had no part in creating. According to research delivered by London Economics for NHS trade unions, pay levels at every single Agenda for Change spine point have lagged behind inflation since 2010-11, resulting in a significant decline in total pay in real terms. Most spine points have exhibited a decline in excess of 10%, and total pay on the Agenda for Change spine point with the highest incidence of staff, at the top of band five, has declined by 15%. That is three times the decline in median earnings experienced by full-time private sector employees across the UK over the same timeframe.

Let all of us here today contextualise the debate by reflecting on the picture faced by our brilliant NHS staff before and going into the pandemic. They have had their pay cut, their spending power slashed, their living standards squeezed, and their morale smashed. That is the so-called old world that the new kids on the block—the Prime Minister and the Chancellor—would rather us all forget, one built by their predecessors. However, no amount of rebranding will disguise the fact that the current Government intend to continue the same legacy of making public sector workers pick up the tab for a crisis they had no part in creating. Indeed, this time it is even worse than that. They are paying for a crisis that they have ensured we have, and will, overcome. Some thanks, I say, and shame on this Government.

In this new decade, the message being received by NHS workers from the Government is this: brace yourself for more of the same. Staff in our NHS have had to endure all of that, and then 12 months ago were asked to once again go above and beyond, to gravely enter the unknown, risking their mental and physical health. They have sacrificed their family and personal lives. Some have paid the ultimate sacrifice of their own lives in the line of service, duty and compassion.

Let us cast our minds back to how terrifying the news headlines, the newspaper stories and social media chatter were when the virus first emerged on these shores. The virus was the absolutely terrifying unknown for all our people, except for our NHS workers who were not afforded the luxury of watching this public health crisis unfold from the sidelines as passive observers; they were the frontline against the great unknown.

To this day, their unrelenting commitment to the public service still moves me, as it should all people here today in Westminster Hall. I am not one to often quote Winston Churchill, or indeed make wartime references, but never was so much owed by so many to so few. If any of this brave few were able to come up for breath for just a moment, maybe because of their shift patterns, and sit in front of a TV screen on a Thursday evening last year, they would have seen many ordinary folk applauding their efforts. They would also have witnessed the galling sight of the occupiers of No.10 and No.11 clapping for the photo op, with little intention of rewarding them for their work, their sacrifice or their trauma.

Appreciation of NHS workers is not about rhetoric, warm words and pats on the head. Let me be absolutely clear. Claps and smiles do not pay the bills. It is about deeds and actions, and when it comes to NHS pay, the only deeds and actions made by the Government have been a fresh round of insulting pay offers, or, in real terms, pay cuts.

The Prime Minister recently told the House of Commons that the Government have delivered a 12.8% increase in the starting salary of nurses. It may well be true to say that some—but not all—nurses have received a pay rise of more than 12% since 2017-18. However, that is in cash terms, not in real terms, and it does not account for the fact that inflation erodes the spending power of workers’ wages over time. It is a flattering figure in other ways: it applies only to one group of nurses rather than reflecting the experiences of all NHS workers in England, and it does not take into account the years of austerity that defined the years prior to 2017-18. The Government cannot spin an assertion that they are awarding pay rises when millions of NHS workers know the exact opposite is true.

All we ever hear from the penny-pinchers that occupy the Government Benches is that we cannot afford this or that—basically, anything of social value or any moral good. The old mantra that public sector equals bad and private sector equals good is making a return. This tired politics draws the economic orthodoxy to the conclusion that suppressing public sector pay is of economic benefit in times of crisis, rather than the opportunity to grow the economy that it represents. It is almost as if a decision has been taken according to the same logic that public wages are a drain on the public purse and therefore a resource to be tapped into in order to control public finances when it suits.

It is sound economics to deliver a just and fair pay rise for NHS staff and a decent pay rise is affordable. Currently, just over 1 million nurses, midwives, allied health professionals and NHS support staff are covered by the Agenda for Change pay framework in England. The same aforementioned research conducted by London Economics concluded that a 10% increase to the NHS England pay bill amounting to £3.4 billion would result in the net expenditure of only £0.66 billion when including factors that are offset against the original figure.

Such offsets include increased tax receipts, because public sector workers pay taxes, and increases in direct, indirect and induced tax receipts, because public sector workers spend money in their local areas that helps to grow local economies and support communities. A pro-public sector agenda is a pro-business agenda. It is a miracle that public and private sector workers exhibit similar economic behaviours—who knew?

There would also be savings in recruitment and retention, because better paid staff are happier staff. There is even an extra £130 million in savings from the lower student debt write-offs for nursing students. This is the sort of sensible, moral and longer-term economic thinking the Government are totally incapable of. Instead, we have crumbs for midwives and support staff; their dignity, livelihoods and take-home pay is unaffordable, according to this Government, but not lucrative, publicly funded contracts for the friends of Tory Ministers to deliver personal protective equipment shortages and botched public health projects to the tune of billions of pounds. Apparently, that sort of spending is every bit affordable: in fact, we are told, it should be celebrated. Not only do we have a Government guilty of cronyism, but of skewed priorities. We see that only too well today when not a single Conservative Member apart from the Minister is here for this debate.

Government policy on the NHS tells us everything that we need to know. Nurses, midwives and support staff are left neglected, their immense contributions disregarded, forgotten by a Government and party intent on reverting to type. There is no policy impact assessment, as the real burden for public sector pay restraint will once again fall on the shoulders of women who make up so much of the public sector, especially our NHS. There is no regional impact assessment on areas more reliant on public sector spending, such as my city of Liverpool—so much for the levelling-up agenda.

To round up, the public overwhelmingly support a pay rise for NHS staff because they, like me, understand and appreciate their service each and every day; in times long before covid, during it and long after. They are out on the frontline, as I speak here today, delivering vaccine shots in the arms of millions of people, as well as catching up on the huge backlog of urgent elective care procedures while the Government parade around this place telling us that the economics will not permit just recognition and reward. If any group of workers in our National Health Service collectively decide that enough is enough and they embark on a course of industrial action, they will have unwavering solidarity. I appeal to the Government to change their course, walk the walk on NHS pay and give the NHS staff the pay rise that they so deeply deserve.

Smoke-free Society by 2030

Jim Shannon Excerpts

Tuesday 23rd March 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I just want to add a few comments. It is all very well to say that smokers should transfer from cigarettes to vaping, but I have a concern. Although I am encouraged that the number of people quitting cigarettes and turning to vaping products shows that they are more successful than nicotine-replacement therapy, does the Minister agree that we need to ensure that people are not, to use an Ulsterism, jumping from the frying pan into the fire? Does she believe that this has been looked at robustly enough to reach a determination? If cigarettes are harmful, we have to be absolutely sure that vaping is safe as an alternative.

Health and Social Care Update

Jim Shannon Excerpts

Thursday 18th March 2021 Commons Chamber

[Matt Hancock]

I can absolutely give that assurance. My hon. Friend is quite right, and he brings his experience as an incredibly impressive Health Minister to bear. It is absolutely standard to tell the system what our future expectations are, but they are expectations, and we are always clear that supply is lumpy. We have set out clear commitments to the public, and those commitments that come either from me or the Prime Minister are the ones that we will meet, and we manage this enormous programme in order to deliver them as best we can.

[Jim Shannon (Strangford) (DUP)]

I, too, thank the Secretary of State for his continued updates on these issues in the Chamber. As a type 2 diabetic who lost four stone when I was diagnosed with diabetes some 13 years ago, I have come to understand the importance of a healthy weight. My specific concern on reported vaccine supply is that the overweight, who are ostensibly more vulnerable to coronavirus, must have access to the vaccine. Can the Minister confirm that shipments to Northern Ireland will continue as scheduled and, further, that clinical priority will continue to be given to those with a high body mass index, despite the alleged shortage?

[Matt Hancock]

Yes. People listening to the news over the past 24 hours might be surprised to hear this, but there are no changes to the prioritisation and no changes to planned appointments. People will be called forward as previously proposed and in the order previously proposed, including with the addition of opening up invitations to those who are 50 and above. The vaccines will be delivered by the NHS across the whole of the United Kingdom, including in Northern Ireland, where I work extremely closely with my counterpart.

Covid-19: Community Pharmacies

Jim Shannon Excerpts

Thursday 11th March 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for setting the scene, as she always does on such issues. I am very pleased to speak on this matter, because it is essential for me. I have often referred to pharmacies in my constituency, and I have often sent questions to the Minister here, and to the Minister whose responsibility they are back home as well.

Those pharmacies have reported much of the concern that has already been outlined by others, and they are in need of Government support. I have a good working relationship with pharmacies in my area and I visit them fairly regularly, but they are under additional pressure because of the recent strains relating to the Northern Ireland protocol. I know that the Minister is not responsible for the Northern Ireland protocol, but this debate is about pharmacies and the Northern Ireland protocol becomes part of that, as it always does with everything, for us in Northern Ireland anyway.

I was in contact with one of my local pharmacies, who spoke with other members of Community Pharmacy Northern Ireland and outlined the following:

“Community Pharmacy NI has been in on-going local and national discussions in respect of matters relating to the supply of medicines to Northern Ireland, and has highlighted the continuing concerns in respect of continuity of supply from a Northern Ireland perspective in 2021/22 and beyond. There is a 12-month derogation in place and Mr Gove has requested that this be extended to 2023.”

That is good news because it helps us in the short term, but we need a long-term solution as well. It goes on:

“there is work being undertaken at policy and operational levels to resolve anticipated supply issues before they impact on contractors and patients here.”

So, we are seeing some conciliation and help for us in Northern Ireland, and we appreciate that.

Community Pharmacy NI continues:

“However, additional regulatory requirements post 2021 may put a significant burden on manufacturers for a small NI market”—

it might be small, but it is crucial for us in Northern Ireland and for our constituents—

“and the fear is that this may force them to withdraw altogether from supplying here and that there may be significant disruption to the supply chain which will result in shortages.

There are also looming implementation dates for full compliance with HMRC and EHC requirements, which may impact on medicines movement. The potential shortage issue could be managed to a large degree by ensuring that the licensing status quo is retained as far as possible to allow the unfettered use of GB packs in Northern Ireland.

Community pharmacies in Northern Ireland provided a vital role in supporting patients, the health service and by maintaining medicines supply to patients during COVID.”

We have all said that.

“As we go forward now in 2021 can Government provide details/give assurances that work is ongoing to identify and quantify any possible medicines shortages and to put in place sufficient measures and contingencies to deal with any anticipated issues in respect of medicines supplies to Northern Ireland?”

Can the Minister respond to that today? If not, can she respond to it further down the line?

Local pharmacies are a focal point of villages and communities across my constituency. Throughout the pandemic, the community pharmacies have battled through as a lifeline for people. In the same way that we owe a debt to the NHS, I believe we also owe a debt to local pharmacies, who did their utmost to keep it together and keep going. There must be a better use of them to relieve the pressure on the NHS. I believe that pharmacies are at the frontline to do that. They could be addressing issues to do with diabetes, minor ailments or small medication problems.

I end by putting on record my sincere thanks to all the pharmacists, technicians and staff who kept making the packs, were available for assistance, and kept their doors open and medication flowing. We could not have done it without them, and now is the time to do right by them.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir Graham. I am incredibly grateful to my hon. Friend the Member for Thurrock (Jackie Doyle-Price), not only for securing the debate today, but for her work as chair of the all-party parliamentary group on pharmacy, and across the health space more generally.

All those who have participated today have shown how important pharmacy is to every one of us. The voices of my hon. Friends the Members for Barrow and Furness (Simon Fell), for Harrogate and Knaresborough (Andrew Jones), for Bolton West (Chris Green), for Carshalton and Wallington (Elliot Colburn), for Henley (John Howell), for Winchester (Steve Brine), for Isle of Wight (Bob Seely) and for Southend West (Sir David Amess) joined those of the hon. Members for Strangford (Jim Shannon), for Birmingham, Selly Oak (Steve McCabe), for Coventry North West (Taiwo Owatemi), for Halifax (Holly Lynch) and for Bootle (Peter Dowd). Everyone recognised how important community pharmacy is in their community, and I want to join in the thanks given to that community today and say how much I value what it does on the frontline. As my hon. Friend the Member for Harrogate and Knaresborough said, pharmacy workers are key, skilled frontline workers and deliver over and above, every day, to our communities. I repeat the thanks of the Prime Minister and the Secretary of State for Health and Social Care, and add my gratitude.

The fact that pharmacy workers are a key part of our NHS family, as my hon. Friend the Member for Thurrock said, and have risen unfailingly to the many, varied and enormous challenges of the pandemic should not go unnoticed. There are 11,210 pharmacies sitting at the heart of our communities. They are easily accessible: 80% of them are within 20 minutes for someone walking there. They are highly rated, as many hon. Members have said, and highly trusted. Throughout the pandemic they have stayed open and served their communities. They have provided vital pharmaceutical services. Medicines are not something that people can choose to have or not have.

I am immensely proud to stand here as the Minister for pharmacy, and I thank everyone involved in community pharmacy for their hard work, whether they talk to patients every day or are involved in the vaccine roll-out or the broader team. From the times I have spoken to them, I know that they are tired. They have worked unbelievably hard for the past year. I do not think that, when this started, anyone anticipated that it would go on week after week. They have been working evenings and weekends, and I would like to thank them for it.

Hon. Members might recall that we agreed a five-year deal back in July 2019, before the pandemic. It commits almost £13 billion to community pharmacy—just under £2.6 billion a year—and was the joint vision of Government, NHS England and the pharmaceutical negotiating committee, the PSNC, for how community pharmacy will support the delivery of the NHS long-term plan, and patients.

As we have heard from many, particularly my hon. Friend the Member for Southend West, there is so much more that pharmacies are saying they want to do for our communities. Having spoken to many pharmacists and their teams, I know that using their full skillset is something they would welcome. It is what they want to do and what they want to see happen.

Over the period of the five-year deal, community pharmacy will be more integrated into the NHS and will deliver more clinical services, taking pressure off other areas in the NHS, as the first port of call for minor illnesses. That recognises, importantly, the skill base in the sector. To that end, more than 2,800 pharmacists each year go into training at the current time; there are more than 10,000 in training at the moment. We are making sure that, as the current cohort come out, they are equipped to be part of that future high-skilled workforce, enhancing their skills for consultation and so on.

[Jim Shannon]

One of the advantages that I am sure the Minister is coming to is that GP surgeries and A&Es will potentially have fewer people to see if the pharmacies take over that role.

[Jo Churchill]

I thank the hon. Gentleman for that point.

We are already making good progress on the journey. The community pharmacist consultation service went live in November 2019, enabling NHS 111 to refer patients into community pharmacies for minor illnesses or the urgent supply of prescribed meds. We have had more than 750,000 referrals so far.

In November 2020, we expanded that service to GP surgeries, so GPs can now formally refer patients to community pharmacies for consultation. In February, we introduced the discharge medicines service, enabling hospitals to refer discharged patients into a community pharmacist for support with their medicines. There will be more services introduced over the financial year.

Those services are to do what pharmacists and their teams do best, and that is to help patients. My hon. Friend the Member for Southend West spoke about hepatitis C. I assure him that, as of last year, we gave access to hepatitis C testing to those pharmacies that chose to take up that option.

I agree with my hon. Friend the Member for Winchester that there is great potential in hub and spoke dispensing. I also agree with the hon. Member for Nottingham North (Alex Norris) that there is already experience to learn from in the sector.

As set out in the community pharmacy contractual framework five-year deal, we want to make dispensing more efficient and, by doing that, free up pharmacist time to provide more clinical services—they are highly skilled, and we know they want to do that. The Medicine and Medical Devices Act 2021 paves the way for us now to progress legislative change to enable the better use of skills in pharmacies, something that several Members this afternoon have alluded to. There is a large amount of will to make sure that the whole team can use their skills appropriately and perhaps free up the pharmacist a little more for him or her to concentrate on other areas.

We have already started informal engagement with stakeholders—that started this week—which will be followed by a formal consultation. I am afraid I cannot give hon. Members an exact date, but I will commit that I want that to be as soon as possible—I want us to get on with this. I thank my hon. Friend the Member for Winchester, who knows the sector extremely well, for his comments about the opportunities that lie therein. I am sure that many hon. Members will want to work to develop that.

New services will develop and expand the role of community pharmacy across three key areas. Several hon. Members alluded to the fact that pharmacies would be expert in helping with prevention, urgent care and medicine safety and optimisation. Those are all areas in which growth is envisaged in the short, medium and longer terms.

That brings us to the pressure. I am well aware of the pressures community pharmacies are under. Not only has the last year brought quite unprecedented circumstances, but it has not allowed some things to go on that we thought would be embedded by this point. Throughout the last year, we have had conversations with community pharmacy and stakeholders, and have tried to respond as best we can by putting in place a package of measures and support for the sector.

Most community pharmacies have been able to access some general covid-19 business support, including various rates reliefs and some retail, leisure and hospitality grants, and we estimate that there has been access to about £82 million in grants. There has been extra funding for bank holiday openings, when—particularly looking back to last Easter, for example—the sector has responded phenomenally by remaining open and giving patients access across long holiday periods; for a medicines delivery service for shielded patients, which has been mentioned and has been hugely appreciated; and for a contribution to ensure that social distancing measures can be in place in every pharmacy.

We are still talking, however. We have provided personal protective equipment free of charge via the PPE portal, and have reimbursed community pharmacies for PPE purchased. We have also provided non-monetary support, such as the removal of some administrative tasks, flexibility around some of the opening hours, support through the pharmacy quality scheme for the sector’s response to covid-19, and the delay to the start of new services, all of which have been requested.

Between April and July 2020, an advance payment of £370 million was made to support community pharmacies with cash-flow pressures, which were extremely acute. Those were caused by several issues, including a sharp increase in prescription items in the March-April period, higher drug prices, delayed payments from the pharmacy quality scheme, and extra covid-related costs. Acting swiftly and providing those advance payments helped to alleviate immediate cash-flow concerns, but since then pharmacies have been paid for the increased items that they have dispensed, reimbursement prices were increased to reflect higher drug prices, and payments have been made under the pharmacy quality scheme.

We are still in discussions with the PSNC about the reimbursement of covid-19 costs incurred by community pharmacy, and I can reassure the House that the Government will take a pragmatic approach. I expect to deduct any agreed funding from the £370 million advance payments, and to discuss timescales around the advance separately with the PSNC, being very mindful of the pressures. We need to assure ourselves that community pharmacies are financially stable. Without that stability, they cannot deliver those services.

I am aware of the concerns that current funding is not enough, and I need to work with the sector to look at things in much more detail, because pharmaceutical services are complex, and there is a range of different providers. The hon. Member for Nottingham North mentioned that he has a Boots in his constituency, but that is a very different operation from many of the individual pharmacists, such as Tim, who has a pharmacy on the harbour in the constituency of the hon. Member for Isle of Wight.

Whether they are independent, small-chain or large-chain pharmacies, no two pharmacies are the same. The solution has to be one that we can tailor. A balanced and considered approach must be taken to maintain the variety and vibrancy that we all recognise as absolutely key in the pharmacy network. People and patients absolutely value the diversity that best suits them and their own needs. We need a sustainable funding model that works for all types.

I have heard the concerns about pharmacy closures, and I can assure Members we monitor the issue very closely indeed. Our data shows that, despite the number of pharmacies reducing since 2016, there are still more than there were 10 years ago. We have seen more closures in deprived areas, as many Members have said. However, importantly, there were more in deprived areas, so making sure that there are still more pharmacies in deprived areas is extremely important.

Proportionally, the closures reflect the spread of pharmacies across England, with closures tending to be where they are clustered. The most recent data shows that three quarters of the closures were part of large chains, and that aligns with consolidation announcements made before the pandemic. It is important that we protect access to pharmaceutical services. The pharmacy access scheme protects access in areas where there are fewer pharmacies and higher health needs so that no area is left without access to a local NHS pharmacy.

It is important to recognise that covid-19 is also an opportunity, which many Members have alluded to. The pandemic has shown across healthcare the value of our highly skilled community pharmacy teams, and how they can contribute and receive more funding. Commissioning community pharmacies to operate the medicines delivery service has been vital to ensure that vulnerable constituents have received their medicine. Community pharmacies have delivered the biggest flu vaccination programme ever, vaccinating more people than ever before.

There are currently around 200 pharmacy-led covid-19 vaccination sites, with a target to double that number by the end of this month, and there have been 60 more this week alone—on many of the questions around vaccines, I will defer to the Minister for Covid Vaccine Deployment. I expect more to follow, and NHS England is looking to designate more pharmacy-led sites, including sites that can deal with up to 400 vaccinations a week in areas where there were not sites that could deal with large quantities of vaccine, which initially put some sites off.

We are considering the important role of community pharmacy and how that can play out in future as we learn to live with covid-19 and having vaccinations. In addition, community pharmacies are taking part in pilots of antigen testing at lateral flow test collection sites. If those are successful, community pharmacies will be able to provide a valuable service to their local area and will be paid to do it.

The community pharmacy continues to be part of local PCNs, and I know it stands ready to take its full part in primary care as we learn to live with the disease. Those examples show how community pharmacy is helping the broader healthcare family fight covid-19. The Government are keen to make better use of the clinical skills, while giving pharmacies opportunities to generate more income above the £2.5 billion per year that the five-year deal went to—and there are opportunities.

Finally, I once again thank my hon. Friend the Member for Thurrock for this important debate. The past year has tested all pharmacies, and the following months will continue to be challenging. I am personally committed to doing everything I can to support all community pharmacies in what I view as their essential role as part of the NHS family, which, again, many have spoken of. This is a responsibility on all of us. Pharmacies bring incredible value to local communities and their patients. We are beginning to see the light at the end of a troubling tunnel, and we would not have made it this far without the contribution from community pharmacy. I look forward to having the conversation to ensure that we get a sustainable funding model not only with colleagues but, mainly, with the sector.

Patients with Heart Failure

Jim Shannon Excerpts

Thursday 11th March 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered quality of life for patients with heart failure.

It is an absolute pleasure to serve under your chairmanship, Mr Mundell, and I look forward to this debate. Believe it or not, I applied for it this time last year. It has taken that long for the opportunity to come round. It does not matter that it did not happen in March or April last year; I am pleased that it is happening now. That is the important thing.

I am very pleased to see Members virtually and in person. I look forward to the contribution from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders). It is a pleasure to see the Minister. I have already enjoyed her company for an hour and a half, and now I will enjoy it for another period of time. We will see how we get on.

I am delighted to have been granted this important debate and I am particularly pleased to see Members from across the House present to take part in it. Heart failure is a progressive, long-term condition affecting nearly 1 million people across the United Kingdom of Great Britain and Northern Ireland; nearly 20,000 people have been diagnosed with it in Northern Ireland alone. I am my party’s health spokesperson, so I am pleased to present the case, and as we are on the UK mainland, I ask the Minister to respond.

I am pleased to see the hon. Member for Birmingham, Selly Oak (Steve McCabe). He and I had an opportunity to observe an operation at St Thomas’ Hospital. I was telling the shadow Minister about it. I will not go into the details, but the hon. Member for Birmingham, Selly Oak will remember it well. The operation was on someone who was having a stent put it. I thought we were going to have a wee chat, and was not fully aware that we were going to see it. When I got there, I suddenly found out. We were in the blue surgical gowns, had the body armour on and were present as the gentleman had his operation. The hon. Gentleman was more prepared than I was; he survived it, and I just about survived it. So, we have seen that in person, and I am sure the hon. Gentleman will make a valuable contribution later in the debate.

Around 98% of people in this country who have heart failure live with at least one other long-term health condition, and many have complex care needs. Living with heart failure means that the heart cannot pump blood around the body as effectively as it should, and it usually occurs as a result of a heart attack, high blood pressure or congenital heart disease, though there are other causes. As people get older, their bodies get weaker. I hope you are an exception, Mr Mundell. I myself am on a list of tablets, and during the last debate, about pharmacies, I knew my tablets were in my pocket, and I was thinking about them when the Minister was speaking, so I know what it is like to live with a disease. In my case, it is high blood pressure and diabetes, not heart disease.

At present, it is not possible to cure heart failure, as there is no way to repair damaged heart muscle, so people with that condition can live their lives dealing with severe fatigue and shortness of breath, among other symptoms. A young lady called Tara Loughlin from Ballyclare was diagnosed with heart failure at the age of just 41, as the result of a rare heart muscle disorder. Tara had symptoms such as breathlessness and extreme fatigue for years. She visited her doctor multiple times with those symptoms. Only when she felt very unwell one day and was referred for an echocardiogram, which is an ultrasound scan of the heart, did she receive the diagnosis of heart failure.

Unfortunately, a significant delay between identifying symptoms and a diagnosis of heart failure is common for many people with the condition. I will speak about that more as we go forward. Life changed forever for Tara, who is a keen runner and loves nothing more than walking her dogs or working up a sweat in Zumba classes. People might think that Tara looks well from the outside, but in fact she battles extreme fatigue and wakes up exhausted and breathless. She gets severe fluid build-up in her hands and legs, to the point where she cannot wear jeans. Tara says this gets her down. Before, she loved clothes and going out, but she is now forced to wear looser clothing and stay home. She said she has still not come to terms with her diagnosis, and the same is applicable to many other patients across the United Kingdom.

Sadly, around half of people diagnosed with heart failure in the UK will die within five years of the diagnosis, but that can be improved; we can do better. With early diagnosis and access to the right treatment, care and support, people can manage their symptoms. Perhaps the Minister will tell us something about that in her response—I look forward to hearing what those things might be. They can have a better quality of life and live longer, which has to be good news.

That, however, has not been a reality for many people with heart failure, which is why the debate is being held —to look at those people who might not be getting what they need. At the end of my speech, the Minister will have heard the four questions that we are asking, and I hope she will be able to respond. We might ask a few more on the way; we do not want to let her off with just four, if we can help it.

As we all know, health services across the country are under unprecedented pressure, and I express my deep gratitude to all frontline staff who work tirelessly to provide care to people who urgently need it. It is vital that we do not lose sight of people with heart failure who may not be able to access the care and support they need at this time, and who may become more unwell as a result. The same is true of other things—for example, cancer has been a big issue, and the Minister understands that disease better than most—but I seek clarifications and reassurance on heart failure.

In 2016, the all-party parliamentary group on heart disease made 10 recommendations to improve heart failure care in England. Its inquiry highlighted issues and opportunities across the patient pathway, including the need to raise awareness of heart failure among generalist medical professionals, so that they understand it. I know that they are experts, but they deal with lots of problems. It would also be good to improve the information given to patients at the point of diagnosis, and to ensure that all patients can access the specialist care needed from a multidisciplinary team. They should also be able to access rehabilitation services and timely palliative care.

Unfortunately, insight gathered by the British Heart Foundation and others suggests that progress has been slow in realising the recommendations. Perhaps the Minister will reassure us about the 10 recommendations made by the APPG in 2016. Services are still not always joined up or consistently addressing the needs of people with heart failure across the patient pathway. That variation starts at diagnosis.

We always say that diagnosis is so important—it is critical—but many people are still diagnosed late and in inappropriate settings. Research shows that although 40% of heart failure patients display symptoms that should trigger an assessment in primary care, as many as 80% of heart failure cases in England are diagnosed in hospital. That can lead to worse outcomes and higher mortality rates. Why has that happened? That is one of the questions that we want to ask.

Staffing shortages and variable access to echocardio- graphy—a key tool for diagnosing heart failure—in primary care and the community are just some of the reasons for late diagnosis. Again, we seek from the Minister some assurance that such issues are being addressed. N-terminal pro B-type natriuretic peptide testing—a blood test that helps in the diagnosis of heart failure—is another key tool, but it is still not routinely available or appropriately used in primary or secondary care settings across the country.

Heart failure can also be challenging to diagnose. What is happening on that? Are we are seeing an improvement? I look forward to the Minister’s response. I know her well, and I am quite convinced that we will get the answers we seek, which will help to alleviate some of our fears and concerns. Symptoms are variable and can be confused with those of other conditions, meaning that it is easy for those without specialist expertise to miss the signs of heart failure. I sometimes wonder how that can happen, but it can, because of the system that we have. Better training of generalist healthcare professionals and improved access to key diagnostics will be critical to improving outcomes, while early intervention allows people with heart failure to live with a better quality of life for longer. I gave an example of that earlier. Their quality of life can be better, and they can live longer as well.

There is also significant regional variation in the quality of care patients receive following admission to hospital; the percentage of patients seen by a specialist is reported to be 100% in some hospitals in England and Wales but less than 40% in others. Why the variation? Specialist input during admission is key, because it increases the likelihood that patients receive the drugs and referral to ongoing support that they need. It is important to note that the audit does not include data from hospitals in Northern Ireland, as this is obviously a devolved matter, although the National Institute for Cardiovascular Outcomes Research seeks the participation of our hospitals back home for future reports. I intend to follow up on that, and I will replicate every question I ask the Minister here to the Minister who has responsibility for this in Northern Ireland.

Regardless of where a person is diagnosed, National Institute for Health and Care Excellence guidance recommends that heart failure be managed by a multidisciplinary team with relevant expertise to optimise medications, provide the necessary information about heart failure and its treatment, and refer patients to other services, such as rehabilitation and palliative care, as needed. Again, it would be helpful to know from the Minister exactly where the multidisciplinary team plays its role.

Hospital data shows that, in 2018-19, only 41% of patients discharged from hospitals in England and Wales were recorded as having relevant follow-up with a member of the multidisciplinary team within two weeks of discharge. That figure concerns me. We need reassurance that that shortfall is being addressed, and that, in the long term, a much larger number of patients will have that treatment and this problem will no longer occur. Access to multidisciplinary team-led care is vital for improving outcomes for people with heart failure. As well as treating the acute episodes that bring someone with heart failure into hospital, it is really important that healthcare services treat each person as someone living with a long-term condition, giving them the tools to self-manage and access routine care in community settings.

Only 13% of patients admitted to hospital were referred to cardiac rehabilitation services at the point of discharge. Many of these services have been severely depleted by the pandemic. I understand the pressures that the Minister and the Government are under, and I know how hard they work to try to address these issues, but that really is a small number, so we need reassurance on that. I found evidence that some people are even disappearing, and others are moving online. Perhaps the follow-up is just not done in the way that it should be.

Rehabilitation services offer a range of support for patients, including exercise to improve cardiac function, advice on living healthier, and psychological and peer support. How important is peer support? It should be there, if at all possible. It is the family around the patient who give them the help that they need. Many people with heart failure who have been referred to rehabilitation services describe them as having a major positive impact on their wellbeing. Many rely on these services to help them exercise safely and to provide the emotional, psychological and physical support needed.

Very few people with heart failure are referred to palliative or hospice support, or are referred late. This is partly due to the disease trajectory of heart failure. Many patients can experience several acute episodes, after which they recover, making it hard to know when they are truly at the end of their life. This means that end of life care decisions may be made late for many heart failure patients, which limits the time for advanced care planning, and increases the chance that professionals without the necessary palliative care skills will deliver inappropriate care at the end of patients’ lives. I find that disturbing—we all do—but it tells us that we have to look at this issue. This reduces the chances of patients having their wishes around their end of life treatment being met.

Although these statistics are not published by nation, it is concerning to see that referrals to cardiac rehabilitation services are low, and that conversations about end of life care are not starting as early as possible during a patient’s heart failure journey. This disrupts their chances of receiving the care they need and of their wishes being met at this critical time. To avoid this, we must stop treating each healthcare touchpoint in isolation. By focusing on the person and taking a full pathway approach, we can avoid disjointed care and better address all care needs, including psychological support and end of life care. Clear leadership across the whole pathway is vital.

Strong leadership in heart failure services has led to significant improvements in care in Scotland. I often look to the Scottish health system with a purpose, because it is always good to share. They have some advantages and have taken good steps—I welcome that. The Scottish Heart Failure Hub is working to raise the profile of heart failure among decision makers and spread best advice across the nation. This has allowed it to respond quickly to the impact of coronavirus. Health services across Northern Ireland, England and Wales must follow suit, identify strong leaders of heart failure services, and give the resources needed to drive change across the pathway, both nationally and regionally.

Despite improvements in heart failure therapies over the past two decades, the risk of premature mortality remains high among heart failure patients. There are inequalities linked to characteristics including age, ethnicity and gender, and details such as geographical location and socioeconomic status. The variability in mortality can be linked to how quickly someone is diagnosed with heart failure and the severity of their condition at diagnosis, the number of times that they are readmitted to hospital, and whether they receive support following discharge.

Socioeconomically deprived groups have consistently worse outcomes than the most affluent. They face a 20% higher risk of hospitalisation, even after adjustment for other factors. This inequality has persisted for several decades. Again, I ask the Minister, what has been done to address this continual problem? Access to important services, such as rehabilitation and other relevant recovery and support services in primary care and the community, can also vary as a result of demographic factors, geographical location and socioeconomic status. It is vital that comprehensive demographic data be collected, so that we can better understand the inequalities in access to care and healthcare outcomes. This will help those with worse outcomes to receive better care. Government, and the Minister in particular, must act to ensure that no one is receiving substandard care just because of their age, ethnicity, or gender, where they live, or their economic status.

It is likely that the coronavirus pandemic has exacerbated all the issues that I have talked about—we all know that. Little did we know this time last year, when we were coming into the covid-19 episode, that we would still be in it a year later. I certainly did not. We all thought that the summertime would be better, but that was not the case. The Government’s strategy and response, here and in the devolved Administrations, together with the vaccine roll-out, has enabled us to look forward with positivity. I give the Government credit for this: there is no doubt in my mind that the Government pushed that and made it happen. From the regional point of view, we in Northern Ireland thank them. Over 600,000 of our people from Northern Ireland have had their covid-19 jab. On Monday coming, at 20 minutes to 5 in the afternoon in the Ulster Hospital, I will have my covid-19 jab. I will go and get the other one about eight weeks later.

While the NHS has rightly prioritised providing urgent and emergency care, the redeployment of clinical staff, combined with the need to maintain social distancing, has resulted in a significant amount of routine care and treatment being postponed. I understand that, but the question is: how do we address the problems that are being caused even now?

The postponed care and treatment include routine appointments that allow for review, opportunities for medication optimisation and access to treatments to prevent the exacerbation of conditions. These are the interventions that enable people with heart failure to maintain a good quality of life, and without them we risk patients becoming more unwell, adding to urgent and emergency care needs, and to a rapidly growing backlog of people for health services to deal with as we come out of the pandemic. That is being seen not just with delays to treatment, but with delays to diagnosis. Again, the issues are very clear.

Although we do not have figures for Northern Ireland, figures from NHS England show that completion of echocardiograms—as I mentioned before, these are scans that can detect heart failure, so it is very important for people to have them—fell by around two thirds, or 67%, in April and May 2020, compared with February 2020. While I understand that there was some improvement throughout the rest of 2020, for which I give credit, can the Minister say whether we have caught up yet and matched the figure from before the pandemic?

The use of echocardiograms has struggled to return to pre-pandemic activity levels, meaning that waiting lists have remained long—perhaps even longer than they should have been. As a result, thousands of heart failure diagnoses are likely to be delayed or even missed, with potential implications for people’s long-term health and quality of life.

The fall in the number of people presenting to hospital with heart failure has also been dramatic, dropping by 41% in England as we entered the second wave of the pandemic. I believe that there is limited information about how these missing patients may or may not have accessed care and support during this period. It seems that many people with heart failure have fallen through the cracks since the pandemic began, adding to the picture of disrupted and fragmented care. Again, I seek an answer to this question: has the Minister any figures or statistics that can identify these missing patients?

While some parts of the country lost heart failure services altogether during the first wave, due to redeployment of heart failure specialist teams to the initial covid-19 response, other parts maintained a skeleton service. The impact on services, combined with the continuing reduction in capacity to deliver face-to-face care, has meant that many people with heart failure have struggled to access the support that they need.

Organisations such as the British Heart Foundation—I work quite closely with it; indeed, I think it works quite closely with everyone—have stepped in to provide information, for example through the BHF’s heart failure online hub and heart helpline. It is vital that people can access the health and care services they need to live well during, and indeed beyond, the pandemic.

The BHF has highlighted in its report, “Heart failure: a blueprint for change”, that one of the main problems is that there is a lack of co-ordinated data outside hospital settings, and particularly in primary and community settings. This has meant that a significant proportion of the heart failure community has been largely invisible to the system during the pandemic, and opportunities to drive real system change have been lost. Again, the information and statistics that the BHF has been able to gather show that many people with heart problems went missing during the pandemic.

The covid-19 pandemic has clearly exposed the huge inequalities in care that people have been experiencing for years. I believe that now is the time for stakeholders across the health service and the Government, and parliamentarians, to come together and seize the opportunity to build back better. I want to ensure that each and every one of the 860 people diagnosed with heart failure in Strangford in the last year, and the thousands more across the United Kingdom of Great Britain and Northern Ireland who have received a similar diagnosis, has the opportunity to live a better quality of life, and that we all have an opportunity to create better outcomes for everyone living with this condition.

I have four asks—indeed, I made a few asks throughout my speech and I know that the Minister has been writing them down. However, there are four key asks that I hope the Minister will respond to at the end of the debate. I will conclude with them.

First, system leaders must take a full pathway approach to improving services. By focusing on the person and taking a full pathway approach, we can avoid disjointed care and provide better support for patients, including addressing their psychological and emotional needs, from diagnosis to end of life.

Secondly, we must stop just treating the acute episodes that bring someone with heart failure into hospital, and instead treat each person as someone living with a long-term condition, providing them with the tools to manage their condition and access routine care in community settings.

Thirdly, leadership across the pathway will be vital. Recruiting heart failure champions at regional and national levels—it is really important that we do this—will help to strengthen leadership and accountability for services, and lead to significant improvements in care.

Fourthly, collecting more reliable, comprehensive and timely data across the whole pathway could break down the barriers to improving heart failure services and drive real system change. I do not know how many debates the Minister and I have been at, but the issue of data comes up continuously. That data will prove where we need to focus the attention, and I think that is what we are likely to do.

In conclusion, for too long people with heart failure have not been given the chance to live well with their condition, and the pandemic has disrupted opportunities to make that a reality for more people. I believe we owe it to those people to finally address this issue and give everyone the opportunity to live well for longer. I thank those who are going to speak for their participation, and look forward very much to the Minister’s response.

--- Later in debate ---

[Jim Shannon]

First, I very much thank the hon. Members for North Ayrshire and Arran (Patricia Gibson) and for Birmingham, Selly Oak (Steve McCabe). The hon. Gentleman in particular referred to the APPG which was started up four or five weeks ago. We look forward to working with many others, and we will probably hold an inquiry about providing a better quality of life.

I am quite friendly with the hon. Lady, but I did not know that her father and stepfather both died from heart failure, which is a very personal thing. She also mentioned poverty and socioeconomic status—to which the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders) and I referred, and the Minister responded—and how that can impact on way of life, affecting us all. She also referred to tackling at source inequality and poverty. We all heard the Minister respond and how she understands that.

I thank the shadow Minister very much for his contribution. He, too, referred to the social and economic backgrounds in which people are severely impacted; to the pandemic’s impact on heart failure; and to late diagnosis, which we all realise is an issue.

In particular, I thank the Minister very much. I always do, but I mean it, because that was a very comprehensive response. We are all heartened by that. You would not have given me the time, Mr Mundell, to go through all the things on which the Minister responded, but what she said was marvellous—quickly, the cardiac rehabilitation input, the community diagnostic hubs, the NT-proBNP community specialists, the primary care network NICE guidelines and the GP surgeries gathering the data. As the Minister, the shadow Minister and we all said, data is very important—with the data, we can focus the strategy on where we want to be.

There are life changes to make and so a role for us all to play, including me. I am a diabetic today, because of my lifestyle. I did not know what I was doing—or I did not know until too late—and it was all that Chinese food, plus two bottles of Coca-Cola. I would not recommend it. My sugar levels were extremely high. Add a bit of stress to that, and all of a sudden, someone becomes a diabetic. I am guilty of that, but I am saying that we all therefore have a role to play.

I thank everyone for their contribution, you for your patience, Mr Mundell, and the Minister in particular for a comprehensive and helpful response. We appreciate it.

Question put and agreed to.

Resolved,

That this House has considered quality of life for patients with heart failure.