Radiotherapy: Accessibility

Jim Shannon Excerpts

Tuesday 18th July 2023 Westminster Hall

[Selaine Saxby]

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward a matter that is so important, which I think all of us here recognise. She has set the scene very well.

Another issue, which the hon. Lady is perhaps coming to shortly, is the shortage of radiotherapists across the United Kingdom. I understand that England is some 1,500 shy, and we have vacancies in Northern Ireland as well. The training takes five years, which means that it will be five years before the workforce, who are under pressure now, make gains, and that is if all the vacancies are filled. Furthermore, the age of current radiotherapists is an issue. Does the hon. Lady think that the Government need to take the initiative and put in place a visionary recruitment plan for the five-year period?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.

I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.

We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.

If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.

We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.

Defibrillators: Public Access

Jim Shannon Excerpts

Tuesday 4th July 2023 Westminster Hall

[Abena Oppong-Asare]

I thank the hon. Member for making such an important contribution and Lucky2BHere for the work it is doing. I acknowledge his constituent, whose life was saved by this work. Volunteers are doing a lot of work to raise money for defibrillators. I have seen it happen in my constituency recently, where the Friends of Lesnes Abbey and Woods have raised money for defibrillators.

I welcome the Minister’s announcement that £1 million will be available for community defibrillators. I am sure that he will set out how that money will be used and what impact it will have. Otherwise, the money risks being more of a PR exercise than an exercise in serious public health policy.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. She was very kind to mention me earlier—I brought the Automated External Defibrillators (Public Access) Bill to the House in 2020, as most Members will know. The Government accepted the need to have defibrillators in schools, which was really good.

The person who made that happen was Mark King, whose son Oliver died in March 2011 from a cardiac arrest—he was an outstanding young man who would have gone very far in the world. There have been 4,500 AEDs placed in schools, 70,000 staff have been trained in AED awareness and 47 lives have been saved. Two of the lives saved were in my constituency, because the defibrillators were in place at the right time. I congratulate the hon. Lady on securing the debate, and I look forward to doing even more. Perhaps the Minister can give an indication what the next steps will be.

[Abena Oppong-Asare]

This is not to blow his trumpet, but I thank the hon. Member for the work he has done on the issue and for the important points that he just highlighted.

Let me go back to my point about the Minister’s announcement of the £1 million that will be available for community defibrillators. I have questions about the timing of the announcement, just a few days ahead of this debate. What will the method of distribution be for the roll-out? I am concerned that Ministers will pitch community groups against one another in a cruel competition to see who wins. The danger is that the winners are either the best organised or have the loudest voices, or else are favoured in the eyes of Ministers. This does happen with schemes of this nature. Resuscitation Council UK warns about

“defibrillators being disproportionately stored in communities that have resources, amplifying the UK’s mismatch between Automated External Defibrillator…density and Out of Hospital Cardiac Arrest incidence. By instead targeting public-access devices in areas of poor health and high OHCA incidence, this initiative could increase the chance of survival in the most high-risk communities.”

There is also the issue of public awareness and knowledge. Each year, there are 60,000 out-of-hospital cardiac arrests in the UK, with less than one in 10 surviving. While immediate CPR and defibrillation can more than double the chances of survival, public access defibrillators are used in less than one in 10 cases. Defibrillators must be located in well-signposted, unlocked and easily accessible places that members of the community can access immediately in an emergency. They must be maintained and ready for use. By the way, the criminal justice system should throw the book at anyone convicted of vandalising public access defibrillators. Few crimes are more mindless than selfishly disabling a defibrillator that might save a stranger’s life. Does the Minister believe that the current range of punishments available to the courts for vandalising a defibrillator is adequate?

As the House will know, there is a national database of locations of defibrillators. It is called The Circuit and is maintained by the British Heart Foundation and the NHS. I pay tribute to Resuscitation Council UK and St John Ambulance for their work, but the database is not complete. The Circuit currently has more than 70,000 defibrillators mapped, but there are estimated to be between 100,000 and 200,000 devices in the UK. This means that emergency services, including the ambulance service, might not be able to direct people to a defibrillator to save someone’s life. Will the Minister explain how that can be acceptable and what the Government are doing to rectify the situation?

[Jim Shannon]

The hon. Lady is right to outline the fact that many people do not necessarily know where defibrillators are located, and there is a need to ensure that that happens. Does she agree that one thing that should happen—maybe the Minister can answer this question—is the teaching of CPR, which is crucial to ensuring that people feel confident enough to use the apparatus of a defibrillator? Does she feel that the Minister should take that issue on board as well?

NHS Long-term Workforce Plan

Jim Shannon Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) is looking at how we deliver more services within the existing contract, and at what incentives and reforms can be put in place to ensure that the parts of the country that find it hardest to recruit dentists are best able to do so, through both our domestic supply and international recruitment.

[Jim Shannon (Strangford) (DUP)]

I welcome the Secretary of State’s statement and the positivity he is trying to bring forward. The NHS workforce plan has concluded that the number of places in medical schools each year will rise from some 7,500 to 10,000, but in Northern Ireland it is a very different story: I know it is a devolved matter, but the Royal College of Nursing is facing cuts that could result in the number of places falling to 1,025 per academic year. Will the extra money that the Secretary of State announced be subject to Barnett consequentials? I know he is always keen to promote all this great United Kingdom of Great Britain and Northern Ireland together, so what discussions has he had with the Northern Ireland Department of Health and the Northern Ireland Assembly to ensure that Northern Ireland is not left behind? When we are crying out for staff, our students should have a real opportunity to learn and work in the NHS field.

[Steve Barclay]

Barnett consequentials will apply to the £2.4 billion funding over the five years. In respect of new roles, regulatory changes apply on a UK-wide basis. The plan itself is for the NHS in England, but we stand ready to work with partners across the United Kingdom where there is shared learning on which we can work together.

Bladder and Bowel Continence Care

Jim Shannon Excerpts

Thursday 29th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you for allowing me to speak, Sir Graham, on the subject of bladder and bowel continence care. I thank the hon. Member for South West Bedfordshire (Andrew Selous) for securing and leading the debate. It is not an easy subject to talk about—it is quite difficult—and for us men it is even more difficult because we usually try to avoid these issues or put them off, so it is good to air the subject for those who have these problems, and to ensure that they know that these things are better understood by the Department of Health and Social Care, by the Minister and by the shadow Minister.

I recently met those behind the Dispose with Dignity campaign. They work closely with Boys Need Bins to raise awareness of male incontinence—bowel or bladder—and to help to break the taboo and the silence around this experience for men. I believe that this debate will be the springboard for that aim. That is why I am here. I am happy to add my support to the hon. Member for South West Bedfordshire. This is the platform and place to ensure that this debate is heard.

In the UK, somewhere between 3 million and 6 million people experience urinary incontinence. Although leaks have traditionally been seen by society as a women’s issue, as the advertisements on TV would indicate, one in three men aged over 65 are estimated to have urinary incontinence. One in eight men will be diagnosed with prostate cancer and some will experience incontinence as a side effect of their treatment. As many as 60% of men who have a radical prostatectomy may experience urinary incontinence.

That brings me to my first questions to the Minister, who always grasps the issues that we bring to him and responds in a positive fashion. What are the numbers for those with prostate cancer? Are those numbers increasing? Are more men having prostate problems than in the past? What is being done by the Department of Health and Social Care to raise awareness of the symptoms of prostate cancer?

As I said earlier, many men do not go to see the doctor when there is something wrong. They should. It could be to do with pride, or embarrassment or shame, or just because they do not want to bother anybody. Whatever it may be, it needs to be addressed. I hope the Minister can tell us what is being done. The hon. Member for South West Bedfordshire said that sometimes men do not go to see their doctor even when they have had symptoms for five years; that is just too long to wait.

A poll of 500 men, half of whom have been diagnosed with prostate cancer—which shows that they are more likely to have these difficulties—shows that some men are resorting to desperate strategies to overcome the near certainty that they will be unable to find somewhere appropriate to dispose of used products outside the home. The survey found that their strategies include taking a bag out with them that they empty when back at home, and asking their partner to keep used products in their handbag, which creates a public health concern by its very nature, is unnecessary in the times we live in, and adds further pressure to partners who may also be in a caregiving role. They love their partner—that is never in doubt—but it can be quite challenging.

Approximately one in three men surveyed—32%—said that they were wearing pads longer than advised, which can cause further health risks. A quarter, or 25%, acknowledged that they have resorted to flushing them down the toilet, even though the water companies and the health service say that should not be done. Their initial response is to get rid of it, which is perhaps why that is happening.

Of the 504 men surveyed with experience of urinary incontinence, two in five, or some 44%, experience anxiety about using public toilets; more than a third leave the house less often—in other words, they just do not bother going out, because they feel that is the best way to deal with it; and almost eight in 10 stated that they feel anxious about a lack of suitable facilities when leaving the home, which is another indication of their concerns.

More than one in four men feel depressed about the impact that experiencing urinary incontinence has on their life, with that figure soaring to 100% of those aged 16-25—the hon. Member for South West Bedfordshire gave an example of a young fella at work. Everyone will agree that this situation is unacceptable. Mental health support should be made readily available.

There is currently no obligation on businesses, local councils or organisations with bathroom facilities to provide male sanitary bins in male toilets. It is time for that to be considered. The Government must change the situation so that men who experience incontinence can dispose of products easily, hygienically and with dignity, offering them the opportunity to live a better quality of life, free from embarrassment, stress or shame.

The Dispose with Dignity campaign is calling for the Health and Safety Executive-approved code of practice and guidance to be updated—the Minister’s thoughts on this would be helpful—to ensure that men have adequate access to male incontinence bins, thereby enabling them to have a better quality of life, free from shame and embarrassment. If that guidance is not updated, men will be forced to resort to unsanitary or environmentally damaging means of disposing of incontinence pads. Providing bins in disabled toilets is not an acceptable solution on its own; distinct and separate provision must be made for men in male toilets.

Urinary infection is not experienced exclusively by older men, so support, guidance and provision for all men is crucial. We have to look at the bigger picture— the spectrum of men from 16 to 66. I had a very positive meeting with the Dispose with Dignity campaign. Is the Minister prepared to meet that group? I think the hon. Member for South West Bedfordshire seeks the same thing. Even going through the civil service would be a positive step forward. It would enable other interested MPs to understand the physical and mental health implications of not having access to adequate sanitary provision, and to discuss potential regulatory solutions.

I believe that we can and must do better to ensure that men and women have dignity in their bladder and bowel continence care. I know that the Minister will take all that on board and will consider how we can do this better. This debate is the first step in achieving just that.

Mental Health In-patient Services: Improving Safety

Jim Shannon Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

It is extremely important that we get support to young people, because many mental health cases start at a young age. Indeed, data suggests that as many as 50% of mental health cases crystalise by the age of 15, so it is important that intervention is made early. Our programme in schools, for example, is focused on that. It is also important for us to have better community support, which is why we are looking at what mental health support can be offered when people phone 111 and at how we can better scale up the use of digital apps that offer support, given that people often access information through their phones or digital channels in a way that they did not five or 10 years ago.

[Jim Shannon (Strangford) (DUP)]

On behalf of my party, I express my sympathy to all the families who have been bereaved and hurt by what has taken place. I thank the Secretary of State for his announcement about the statutory inquiry and the new powers. It is clear to those of us in the House who listened to his statement that he is committed to making patients’ lives better; we thank him and I put it on the record that he deserves credit for that. I know that the Secretary of State is always keen to share progressive strategies and policies with the regional Administrations; he is on record as having said that. It is clear that many lessons can and will be learned, so does he intend to share them with the regional Administrations?

[Steve Barclay]

I am extremely keen to share our experience, so that we can learn from each other. As the hon. Gentleman knows, this is a shared challenge across our United Kingdom. The pandemic shone a spotlight on the mental health pressures that many people face, and I am extremely keen to work on a UK-wide basis with colleagues to ensure that we learn from each other as we take these measures forward.

Ultra-processed Food

Jim Shannon Excerpts

Wednesday 21st June 2023 Westminster Hall

[Suzanne Webb]

I thank the hon. Member for her intervention. Again, we are having the same conversation and I hope to answer her question later in the debate.

Ultra-processed food makes up half of the total purchased dietary energy in the UK. In fact, when it comes to UK children, more than 60% of the calories consumed comes from ultra-processed foods such as frozen pizza or fizzy drinks. All that food is linked to obesity, which causes me great concern. In England, 64% of adults and 40% of 10 to 11-year-olds are either obese or overweight. Those figures are taken from the Dimbleby report. They are staggering.

Figures from 2019-20 show that 1.5 million years of healthy life are lost to diet-related illnesses every year. Tackling obesity costs the NHS about £6.5 billion a year and is the second biggest cause of cancer. To put it starkly, it is a ticking timebomb. Some might say that the ticking has stopped and the bomb has already exploded.

Some 100,000 people have a stroke each year. There are 1.3 million stroke survivors in the UK, thanks to the advances of medicine and medical interventions such as blood pressure tablets, statins and so forth. Children who have high levels of ultra-processed food consumption have been shown to have high levels of cholesterol, increased weight and tooth decay. Obesity has been brought to the fore due to covid. Living with excess weight puts people at greater risk of serious illness or death, with risks growing substantially as body mass index increases.

The cost of all that to the NHS is significant, from prescription drugs and GP and out-patient appointments to the orthopaedic impacts on limbs of weight bearing. Of course, the greatest impact is on NHS hospital admissions. Tackling obesity is one of the greatest long-term health challenges that this country faces. Ultra-processed food is one of the main routes to all obesity issues, because the food is mainly high in fat, salt and sugar. It is marketed aggressively, to the detriment of our health, feeding a growing obesity crisis and feeding our arteries full of fat.

The food supply chain endorses and promotes products that are linked to serious health outcomes, marketing products for which the motivation is profit over health. Certainly at the cheaper end of the market, ultra-processed food does not provide a fully nutritious meal. The marketing and branding of ultra-processed food is relentless. Have we ever seen a high-profile marketing campaign for anything that falls off a tree or comes out of the ground? The answer is no. Instead, we see highly aggressive campaigns selling us the dream of so-called delicious meals. In reality they are highly addictive foods and, without moderating consumption, contribute significantly to poor health outcomes.

I am slightly disappointed that the Government are not proceeding with the plan to ban two-for-one junk food deals. That plan, which has been delayed, would have prevented shops from selling food and drink high in fat, salt and sugar through multi-buy deals. However, at a time when household budgets are under continuing pressure from the global rise in food prices, it would not be right to restrict those options. The principal issue for health outcomes is not so much two-for-one deals anyway; it is the food itself, and we should not lose sight of that. Buying multi-deals does not matter; it is the product itself that matters. That is what we should focus on: trying to eliminate addictive products that are creating poor outcomes for our children.

A good step forward would be an advertising watershed—a 9 pm watershed has been mooted—that would restrict the TV advertising of foods that are high in fat, sugar and salt, not forgetting those online. Current advertising regulations do not go far enough in protecting children from a significant number of unhealthy food adverts. I think that we have all seen the continual adverts for pizzas when we watch family programmes, certainly at the weekend. Those should not be allowed. Half the time, I am moments away from going online to order a couple of those pizzas, but I don’t do that any more.

[Jim Shannon (Strangford) (DUP)]

Don’t order a couple—just order one.

[Suzanne Webb]

Jim, it would be two.

Children and young people are not sufficiently protected from exposure to adverts for unhealthy products. It has been pointed out to me that Government research shows that TV and online advertising restrictions on food that is high in sugar and salt could reduce the number of children with obesity by more than 20,000. I therefore urge the Minister to look at that and bring the timeline forward. I think at the moment it is going to be 2025, but we could and must move faster. There should be a watershed for adverts for both ultra-processed food and products high in fat, sugar and salt, sooner rather than later.

A bigger light must be shone on the manipulative marketing tactics that companies use to lead us into consuming and over-consuming foods that are bad for our health. My office manager and my comms guy are advocates of disgusting microwave burgers, which further strengthens my resolve on the matter. When I first looked at the product that they are addicted to and that they shove in that microwave, I thought, “What is not to love?” It says that it is 100% beef—it tells me three times that it is 100% beef—and with that look, I was hooked. I thought, “I want one of those,” but then I read the side of the packet. It is in fact a composition of beef fat, soya protein, salt, wheat flour, stabiliser E451, dextrose, sugar, egg white powder, yeast extract, something called hydrolysed soya protein, barley malt extract and flavourings. It is 44% beef, so not quite the 100% beef that was advertised. In fact, it is a concoction of emulsifiers, preservatives, colourings and other things, which made it look like the tastiest 100% beef burger in the world. The beef was 100% beef, but it was actually only 44% of the burger itself. That is incredibly misleading. I nearly went out and bought it myself.

The obesity crisis is not helped by the overly aggressive marketing of highly addictive food. Let’s face it: if advertising did not work, companies would not do it. That is what encourages us to go out and buy such products. We saw it in the cigarette market. Changes were needed to advertising, starting way back in 1965, when the poor health outcomes from smoking were being understood. It was many years before one of the biggest health interventions, which was the ban on smoking in public places in 2007. I was one of those smokers many, many years ago. I think I gave up before it was banned in public places, but I can tell hon. Members that smoking is highly addictive, and it was sold to be highly addictive.

When I worked in logistics, the company pushed out the cigarettes into big lorries, which took them to the centres to sell. Even there, packs of 200 cigarettes were handed out to employees as an incentive at the end of the week: “Well done—they have done a great job.” People were allowed to smoke in their offices, although I believe that at the time they were not supposed to. Unhealthy food is now being peddled and pushed in a similar way. We really have to think about that. Something very akin to what happened with cigarettes is happening with ultra-processed food.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is indeed a pleasure to speak in this debate. I thank the hon. Member for Stourbridge (Suzanne Webb) for raising the issue. She comprehensively set the scene and, with the interventions, added to the understanding of why the debate is so important. My research for today mimicked some of the research carried out for the debate on fatty livers a number of weeks ago, and the links are clear. I noted during that debate that my good friend the Minister of State, the hon. Member for Colchester (Will Quince), noted that there is no definition of “ultra-processed”. That is an important starting point so that we can begin to address the problems of a highly ultra-processed diet.

The hon. Member for Stourbridge referred to diabetes, and others have as well. I am a diabetic today because for a long period of time—probably a number of years, I suspect—I was the person who bought a Chinese five nights a week with two bottles of coke. That was the way I was; that was the way I lived. It saved me going home to get something to eat, and I ate in the office. Added to that was probably a fair level of stress, and all of a sudden I was almost 17½ stone. I never realised just how the weight had crept up, and I went to see my doctor. My doctor always says “I’ve got good news and bad news for you.” I said, “Well, tell me the good news first.” “The good news,” he said, “is that you’ve got a heart like an ox. But the bad news is that you’re a diabetic.” That is a fact of life.

That was my lifestyle. I was to blame; I will not blame anybody else for that. I am not blaming the Chinese people who sold me the Chinese, nor the shop that gave me two bottles of coke, because it was something I did and I realised what was happening. I am now on medication, so that has helped to administer and control my diabetes. The point that I am making is that we have to be careful what we eat. What we eat is what we are, and, indeed, what we become.

As has been noted, the UK is at the top for ultra-processed foods in Europe. When I say that, I include packaged baked goods, snacks, fizzy drinks, sugary cereals, ready meals containing food additives, dehydrated vegetable soups and reconstituted meat and fish products. They often contain high levels of sugar, fat and/or salt, but lack vitamins and the fibre that I, as a diabetic, need. Those were all noted in the BMJ report on ultra-processed foods in 2019.

Such foods are thought to account for around 25% to 60% of the daily energy intake in many countries. Previous studies have linked ultra-processed foods to higher risks of obesity, high blood pressure, high cholesterol and some cancers, but firm evidence is still scarce. There is some evidential base to be arrived at.

Results in the BMJ report showed that a 10% increase in the proportion of ultra-processed food in a diet was associated with significantly higher levels of overall cardiovascular disease, coronary heart disease and cerebrovascular disease, with increases of 12%, 13% and 11% respectively. I am my party’s health spokesperson, so I am very conscious of health issues. In contrast, the researchers found a significant association between unprocessed—or minimally processed—foods and lower risks of all reported diseases.

Results from another test showed that higher consumption of ultra-processed foods—more than four servings per day—was associated with a 62% increased risk of all causes of mortality, compared with a lower consumption of fewer than two servings per day. In her introduction, the hon. Member for Stourbridge referred to ordering a couple of pizzas. I was not responding to her facetiously, but the point I am making is that, yes, it is easy, and, as the hon. Member for Glasgow North West (Carol Monaghan) said, when people start, they want to keep on eating, and that is a problem.

For each additional daily serving of ultra-processed food, mortality risk increases by 18%. It is clear that more research should be done, and I join colleagues who have spoken—including the hon. Member for Stourbridge—and of all those who will speak afterwards to ask the Minister, who always responds very positively and helpfully, and our Government, to get the information and begin the public awareness campaign that must follow those results.

The health of our nation is the wealth of this nation—this great United Kingdom of Great Britain and Northern Ireland—and we must take the necessary steps to make people aware of the dangers of their diet choice, because it is a choice. Hopefully today is the next step, perhaps maybe the first step, in that journey to better health.

Smokefree 2030 Target

Jim Shannon Excerpts

Tuesday 20th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for securing this important debate. I am always pleased to come along and make a contribution.

Although Northern Ireland does not yet have a smoke-free target, I strongly support the Smokefree 2030 ambition. I welcomed the Minister’s announcement in April, which set out a number of bold and innovative measures. Putting in place the measures needed to make England smoke free by 2030 will enhance efforts to tackle smoking across the whole United Kingdom. Although Northern Ireland and the other devolved nations hold responsibility for their own health policies, the Government in Westminster maintain responsibility for UK-wide policies, which will impact progress in the devolved nations. I know that the Minister is always keen to respond in a positive way; perhaps he could confirm that discussions have taken place and tell us their outcome.

I particularly welcome the commitment to hold a consultation on pack inserts. All of us have probably called for that—I know I have—and I am pleased to see that it has been adopted by the Government. Cigarette pack inserts providing health information have been required in Canada since 2000, and there is substantial evidence that they are effective. Research carried out in the UK supports their use here too. I hope that the Minister will confirm when the consultation will open—that is my first question.

As the Minister knows, healthcare services are under severe pressure across the United Kingdom. Tackling smoking, which is a leading preventable cause of death and disease, killing 2,300 people in Northern Ireland each year, is vital if we are to ease that pressure. In Northern Ireland, cases of lung cancer among men are projected to increase by 74% by 2035. That is massive, but the figures are even more massive for women, for whom cases are projected to increase by 91%. Smoking is responsible for over seven in 10 cases of lung cancer. Therefore, real, targeted action needs to be taken. I am keen to get the Minister’s thoughts on that.

In 2016-17, the estimated hospital costs for treating smoking-related diseases in Northern Ireland were £172 million. If we do not take urgent action now to reduce smoking rates, our healthcare service will continue to face huge pressure. Analysis by Cancer Research UK shows that current rates of decline in Northern Ireland will not achieve the smoke-free ambition of smoking rates of 5% or less until the late 2040s, which is a decade after England. That means that our deprived populations will not be smoke-free until 2050. We need to step up efforts to achieve a smoke-free future at both the devolved level and the UK level.

I was interested to see the Minister’s announcement on how the Government intend to crack down on illicit tobacco and vaping products. We can give some credit to the Government, and to the Minister in particular, for the action they have put forward. The sale of illicit tobacco undermines efforts to reduce smoking rates. It is concentrated among poorer smokers and disadvantaged communities, contributing to higher rates of smoking. Retailers who sell illicit tobacco are much more likely to be happy to sell to children, so the illicit market also poses a particular risk to children’s health. Addressing the issue requires tackling not just the supply but the demand for illicit tobacco in communities where smoking is endemic.

The UK has made great strides in reducing the trade of illicit tobacco in the last two decades, with a comprehensive anti-smuggling strategy, which has more than halved the market share of illicit cigarettes, from 22% in 2000-01 to 9% in 2021. The Government need to be thanked and congratulated for that. It is a very positive and clear strategy, and it is working, but we need perhaps to sharpen it up a wee bit. There is still more to be done.

The announcement that His Majesty’s Revenue and Customs and Border Force will publish an updated strategy to tackle illicit tobacco is welcome. Northern Ireland, with its land border with the EU, is particularly geographically vulnerable to illicit trade run by criminal gangs, and we have a proliferation of paramilitary groups on both sides using the illicit tobacco sector to create moneys for their criminal uses. Border Force and HMRC have a key role to play in tackling smuggled tobacco, especially in our most disadvantaged communities, where smoking rates are highest. It is not the Minister’s responsibility, but perhaps he could give us some idea about how that co-operation between the Police Service of Northern Ireland, Garda Síochána and the mainland police here is working.

I also welcome the Minister’s commitment to adapting the tobacco track and trace system to strengthen enforcement and target the illicit market. In particular, the Minister’s commitment to explore how to share with local partners information about who is registered on the track and trace system is critical. Will he confirm whether sharing information with local partners from the track and trace system overseen by HMRC will be part of the new strategy? It is important that it is. The Minister is nodding, so I expect that the answer is yes, which would be good news. Will he also tell us whether the new illicit tobacco strategy will be launched before the summer recess? As MPs, we always like timescales—I know I do, so perhaps he could respond positively to that question.

Podiatry Workforce and Patient Care

Jim Shannon Excerpts

Tuesday 20th June 2023 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[Jim Shannon (Strangford) (DUP)]

I declare an interest as a diabetic, so I understand exactly what the right hon. Gentleman is saying. I am aware of the silent but vital work carried out by podiatrists throughout the United Kingdom. In my constituency of Strangford, a nursing home where funded podiatry appointments were cut was still visited by a podiatrist. He was able to attend, but he treated people without taking any money. Does the right hon. Gentleman not agree that access to podiatry for the elderly in care homes should be fully funded and that they should not have to rely on family or kind-hearted podiatrists to get their health needs taken care of?

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Dowd.

Let me say first how grateful I am to the right hon. Member for Hayes and Harlington (John McDonnell) for raising this important issue. He said that he did not know a huge amount about podiatry. I must say that I did not either, because I am not the Minister with responsibility for primary care, but I do have responsibility for the workforce. One of the powerful aspects of debates of this nature is that they force not only Ministers but the Department to focus on a particular issue and give Members from across the House—including the Minister —a crash course in it. As a result of my research ahead of the debate, I know far more about podiatry than I did yesterday. I thank the right hon. Gentleman for that.

I know having undertaken that research—and, indeed, from my constituency inbox—that podiatrists are a hugely important part of the workforce. They are an invaluable part of our NHS, as the right hon. Gentleman eloquently set out. I join him in saying how hugely grateful I am for their vital work supporting patients day in, day out across our NHS. The Government know that personal care that is responsive to people’s needs is essential and the service that podiatrists provide to local communities is important in helping people maintain their mobility, independence and wellbeing.

As the right hon. Gentleman rightly pointed out, early identification of foot problems helps to prevent or delay the onset or exacerbation of long-term conditions, thereby reducing the risk of wounds, infection and, ultimately, amputation. He also pointed out that foot problems have a significant financial impact on the NHS through out-patient cost, increased bed occupancy and prolonged stays in hospital. Working mainly at the heart of primary care, podiatrists are well placed to ensure patients receive a quality foot screening service, as well as the appropriate onward referrals for foot and lower-limb interventions.

The right hon. Gentleman correctly pointed to our ageing population. That is not exclusive to us; it is a global problem, certainly in the western world. I say “problem” but, actually, it is a great thing that people live longer. However, it is a challenge for health systems, because people are living longer with long-term conditions and complex needs that we need to ensure we can support and manage as a society. As the right hon. Gentleman pointed out, the need will continue to grow.

The right hon. Gentleman raised a number of issues but, with his permission, I will focus mainly on the workforce rather than on podiatry more generally. I recognise that the workforce remain under sustained pressure, having worked tirelessly throughout the pandemic to provide high-quality care for those who need it. I recognise that podiatrists’ role in supporting our NHS is as important as ever. It is vital that we support the workforce both now and in the future.

[Jim Shannon]

The right hon. Member for Hayes and Harlington (John McDonnell) referred to volunteers. I have them in my constituency, and if it were not for the volunteer podiatrists who give their time every day of the week, free of charge, I believe the NHS would be suffering even more. That is why we need to push for the recruitment that he referred to.

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

Hospice Services: Support

Jim Shannon Excerpts

Wednesday 14th June 2023 Westminster Hall

[Paul Holmes]

My hon. Friend, who is my past employer, makes a good point—although not as good as when I wrote his speeches. He is absolutely correct that there is uncertainty about that grant, and about how it is handed out by local commissioning groups. It is not getting through to children’s hospices, and I hope the Minister will have something to say about tweaking the way that grant is allocated to local areas.

[Jim Shannon (Strangford) (DUP)]

Sixty-six per cent. of adult hospice income and 80% of children’s hospice income is raised through fundraising—bake sales, charity shops and marathons—and Marie Curie depends on that more than others. Does the hon. Gentleman agree that we should put on the record our thanks to the volunteers who make the effort and get the money in?

[Paul Holmes]

The hon. Gentleman is absolutely correct. I only have to see Mountbatten local networks of fundraising and charity supporters, whether in charity shops or in fundraising roles. I am honoured that I may become part of that community—if I land on the ground safety, alongside Miles—but it will not end there. I will carry on fundraising for a fantastic cause.

When Mountbatten hospice wrote to me in January to outline those extraordinary energy costs, I was happy to write on its behalf to the Secretary of State. Unfortunately, the energy bill relief scheme and the later energy bills discount scheme did not ease the pressures, as the hospice was not eligible. Mountbatten still faces unsustainable pressure, as do hospices across the United Kingdom.

Of course, there are some people who ask whether a charity should not take the majority of its funding from its local community—from donations and contributions, rather than from Government funding. That is a fair question, but unfortunately it does not provide a solution, especially considering that community donations already support 70% of Mountbatten’s funding, which it has calculated to be the limit of what it can ask from people.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

This is one of those occasions when being called last means I gain a minute, so I am pleased to have the opportunity to do just that—thank you, Ms Nokes. I thank the hon. Member for Eastleigh (Paul Holmes) for setting the scene so well, and for giving us the chance to participate in a debate that moves us all. Some Members have told very personal stories.

I put on the record my thanks to all the charities, groups and staff who give hospice care, and give families, and us in this House, so much across this great United Kingdom. Our NHS is under immense strain, and we completely understand that there is a finite budget, but questions have to be asked about the use of funds when we look at those at the end of their lives living in conditions that are not acceptable. Rising costs from energy, food prices and staff costs, which are required to meet expected NHS pay rises, mean that hospices across the United Kingdom of Great Britain and Northern Ireland are collectively budgeting for a massive deficit of £186 million this year. Unless we are going to understaff, under-feed, under-medicate or under-heat our dying patients, more money is needed—that is the bottom line.

It is always a pleasure to see the Minister in her place. She grasps the situation very well. She is a lady well known for her compassion and understanding, and I look forward to her response. I agree with Hospice UK, which says that hospices need financial support to continue to offer their essential services. Government funding of £30 million for UK hospices to offset the increased cost of energy bills in the year ahead needs to go beyond the energy bills discount scheme. Additional funding for hospices from the Department of Health in Northern Ireland is also needed; I do not know whether the Minister has had a chance to consider that. The fact is that funding for hospice care is unsustainable. By the end of the year, 86% of hospices will be impacted by increasing energy prices. They need to keep medical machines running and their in-patient units warm for those in their care. Some 71% of hospice expenditure is on staff, which is a massive issue. As I referred to in an intervention, charities and volunteers run 66% of adult hospices and 80% of children’s hospices.

Over the next few years, I and others, as we often do, will help those hospices. Marie Curie, based in Knock Road in Belfast, is a hospice that I have visited to see people who have now passed away. I understand what such hospices do. The facts are clear: savings can always be made with improvements, but on nowhere near the scale that is needed. I therefore believe, with respect, that the Government and the Minister must man the breach. We regularly prioritise human rights in other nations, and the most basic right to a good death must be prioritised in the United Kingdom. That is what we want. It is a very simple request, and I hope the Minister can answer in a positive fashion.

[Caroline Nokes (in the Chair)]

That brings us to our Front Benchers. I call Patrick Grady.

New Hospital Programme and Imperial College Healthcare NHS Trust

Jim Shannon Excerpts

Tuesday 13th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to speak in this debate, and I congratulate the hon. Member for Hammersmith (Andy Slaughter) on securing it on this issue. He is indeed a hardy, dedicated and assiduous MP. I say that in all honesty, because I think the good people of Hammersmith have an excellent MP, and they should be very proud of the efforts he makes on behalf of his people in the Chamber and Westminster Hall.

This debate is about the new hospital programme, which applies to the UK mainland. I have come along to add my support to the hon. Gentleman, as I do for many right hon. and hon. Members, here and in the main Chamber. That is my purpose for being here. I am also here to discuss the new hospital programme, which was announced at the 2019 Conservative manifesto launch and would have delivered 40 new hospitals in the UK by 2030. I understand the reasons for the delays—the covid pandemic has focused attention elsewhere and taken away much of the funding—but there is a real need, and hon. Members have made that case today on behalf of their constituents.

I also understand the position of the hon. Member for Hammersmith on the refurbishment works at Charing Cross and Hammersmith Hospitals. As MPs, we want the best of care, access and opportunities for our constituents, and delays to any work are often frustrating, so I understand the request very well, and support his position and his ongoing commitment to his constituents.

I am pleased to see the Minister in his place. He responded to the first debate in Westminster Hall this morning on cancer very well. If he answers hon. Members in the same way in this debate as he did in that one, they will be more than satisfied. With the support of the new hospital programme, Imperial College Healthcare NHS Trust is beginning the next phase of redevelopment planning work for its three main hospital sites, all of which are included in the 40 new hospitals that the Government have committed to building by 2030.

I will quickly give a Northern Ireland perspective: what is happening here is also happening back home. It is important that we all remember that the demands for hospital care and better hospitals are not just in London; they are across the whole of this great United Kingdom of Great Britain and Northern Ireland. Northern Ireland has around 3% of all hospitals, with 40 across the Province.

In a constituency neighbouring mine, Belfast East, we have Ulster Hospital, which is the main hospital for us and is currently undergoing a £261 million revamp being done in stages. I believe that we are now going into section C of this refurbishment. So far there have been developments to a 30,000-square-metre in-patient block that is six storeys high, with a day surgery unit, an endoscopy unit, an angiography unit, and a cardiac investigation unit, with 12 in-patient wards. It is very much a modern hospital and very much of the modern programme that we have in Northern Ireland. The Minister is not responsible for that, but I just wanted to put it on record.

In order to clear our waiting lists, it is crucial that we do all we can to update outdated and old facilities. For a modern society and a fully functioning working hospital, things need to be modern and up to date. That is what the hon. Gentleman has asked for, and that is important. Hospital waiting lists in Northern Ireland are supposed to be banished by 2026—that is pie in the sky, in all honesty—according to a roadmap set out by the former health Minister, Robin Swann. More than 330,000 people are on some sort of waiting list in Northern Ireland and the new elective care framework proposes a £700 million investment over five years. It is important that the Government are committed to the requests of the hon. Member for Hammersmith and the hon. Member for Westminster North (Ms Buck), and to other requests that will follow.

[Sir Mark Hendrick (in the Chair)]

Order. Health is devolved in Northern Ireland, and the focus of this is very much on—

[Jim Shannon]

That is what I have done in my comments, Sir Mark. I just want to give you the example of Northern Ireland—

[Sir Mark Hendrick (in the Chair)]

But it is not a speech about the Northern Ireland health service, surely.

[Jim Shannon]

I have every hope that the Department of Health and Social Care will be able to give us timely updates on hospitals in England. This is a discussion I always have with those in the devolved Assemblies. We must—I conclude with this—do our best for our constituents and ensure that the collective facilities are in place to serve their needs. I hope the work in the constituency of the hon. Member for Hammersmith will commence soon as some reassurance for his constituents. He put his case forward—the Minister, I am sure, will respond—and I support him in what he has requested.