Eye Health

Jim Shannon Excerpts

Thursday 15th December 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered a blueprint for eye health in England and the devolved nations.

I thank the Backbench Business Committee for scheduling this debate. The hon. Member for Battersea (Marsha De Cordova) was going to be here, but she has a funeral to attend. As she is the chair of the all-party parliamentary group on eye health and visual impairment, her contribution would be significant. The funeral was at half-past twelve, so it is probably ending about now, and she said she would try to get here. Her contribution to this debate would be of significance to all of us here, particularly the Minister.

I also thank the Eyes Have It partnership, which includes the Royal College of Ophthalmologists, the Macular Society, the Royal National Institute of Blind People, the Association of Optometrists, Fight for Sight and Roche, for its support. The name of the group is my favourite of all the names. The work that the group does is incredible. What could be better for a Westminster Hall debate in the House of Commons than the Eyes Have It? When the ayes have it, that means we are on the right road. I am pleased to see the Minister in his place. My staff have been in touch with him, so he will have a fair idea of what we are trying to achieve.

I am also pleased to see the Labour spokesperson, the hon. Member for Tooting (Dr Allin-Khan), who brings much knowledge from her own personal job to the debate. I look forward to her contribution. I also welcome the hon. Member for Motherwell and Wishaw (Marion Fellows) from the Scots Nats. We speak in all these debates, and it is hard to find a margin of difference between the two of us when it comes to our proposals—indeed, between the three of us.

I thank the Minister for his presence. I know the issues raised will be heard and acted on, which is what we want in these debates—a responsive Minster with a good ear to listen and to grasp the issues, which I know he does, and build on what we say. I am ever mindful that health is a devolved matter, so my contribution to a blueprint for eye health in England and the devolved nations will be from a Northern Ireland perspective. I know the Minister will respond specifically to what we have here on the mainland. The spokesperson for the Scots Nats will add her knowledge from Scotland. I like to hear the contributions from our Scottish colleagues because they have a health system and an eye care system that might be the envy of many of us.

Today’s debate seeks to build on the previous debate, held in January 2022, on eye health and macular disease. It was a Tuesday morning debate, so probably more amenable to those who wanted to attend. Sometimes on a Thursday afternoon, when there are difficulties with trains and suchlike, the people who could be here are not. Since the debate in January 2022, some good things have happened. NHS England has appointed its first national clinical director for eye care. At the same time, England has established integrated care systems, which empower local areas to increasingly shape their healthcare provision. What has been done therefore has a local, community impact.

At present, every nation of the United Kingdom except England has some form of eye care plan, whether it is self-contained or part of a wider strategy. I am sure that the Minister will give us his thoughts on that. However, the content and focus of the plans vary significantly, as I am sure we will hear from the shadow Minister, the hon. Member for Tooting. Additionally, policy progress has often been fragmented, and what planning guidance there is for services in England does not contain longer-term ambitions or measures for improvement. I hope that the debate will perhaps outline another, stronger direction. If we can do that, the debate will have highlighted what we want it to highlight.

A plan for England would empower the NCD by providing a framework that enables effective oversight of ICSs without undermining local autonomy. It would create a shared long-term vision that encompasses primary, secondary and community care, and that future-proofs services. If we can achieve that, we will have done well. At the same time, it could provide a basis for increased alignment between nations, and I hope that the Minister will give us some pointers on how to address this issue better together. The fact that I always make this point does not weaken it: we can learn how to do better from all the regions. By doing better for one—England, for example—we can improve the situation for Northern Ireland, Scotland and Wales. If we can do that, that would be good news.

Over 2 million people in the United Kingdom are living with a condition that can cause sight loss, such as glaucoma, cataracts, macular disease or diabetic retinopathy. Some 340,000 people in the United Kingdom are registered as blind or partially sighted, and 50% of UK sight loss is thought to be preventable. I say this honestly and with deep respect to everyone here, including the Minister: if we can prevent sight loss by doing early checks in opticians and GPs’ surgeries, that would be good. If we cannot, we will leave people with sight loss for the rest of their lives.

I often think that, of all our senses, eyesight would be the hardest to lose. If I did not have the ability to hear, at least I would have vision, which colours everyday life as it goes by; losing eyesight becomes more and more difficult to handle. If 50% of UK sight loss is thought to be preventable, what is being done to prevent it? Members will know that sight loss affects people in many ways, but it is clear to everyone here that the impact of sight loss is profound for individuals, as well as their friends and families.

The Royal National Institute of Blind People once asked me to do a walk around Holywood with guide dogs, which I was more than glad to do. That gave me a better understanding of what it means to have sight loss. I put a black mask over my eyes; I could see no light whatsoever. I had a guide dog that I had never met, and the guide dog did not know me. That guide dog stayed at my right knee, and guided me up the Holywood street, which was full of shoppers, and I got a perspective on having sight loss. The dog took me where it wanted me. It stopped on the footpath before crossing the road. That left an indelible impression of what it means to be blind and what we must do to help. I thank Guide Dogs for all that it does. We all respond to the adverts on TV, and many of us in this debate, and outside of this House, probably contribute to the charity, so that someone else can have a dog as their companion and guide.

Choices made about the provision of eye care can change the trajectory of a person’s life. The experience of sight loss can often be similar to bereavement, inspiring feelings of denial, anger and fear. The impact of sight loss is also felt beyond individuals and their families. In England, the data is most readily available; it is always good to have the data, because it gives us the possibility of establishing a strategy and a way forward. In England, ophthalmology is the single biggest out-patient speciality, with over 7.5 million attendances at ophthalmology out-patient services in 2021.

Recent calculations show that eye conditions cost the UK economy some £25.2 billion per year, a figure expected to rise to £33.5 billion per year by 2050, and 84% of the economic costs of sight loss lie outside the health and social care system. Again, Minister, how best can we draw sight loss within the health and social care system, to ensure that the delivery of treatment for people with sight loss is achieved in a positive fashion?

A range of pressures contribute to what is now a capacity crisis in eye care. Over recent years, demand for eye care services has increased, driven by an ageing population, with people rightly concerned about losing their sight; if we can prevent that, then we will have achieved much. However, such concern can lead to unnecessary referrals, increasing pressure on services. A recent Moorfields study found that 52% of patients referred for specialist assessment did not need specialist treatment.

There are also significant workforce pressures. In 2018, the Royal College of Ophthalmologists identified a shortfall of 230 consultants and 204 staff and associate specialist ophthalmologists. That situation is predicted to get worse, so again I ask the Minister: what can be done to retain the number of staff, and indeed increase their number?

These structural factors have been combined with severe disruption to services due to the pandemic, making it harder for services to implement innovations that could mitigate growing demand. As a result, there are significant ophthalmology backlogs across the United Kingdom and indeed in Northern Ireland as well. Some patients are now waiting six months or longer to access eye care services. With great respect, I believe that situation really needs to improve. Eyesight can be saved if waiting times for appointments are shortened. Back home, I am aware of some people whose appointments were delayed and unfortunately in that short time they lost their sight.

In England, 641,000 people were waiting for specialist eye treatment as of October 2022, accounting for some 9.2% of the NHS waiting list and 1.1% of the entire population of England. In Scotland, ophthalmology accounts for 12.2% of waiting lists; in Wales, the figure is 11.9%; and in Northern Ireland it is 9.9%.

In my constituency of Strangford, the local health and social care trust is the South Eastern Health and Social Care Trust. As of 30 June 2022, 49% of patients waiting for ophthalmology out-patient treatment in the South Eastern HSCT have been waiting longer than 18 weeks. We need to shorten that and I have been in touch with the Minister back home—Robin Swann, who by the way is a very responsive Minister—to see how we can cut down that waiting period of 18 weeks.

According to figures for Northern Ireland from the Office for National Statistics, almost 18,000 patients were waiting for ophthalmology services. Of those, over 9,000 ophthalmology patients—about 55%—were waiting more than 52 weeks for a first consultant-led out-patient appointment. That situation is the reason why people have lost their sight and it really has to be improved. In total, 82% were waiting over nine weeks. Again, it is very clear that something has to be done. It is not the Minister’s responsibility—I know that—but I am just putting the facts on the record in Hansard because I think that there are many issues for us to address, including back home.

Evidence suggests that the mega-clinics are making some progress on cataract surgery waiting times. My own mother is 91 and she has had one of her cataracts done. She was treated on Tuesday and she made the appointment for the second cataract. This treatment will definitely improve my mum’s vision greatly, as well as her participation in life. She may be 91, but she is still a formidable lady. She has a deep interest in all that happens in the world, including in the political things that happen here; no doubt, she will want to watch this debate as well to find out what has been said.

The figures for cataract surgery waiting times are deeply troubling, and the impact on patients’ lives, including their physical, psychological and emotional wellbeing, continues to be significant. It is my belief that the next Assembly or Executive should prioritise addressing waiting times for treatment in Northern Ireland by investing in and expanding the use of timely, targeted interventions, such as mega-clinics and community-based care and support. A greater use should be made of accessible patient communication to address waiting times and treatment delays.

Treatment delays can have a significant impact. Up to 22 people per month experience severe or permanent sight loss due to delays to follow-up care. A national plan for eye care is needed to address the capacity crisis and ensure everybody can access the care they need at the right time and in the right place. Ultimately, that would prevent avoidable sight loss, which would be a massive step forward.

Scotland, Wales and Northern Ireland have some form of eye care plan, but they vary in scope, focus and content. The Eyes Have It identified four key areas that the national plan should address. The workforce should be expanded to ensure the NHS has the skills it needs now and in the future. Ophthalmology training should be expanded, and optometrists and multi-disciplinary eye care teams should be enabled to work at the top of their licences. In other words, there should be a focus on them.

New technologies, such as digital remote monitoring and remote triage, should be used to ensure the care delivered is efficient, prioritises those with the greatest needs and fits around patients’ lives. If we can do that, we will have achieved much.

There should be research into the future of treatment to better understand sight loss, and that should be translated into innovative treatments that enable more people to keep their sight. That has to be a central goal of what we are trying to achieve. The uptake of innovative treatments will improve patient outcomes, prevent the deterioration of sight and reduce the burden of care on the families impacted. We need to address them, too.

The national plan can support systems to ensure that patients access the right care at the right time. That would reduce unnecessary referrals and, ultimately, the pressure on NHS eye care services. A national plan would also help to improve the integration of all levels of community and hospital eye services. It is important that community and hospital eye services are married as one so they can do better. That would enable new integrated care systems to deliver care that is joined up, works for patients and local communities, and supports national oversight. In other words, the strategy starts here and works its way down to communities, councils and all the other systems.

It is of course right that the nations of the United Kingdom of Great Britain and Northern Ireland can develop healthcare services that meet the needs of their own populations. I understand that, but a well-designed plan for one nation can provide a valuable blueprint for others, supporting all nations to improve their eye care services and prevent more avoidable sight loss.

I am my party’s health spokesperson, which is why I am involved in all health debates and why I secured this debate, along with the hon. Member for Battersea. The cancer strategy in England provides a helpful guide for the structure of a well-built, potentially successful national plan. NHS England’s national cancer transformation board publishes an implementation plan for the strategy, and there is a commitment to a £200 million cancer transformation fund.

There are yearly progress updates from NHS England. Alongside its principles, the strategy for cancer details the current landscape in cancer care and sets out ambitions and performance metrics, rather than measuring progress. At the end, it sets out practical recommendations for transformation: improving the experiences of care, treatment and support, improving the efficiency of delivery, and driving implementation and cost savings. Costs are a part of no matter what we do nowadays, and we should make cost savings as long as there is no detriment to the service. Those will be key components of a national eye care plan that tackles the big issues while proposing specific metrics and making recommendations for policymakers.

As highlighted by Professor Kathryn Saunders, the division head of optometry in Ulster University back home, a blueprint for each nation would need to address eye health inequalities, and not just those of a geographical nature. We must ensure that there is more equitable access to eye care among the different communities and populations that are at a significantly increased risk of having a sight problem but may not be accessing NHS sight tests, such as people who are homeless, people with dementia—I make a special plea for them—and children and adults with learning disabilities.

The charity SeeAbility has highlighted the wonderful work of Professor Saunders and the issue of eye care inequality. Some people in the Gallery today are directly involved, and I am pleased to see them here. I am also very pleased that they passed information through to us. Professor Saunders has said:

“I’m sorry to say that not enough action on these inequalities is happening. I’m even sorrier to say that even a service currently offered in special schools appears under threat.”

We need to marry things up better. She continued:

“NHS England will not say what happens after 31 March 2023 to the NHS Special Schools Eye Care Service. It started last year and has reached 83 special schools so far supporting over 9000 children.”

I commend the pilot scheme promoted by the Government and the NHS. It has done much—it is a success story—but I seek assurance that the special schools eye care service will continue beyond March 2023. That evidence-based, inclusive service was celebrated globally last year on World Sight Day, and it was a first for the UK, with Northern Ireland, Wales and Scotland watching closely. It was established by the NHS on the premise that children with learning disabilities are 28 times more likely to have a sight problem but struggle to access sight tests or glasses.

The evidence is compelling. Half of children in special schools have a sight problem, yet only four in 10 have ever had a sight test. What can we do to improve that? I would be pleased if the Minister gave us some indication of what could be done, ever mindful that two Departments probably need to be approached to ensure that it takes place. I am pleased that research from Ulster University has provided evidence to support the benefits of in-school eye care for this vulnerable group. We are moving towards that strategy for Northern Ireland, which is positive, demonstrating that that model of eye care has educational benefits as well as positive impacts on vision.

If the service is to be scaled back or abandoned, what will happen to the 9,000 children in a few months’ time? I do not think that we can ignore the good work that has been achieved. Surely the intention is not for them to return to overstretched hospital clinics. We must do better. If there was ever an example of the need for joined-up strategic thinking on eye care, surely this is it. I ask the Minister the question that Professor Saunders asked me to pose: will he take action to ensure that NHS England does not close the service without proper consultation? There is real good here, and it is important that we have the opportunity to see it continue.

This is a slightly different point, but it is related to eye care in England and the devolved nations. The Older Drivers Task Force sent me some information and was keen to feed into the process, so it is important that we record that. Only the UK uses the ability to read a vehicle number plate at a set distance—20 metres—to assess someone’s visual fitness to drive at their first licence application, with no further requirement for visual assessments. The UK’s reliance on the number plate test has been widely criticised as not fit for purpose. Not only is it a crude measure of visual acuity, but, according to the Driver and Vehicle Licensing Agency in 2021, many motorists are unaware of that requirement for driving.

There have been recent calls for vision checks, such as evidence of a recent sight test, to be introduced at licence application and renewal every 10 years. Those calls are in accordance with the Department for Transport’s “Road Safety Statement 2019”, which stated that consideration was being given to having a mandatory sight test at age 70 and at three-year intervals thereafter, to coincide with licence renewal. The covid pandemic has slowed things up, and we have lost two or three years of progress in the NHS and many spheres of life, but I am keen to hear the Minister’s thoughts on this issue. There is evidence of strong support from older drivers—those aged 60 and over—for compulsory eyesight testing when renewing a licence. The over-60s are entitled to free sight tests, so such a requirement would be at no cost to those drivers. If there is no cost, it seems to be a win-win, so let us do that.

The Older Drivers Task Force recommended the introduction of mandatory eyesight testing, with an optometrist or an ophthalmic or medical practitioner providing an “MOT” of a driver’s eyesight at licence renewal at the age of 70, and at subsequent renewals. Should that be implemented, the NHS contract for free eyesight tests would need to be amended so that drivers aged 70 and above could have a more detailed “MOT” sight test. That is the request of the Older Drivers Task Force, and I believe it would benefit those in that age group who drive and everyone on the road.

The covid pandemic has had a very negative effect on the visual health of the nation. In September 2020, the Eyecare Trust announced that an estimated 5 million routine eye tests had been missed. With subsequent lockdowns and restrictions, the situation has since worsened, which raises serious concerns for road safety, as the UK licensing system relies on drivers being responsible for ensuring that they meet the visual standards for driving. The pandemic has led to long waiting times for patients referred for assessment and treatment of DVLA-notifiable sight conditions. While they wait, they may continue to drive even though their condition may be deteriorating, jeopardising both their safety and that of other road users, so there is a practical reason for this request.

Delays to cataract surgery—my mum, who has been on the waiting list for three years, had her first cataract surgery some three months ago, with the second to come shortly—have been identified as a particular concern. It is difficult to quantify the crash risk of visually impaired drivers, as data is not routinely collected. However, according to the College of Optometrists, a recent analysis of contributing factors recorded in STATS19 showed an association between visual impairment and injury collisions for drivers aged 60 and over. An earlier study by the Road Safety Authority estimated that some 2,000 drivers in the UK were involved in accidents in 2013 due to poor vision, causing nearly 3,000 casualties.

The recommendations made by the Older Drivers Task Force are quite simple, but I believe that they are very practical and helpful. It calls for a change in the way that visual standards for fitness to drive are assessed and monitored for all drivers, but particularly for those aged 60 and over. It recommends that the number plate test should be replaced with a standardised measure of visual acuity plus an assessment of visual fields, contrast sensitivity and twilight vision. In other words, we should test both night and day driving; I think that is important for licence renewals. The Older Drivers Task Force also repeats its recommendation to introduce mandatory eyesight testing and to provide an “MOT” of driver eyesight at licence renewal at the age of 70, and at subsequent renewals.

I will conclude by giving a couple of examples of the importance of people visiting their optician regularly. I know of two people in my constituency who have been affected by this issue. One lady was having headaches and went to see her optician, who checked her and found a growth, which turned out to be a tumour. He sent her to the Ulster Hospital, which is just up the road from Newtownards in my constituency. Ultimately, the lady was hospitalised and had an operation. Opticians, and regular attendance, can save people’s lives.

A good friend of mine had not been feeling well for some time. He came in on a Monday to see me in the office before I came over here for work. He said, “I haven’t been well.” I looked at him and said, “You look very pale and have lost a bit of weight.” He replied, “Jim, I’ve had sore heads for almost three weeks.” He was going to see his optician that day. As a result of the eye test, the optician diagnosed a tumour or growth. My friend was told to go to the Ulster Hospital immediately and, within two days, he had an operation to remove a tumour the size of a tennis ball. It is hard to comprehend such things. I tell those two stories because they are examples of how regular check-ups with opticians save people’s lives.

In conclusion—I have said that already, but I really will conclude with this—eye care services across the whole United Kingdom of Great Britain and Northern Ireland are facing significant pressures, with implications for individuals, the NHS and the wider economy. Developing a national plan for eye care will help tackle the capacity crisis in eye care in England and provide a blueprint to share good practice across the United Kingdom, including Scotland, Wales and Northern Ireland.

I thank you, Mr Sharma, and I thank the Minister for his time. I also thank the two shadow Ministers, who will speak shortly. I have not read their speeches, but I suspect that we will all be on the same page, asking for the same thing. We look to the Minister to respond in a positive fashion.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important debate. He has been a strong advocate for eye health for a long time. He speaks from huge knowledge and personal experience, and I listened to his speech with great interest. Given that health is a devolved matter, a lot of my response will focus on England, as he suggested. I understand that the devolved nations are facing similar challenges. We are always interested in sharing ideas and working with our counterparts, in answer to the question asked by the hon. Member for Motherwell and Wishaw (Marion Fellows).

There are 2 million people living with sight loss, and that is predicted to double to 4 million by 2050 as a result of an ageing society. Sight loss is often preventable, and that is why prevention and early detection, along with access to diagnosis and timely treatment, are key. One of the best ways to protect our sight is to have regular sight tests. The hon. Member for Strangford rightly underlined why that is so important with his powerful story about the tennis ball-sized tumour that his constituent had taken out.

When combined with early treatment, sight tests can prevent people from losing their sight. That is why we continue to fund free NHS sight tests for many, including those on income-related benefits, those aged 60 and over, and those at risk of glaucoma and diabetic retinopathy —two of the main causes of preventable sight loss. More than 12 million NHS sight tests were provided to eligible groups in 2021-22. We also provide help with the cost of glasses and contact lenses through NHS optical vouchers. Eligible groups include children and those on income-related benefits. The NHS invests over £500 million annually to provide sight tests and optical vouchers.

The risk factors for sight loss include ageing, medical conditions such as diabetes, and lifestyle factors such as smoking and obesity. We are taking action to reduce obesity and smoking. Smoking rates in England are already the lowest in history, and we remain committed to going further to be smoke free by 2030. We are working to drive down the number of people who take up smoking, and we are supporting those who wish to quit. We are also working with the food industry to ensure that it is easier for people to make healthy choices, and we are supporting adults and children living with obesity to achieve and maintain a healthier weight.

Turning to the medical conditions that lead to sight loss, diabetic retinopathy—a common complication of diabetes—is a potentially sight-threatening condition. The diabetic retinopathy screening programme now provides screening to over 80% of those living with diabetes annually. Between 2010 and 2019-20, the number of adults aged between 16 and 64 who are registered annually as visually impaired due to diabetic retinopathy has fallen by 20%, meaning that it is no longer the main cause of sight loss in adults of working age. The screening programme has played a major role in that.

[Jim Shannon]

I thank the Minister for his helpful response. The target of providing retinopathy screening to 80% of those living with diabetes has been achieved. Are there any plans to try to reach the other 20%? I am diabetic. I had my retinopathy test about four weeks ago; I get it every year. I know the encouragement and confidence that testing gives people once they know they are okay. Are there any ideas for how we can get to the other 20%?

[Neil O'Brien]

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

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[Neil O'Brien]

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.

[Jim Shannon]

The answers are very helpful. One thing that all three Members referred to was the waiting list, and those who lose their eyesight just because they have been on a waiting list for diagnosis, examination and investigation. I know the pandemic created lots of problems in relation to the waiting list. Does the Department intend to have a strategy that will reduce the number of people on waiting lists to ensure that those waiting for a diagnosis retain their eyesight?

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[Jim Shannon]

I thank the hon. Members who spoke in the debate. The hon. Member for Motherwell and Wishaw (Marion Fellows) brought a breadth of knowledge to it, and we thank her for that. As I said earlier, I always like to hear what the other devolved nations are doing, and she outlined very well what Scotland is doing. With the See Hear provision, Scotland is expanding its eyesight services, with regular checks and free examinations every two years. She referred to her personal circumstances—it is always good to bring a personal story—of having had cataracts in both eyes. She does not miss too much, so I think we can be pretty sure that her eyesight has greatly improved. She also referred to improving people’s quality of life with eyesight care, and she referred to smoking, drinking and diet and the need to address those three things.

Every one of the things that the hon. Member for Motherwell and Wishaw referred to was also referred to by the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan). She referred to the need for a plan, and to people waiting for six years at the Western Health and Social Care Trust in Northern Ireland. My goodness—that is unbelievable. My mum waited three years for a cataracts operation. She was not desperate for it, so she did not mind waiting for three years, but in the last six months it was coming to the stage where she was unable to drive, which was a problem.

The hon. Member for Tooting said that patients deserve better, and she referred to the staff shortages—I think the Minister heard about that very clearly—and the integration of services. She gave Wales as an example. We hear much about Wales in a negative fashion; today, she introduced a positive. It is evidentially-based as well, which means that it is absolutely on the button. Again, we thank her for that. She also referred to the new IT system in Wales, and the fact that patients cannot wait any longer.

I gave an apology for the circumstances of my friend, the hon. Member for Battersea (Marsha De Cordova), which we understand, and I spoke to you personally beforehand, Mr Sharma, so you know the reason for it. We really missed her contribution to the debate because she brings a wealth and a breadth of knowledge. I commend her for being the chair of the APPG on eye health and visual impairment. She was able to make an intervention that was as good as a speech, so well done to her.

I thank the Minister, as always. He comes with a positive attitude, which we are all very pleased to see. He is committed to sharing ideas with the regions. I want to see that. The hon. Members for Motherwell and Wishaw, for Tooting and for Battersea want to see that as well. The Minister referred to the 12 million eye tests in 2021-22. That is an achievement. We cannot deny the positive things that he referred to. He also referred to ageing, diabetes, childcare and the healthy child programme, learning disabilities and, in answer to my question, the steps that have been taken to address eye tests for children who are disabled and educationally challenged. I think that is good. Those are some of the things that the hon. Member for Battersea and all of us present are very keen to see.

The Minister was also very positive in relation to primary and secondary care combined under his ministership. He confirmed that one of things that we asked for has happened, which is good news. He also referred to the workforce, which we have some concerns about; I think the shadow Minister referred to them, and I know that I did. It is important that we have strategy to fill those vacancies.

Lastly, research has moved on fantastically. I went to an event in Portcullis House yesterday on some of the medical research that has been done. The advances in medicine are incredible. We can never fail to be moved or encouraged by what we see. The investment and research that the Minister referred to is good. On the waiting lists issue for reversible sight loss and elective recovery, the moneys are there to make that happen.

In introducing the debate, I referred to the lovely terminology that we use for all the different groups that come together: The Eyes Have It. Well, today, the ayes have it. The Minister has given us a very positive response, and we thank him for it.

Question put and agreed to.

Resolved,

That this House has considered a blueprint for eye health in England and the devolved nations.

Motor Neurone Disease Research: Government Funding

Jim Shannon Excerpts

Tuesday 13th December 2022 Westminster Hall

[Karl Turner (Kingston upon Hull East) (Lab)]

I beg to move,

That this House has considered Government funding for research into motor neurone disease.

It is an absolute pleasure to serve under your chairship, Mr Mundell. MND is a devastating, debilitating and untimely life-limiting disease. We saw that just two weeks ago with the tragic loss of Doddie Weir, to which you have referred. Doddie was a giant of a man, both on and off the field, but the MND Association estimates that in the UK six people a day die of MND. A third of them die within 12 months of diagnosis, but it is now more than a year since the Government pledged—in response to the tireless efforts of campaigners and following meetings between me and the then Business Secretary, the right hon. Member for Spelthorne (Kwasi Kwarteng)—to invest £50 million. We met the Secretary of State that day with campaigners, and he gave an assurance to us all that immediate action, meaning immediate money, would be forthcoming. It was not.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing forward this important issue. I have a close working relationship with MND campaigners back home, and ahead of the debate they got in touch to point out the lack of adequate care and provision in Northern Ireland. The Department of Health back home needs help to improve the standard for accessing clinical trials, and the same applies for people across the UK. Does the hon. Gentleman agree that it is imperative that people in all parts of this great United Kingdom of Great Britain and Northern Ireland are able to gain from research and be involved in clinical trials? We all stand to gain from that.

[Karl Turner]

I agree with the hon. Gentleman, who is an incredibly impressive campaigner on the issue. I pay tribute to him. He is knowledgeable on the subject, and he raises it both publicly in debate and privately with Ministers when given the opportunity. I commend him for that.

I very much welcome the Secretary of State for Health and Social Care commenting at the weekend that the money will be fast-tracked into the hands of researchers, but I am sorry to say that it feels as though the Government have dragged their feet. They have been dragged kicking and screaming to this point by the impressive dedication of MND campaigners—not least Rob Burrow, who is a rugby league legend—and it is disappointing that we have had to wait 12 months for anything. This debate was secured, then there was talk in the media that there would be funding available, but campaigners are entitled to be a little concerned and a little nervous about where and when that money will be forthcoming.

I pay tribute to the campaigners. I have briefly mentioned Rob Burrow; for all his brilliance on the pitch, the whole rugby league community has been blown away by his determination to raise awareness of MND. It is his tenacity that has brought us to where we are today. I have to be honest that I knew very little about MND. I am a rugby league fanatic; I support both of the rugby league teams in Hull. I am bound to say, being the Member for east Hull, that I support the red and whites a bit more than the black and whites on occasion. Rob is the person who brought this to my attention. Special mention should also be given to Rob’s former teammate and best pal, Kevin Sinfield, who has completed seven ultra-marathons in seven days to raise about £1.5 million for MND charities. That is an incredible effort from an incredible campaigner and man.

This debate was secured before the Secretary of State announced the money at the weekend. I want to mention that I have spoken with the MND Association at length, and my office has spoken with it in preparation for this debate. It has one single ask. It desperately needs a meeting with the Secretary of State for Health and Social Care and the Secretary of State for BEIS, so that it can get a timeline and some understanding of when the money will be made physically available. It is no good promising money and then not delivering it. The promise was made more than 12 months ago—nothing has been forthcoming.

I am quite annoyed at the fact that the debate was secured, and all of a sudden there is discussion in the media that the money is coming. People are asking me whether it means 50 million quid last year and 50 million again this year. The reality is that it is 50 million quid, which is much needed—the association and campaigners are grateful for it—but they need to know when and how the money is going to be made available.

I am going to rest there; I do not think I have anything further to add. It is a simple ask: will the Minister agree to speak to the Secretaries of State concerned and put the meeting together as quickly as possible, so that we can move forward?

Aortic Dissection: Patient Pathways and Research Funding

Jim Shannon Excerpts

Tuesday 13th December 2022 Westminster Hall

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

I beg to move,

That this House has considered patient pathways and research funding for aortic dissection.

It is a pleasure to serve under your chairmanship, Mr Pritchard. After many applications, I am delighted to have secured an opportunity to have this very important debate. Hon. Members may be aware that this is an extremely difficult and personal topic for me, but I hope that sharing my experiences will prompt action that could save lives in the future.

I will begin with a case study, which happens to be my personal story, then move on to what we do in this place to improve patient pathways and research funding for aortic dissection. Before I do so, I must draw the House’s attention to my entry in the Register of Members’ Financial Interests: I am an unpaid trustee of the Aortic Dissection Charitable Trust, a charity that I helped to set up.

In the early hours of 11 December 2018, I received a phone call that no mother would ever want. I was told that our son Ben had died. Four years later, we all still feel numb. It seems implausible that Ben, a gregarious 44-year-old with two children and a loving wife, will not simply walk back into our lives. Ben died after suffering an aortic dissection. He had been feeling unwell the previous day, but was sent home after spending four hours in A&E and told to return the next day if he did not feel better. Tragically, the emergency doctors had not understood his symptoms and had not come up with a diagnosis.

Aortic dissection is a tear in the aorta, the body’s largest artery, which carries blood from the heart to the brain, limbs and vital organs. It is a condition that affects approximately 4,000 people a year in the UK and, like Ben, almost all of them are unaware that they have it. Half of them—almost 2,000 people—die soon after the dissection occurs, which is more than die from road traffic accidents in this country. Five hundred of those who die reach hospital, but sadly, as in Ben’s case, their condition is not diagnosed quickly enough, or at all. The other 1,500 die almost immediately after the acute event.

Many of these deaths are preventable. With proactive genetic screening for family members of those who have suffered an aortic dissection and with better treatment of high blood pressure, many of these deaths could be avoided. I am delighted to learn today that the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), has announced a fund of £175 million for cutting-edge genomics. As a charity, we would be happy to work with the Department on this issue.

I have to admit that, like most people, I knew nothing about aortic dissection before Ben died, but knowing what a gap his death has left in our family I have immersed myself in efforts to prevent other tragedies. In late 2020, with the eminent cardiac surgeon Graham Cooper and the long-time aortic dissection campaigner, patient and public voice co-ordinator of the NHS cardiac clinical reference group, Catherine Fowler, whose father died in Ireland from this condition, I helped to set up the Aortic Dissection Charitable Trust. I am delighted that Graham and Catherine are in the Gallery and listening to the debate. The trust is now a leading UK-registered charity that aims to unite patients, families and the medical community. Our mission is to improve diagnosis, increase survival rates and reduce disability caused by aortic dissection.

Our work encompasses the whole patient pathway, from prevention to diagnosis, treatment, follow-up and support for all those living with aortic dissection. So far, the charity has designed and delivered accredited education events reaching over 3,000 medical professionals, and produced a fantastic set of patient resource videos to support those living with aortic dissection and their families. Instrumental in creating the videos was “Whispering” Bob Harris, who has suffered an aortic dissection and given up a huge amount of time to be an ambassador for the charity. I am delighted that Bob is also in the Gallery today.

The charity has created an online learning portal for the medical community, with learning modules that cover all the multidisciplinary aspects, in order to improve education on aortic dissection in the medical community, and ultimately to improve patient experiences and outcomes. The free and accessible learning portal, produced with experts in the field of aortic dissection, will be launched this week. We have also attended a number of medical conferences and presented to cardiac specialists and emergency medicine doctors, most recently in October at the European Emergency Medicine Congress 2022 in Berlin. We have designed and delivered national all-day education symposiums to establish learning communities and to increase knowledge and education for paramedics, emergency medics and surgeons in Scotland, Ireland and England, with many more such events planned. I have to say that the “we” are mainly the other trustees, because I am very much the junior and more silent trustee of the partnership.

The charity has also worked with NHS England and a group of clinical experts on the design of the aortic dissection toolkit. Seven key principles have now been established, setting out best practice for the patient pathways from the point of treatment through to diagnosis. We are delighted that the toolkit has reached the implementation phase, and the charity is actively supporting this critical phase by working with the regions that have reached out to the charity for support.

The charity has also launched research grants to fund research into how we can better diagnose and treat aortic dissection. For my part, I have sought to raise the issue in the House of Commons, including at Prime Minister’s questions in March and since then in meetings with Ministers. I thank the Minister responding to the debate for her commitment to aortic dissection and for having taken the time to meet the charity trustees last month.

In almost two years, the charity has had a big impact, but there is much more that we can do to save 2,000 lives a year in this country. I would like to set out some of the important changes we would like to see. So far, I have spoken about 2,000 deaths a year and 4,000 cases of aortic dissection, but a worrying statistic is that as our population ages, we expect to see about 7,000 cases of aortic dissection every year by 2050. It is crucial that we take steps now to improve the patient pathway, to ensure that as few of these cases as possible are fatal.

It is surprising but true that there is a lack of detailed and accurate data regarding the incidence, treatment and patient outcomes for acute aortic dissection in England. That is particularly true for patients like Ben, who do not reach a specialist treatment centre alive. Such data would assist in understanding the true scale of the problem and where any interventions might be directed. Of course our family understands that, even if he had been diagnosed, Ben might not have survived the catastrophic event, which happened in the middle of the night, but our passion to learn more about why he died seems to have highlighted gaps in the system, which, if filled, will help others. The least we can do is to press for that to be so. No child deserves to have their mother or father taken away, no wife should be bereft at the sudden loss of a husband, and no parents should have to bury their son.

[Jim Shannon (Strangford) (DUP)]

The hon. Lady is making an incredibly passionate and personal contribution to the House. We all recognise that this is a subject very close to her heart, and we recognise her passion and commitment.

[Mrs Latham]

I thank the hon. Gentleman for his intervention. It is important that all parties work together to make this better.

First, I encourage the Minister to see what more can be done to increase and improve data collection around aortic dissection, to make as much of the data as possible publicly available to assist with clinical research. Secondly, I would like to focus on improvements that we can make to the patient pathway. The single most important improvement is in diagnosis. For those accurately diagnosed, more than 80% survive.

I will come back to how we can focus research funding. For now, I would like to emphasise that increased research funding for diagnosis is required. The other improvement on diagnosis that the Government can make is to ensure that doctors in emergency departments receive adequate training and advice on the symptoms of aortic dissection and how to spot a potential case. A freedom of information request recently showed that only half of NHS trusts  had a policy or procedure concerning the diagnosis of aortic dissection in the emergency department and that only a small proportion used the guidelines from the Royal College of Emergency Medicine or from the Royal College of Radiologists. The charity is doing a huge amount to educate medical professionals. Can the Minister comment on what central guidance has been made available from the NHS for emergency departments?

The launch of the NHS aortic dissection toolkit, which I mentioned, is incredibly important, but it only covers the patient pathway from the point of diagnosis to treatment and does not cover diagnosis itself. Can the Minister commit to considering extending that toolkit or working with experts and the charity to design and develop a new toolkit for diagnosis of aortic dissection, which can be rolled out in all emergency medicine settings around the country?

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

First, I commend the hon. Member for Mid Derbyshire (Mrs Latham). It is never easy coming to Westminster Hall to lead a debate; it is even harder to come and tell a personal story—one that is so heartbreaking for the hon. Lady. She has made us more aware of the condition. We sympathise greatly with her on the loss of her son Ben. We support her and what she asks for.

No parent should have to go through the horror of losing a child. I have the greatest respect for the hon. Lady for coming here today and talking about it, which is often the hardest thing to do. As my party’s spokesperson on health, it is great to be here to support wholeheartedly her call for better patient pathways and more funding for aortic dissections. She set out a really good case and has asked for a number of things. I endorse what she has asked for and will give some factual background to the debate.

Aortic dissection kills over 2,000 people a year. The UK statistics are clear: three to four people per 100,000 are diagnosed with aortic dissection each year. It typically presents with abrupt onset chest, back or abdominal pain that is severe in its intensity, or is described as ripping or tearing, particularly in the patient with a high-risk condition such as Marfan syndrome or a family history of aortic disease.

The hon. Lady was right to refer to diagnosis. We often refer to diagnosis in these debates, and she has asked for work on that. The Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), has taken her thoughts on board, and I know that next year, or whenever the inquiry is done, when the hon. Lady makes her contribution, we can expect a fairly good response from him. He will never be found wanting in that regard. It is good to have him here to hear the story.

By improving diagnosis of aortic dissection in terms of familial connection, we can improve patient pathways to get better treatment and easier maintenance of the disease. Aortic Dissection Awareness UK & Ireland is the national patient charity for aortic dissection in the UK. It was founded by a small group of people who were diagnosed with aortic dissection in 2016. The charity provides vital information and support for patients and families affected by the condition, which the hon. Lady outlined so well, including the families who are left to deal with what happens. The charity works with healthcare providers to improve diagnosis and treatment and reduce healthcare inequalities. It partners with researchers to bring forward new insights that will improve future care for aortic dissection patients. In addition, the Aortic Dissection Charitable Trust research advisory group has been actively promoting research in the field of aortic dissection, aiming to save lives and improve the quality of life for those suffering from the condition now and in the future.

The hon. Lady asked very clearly for more to be done. The Minister and all of us were listening intently to her contribution. It would be very hard for anyone in this House not to respond in a positive fashion to her requests. More needs to be done across the whole of the United Kingdom of Great Britain and Northern Ireland, especially in co-operation with the devolved nations. This is something we should all work together on. We can always exchange ideas in these debates. The hon. Lady and I have both participated in debates in the past 24 hours. There was an Adjournment debate last night and a debate this morning at 11 am—the Minister has been kept extremely busy. We always have a helpful response from her and I look forward to something similar this afternoon. We owe a duty of care to the hon. Member for Mid Derbyshire, and I am sure the Minister will respond in a positive fashion.

We also need to produce a research strategy that is developed and implemented as a support network for all. The Royal College of Emergency Medicine has made the diagnosis of acute aortic syndrome and dissection one of its top 10 priorities, and we must do the same across the whole of the United Kingdom of Great Britain and Northern Ireland. I encourage the Minister to engage with her counterparts in Northern Ireland and other devolved Administrations to ensure that we approach this in collaboration, with all of us asking for the same thing and all working together to achieve the same goal and ensure the correct patient pathways and sustainable funding for aortic dissections.

Again, I commend the hon. Member for Mid Derbyshire; I think we were all particularly moved by her contribution. This debate would be suitably concluded with the support that the Minister can give us. I very much look forward to hearing from the two shadow Ministers: the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) and the hon. Member for Enfield North (Feryal Clark).

[Mark Pritchard (in the Chair)]

We now come to the Front Benchers, who will have five minutes each, and then the Minister will have 10 minutes.

--- Later in debate ---

[Jim Shannon]

I see more of the Minister than my wife.

[Helen Whately]

The third welcome I want to give is to Bob Harris, who is here today. He himself has suffered aortic dissection, and is working as an ambassador on this issue. It is very good to have him here with us.

We have heard during this debate about the sudden and heartbreaking impact that aortic dissection can have on families. That is why it is absolutely right that we should be talking about this issue today: we should be talking about how to raise awareness of the condition among medical professionals, about how to improve diagnosis so that aortic dissection is detected as quickly as possible, and about the research we need to make sure that more people survive. Sadly, around 4,000 people suffer from an aortic dissection in the UK each year, yet still many people have never heard of the condition. It is crucial that it is diagnosed and treated urgently, otherwise very sadly, it can be fatal. It need not be.

As we have heard today, diagnosing aortic dissection promptly is, unfortunately, not straightforward. The condition is relatively rare, which means medical professionals may be less familiar with its presentation. The symptoms of aortic dissection, such as chest pain, can be similar to other more common conditions, making it harder to accurately diagnose. Care pathways for aortic dissection vary across the country, meaning different patients often get different treatments.

I can reassure my hon. Friend the Member for Mid Derbyshire and other hon. Members here today that I am determined to improve the way the condition is diagnosed and treated. Earlier this year, NHS England launched its aortic dissection toolkit, which sets out the steps that commissioners, providers and clinicians should take to improve the care of patients with acute aortic dissection. The toolkit covers the pathway for aortic dissection, from recognition and diagnosis to treatment.

NHS England’s regional teams are currently implementing the toolkit within their local services, and we expect those improvements to significantly reduce delays to diagnosis and improve patient outcomes following treatment. NHS Digital has also made changes to NHS Pathways, which is a triage system used by NHS 111 and 999, to improve the recognition of chest pain likely to be associated with aortic dissection. However, I heard my hon. Friend say that the toolkit does not cover all the challenges that she is aware of in the pathway, so I will take that away and see how we can go further to make sure the toolkit is comprehensive or supplement it as necessary.

We have also heard today about the importance of raising awareness of aortic dissection among medical professionals. The Royal Colleges of Radiologists and Emergency Medicine published a best-practice guideline last year on the diagnosis of aortic dissection in the emergency department, in response to a report published by the Healthcare Safety Investigation Branch in 2021. I expect that to have a major impact on the prompt diagnosis of aortic dissection. The Royal College of Emergency Medicine, which sets standards of care in all emergency departments in the UK, has also developed guidance to support the timely diagnosis of aortic dissection. However, my hon. Friend told us that a freedom of information request showed that only some EDs are using the guidelines. Again, I will look into that, as guidance should be followed consistently across emergency departments.

Research is the piece of the puzzle that will drive forward progress and find the treatments of tomorrow. We need to understand better who is at risk of aortic dissection and how we should monitor them, we need to know how to most effectively detect and diagnose aortic dissection in emergency settings and how to improve treatment to make sure patients recover successfully. That is why the Department of Health and Social Care brought together a multidisciplinary group of experts and patient representatives in 2020 to consider research priorities for aortic dissection. That significant event identified research questions in diagnosis, treatment, care, awareness and education and, crucially, what matters most to people with aortic dissection and their families. In response to that event, the Department of Health and Social Care-funded National Institute for Health and Care Research launched a call for research on surgical treatment for aortic dissection. We await the outcome of the commissioning pool early in the new year.

The NIHR invests around £50 million a year on research into cardiovascular disease, including aortic dissection and other heart conditions. For example, the NIHR funded a major programme of work at Barts Health NHS Trust to develop and test a novel surgical treatment for aortic dissection, which is less invasive than routine care, allowing quicker procedure times and shorter hospital stays. It is also vital that we harness our understanding of risk to help prevent aortic dissection. UK Research and Innovation, which is funded by the Department for Business, Energy and Industrial Strategy, is supporting a study on how we can use genetic and other factors to predict aortic dissection and identify people at greater risk. That will pave the way for more preventive measures, such as blood pressure control, to be prescribed.

We know that there is interest in the academic community for a pipeline of research to improve outcomes for people at risk of and who have survived aortic dissection. I encourage researchers working in the field to harness the momentum building around aortic dissection research and to please come forward and make applications for funding.

My hon. Friend the Member for Mid Derbyshire also asked about data and called for more data on aortic dissection to be collected and made public. I will take that request away and raise it with NHS England, because she makes a really important point: the more data we collect, the more we know. Again, making it available more widely is one of the best things that we can do to improve understanding and support research into prevention, diagnosis and treatment. My hon. Friend also requested that we meet to discuss guidelines for genetic screening, which is another thing that I will take away and look into. I will get back to her on that.

This debate has made us all stop and reflect, and I will pause for a moment as well, because I think the hon. Member for Strangford is waiting to intervene on me.

[Jim Shannon]

I thank the Minister for her very helpful response. I always ask these questions, because it is important that we share the issues. In my contribution, I asked whether we could share information with Northern Ireland, Scotland and Wales, because we can all learn from it. We need to collaborate on research, because we can all benefit from it, wherever it may be—in Northern Ireland in my case, and in Scotland in the case of the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar). That might be helpful for us all.

[Helen Whately]

I completely agree with the hon. Member, and we can only do better if we share information across the whole United Kingdom and internationally, as work on this condition will be going on across the world.

This has been a really powerful debate, but it is not a patch on the pain that my hon. Friend the Member for Mid Derbyshire has been through. As she said so powerfully, each life lost to aortic dissection is not just one life affected. The condition affects the lives of all those around the person who is lost, be they mothers like her, fathers, husbands, wives, sons, daughters, grandchildren or friends—everyone who is affected when somebody is sadly lost too soon. I thank her again for her tireless work in raising awareness and campaigning, and I assure her that I will, in turn, do what I can in Government to support her efforts and to improve outcomes for all those affected by aortic dissection across the country.

Moles and Skin Tags: Testing for Cancer

Jim Shannon Excerpts

Monday 12th December 2022 Commons Chamber

[Bob Seely]

I thank the hon. Gentleman for his intervention. I am going to follow up on several of those points, but I am delighted to see that he is one of the many people who have survived a malignant melanoma.

If Zoe’s mole had been diagnosed early—especially at stage 1 or 2, and possibly even at stage 3—she may have well survived. Just before I come to some of those suggestions, I must point out that these melanomas are a specific concern on the Isle of Wight, because we have one of the highest rates of skin cancer.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for his assiduous attention to his constituents and to the family who have been bereaved. By his words today, we all recognise that he is deeply concerned and compassionate, and we thank him for that.

May I gently tell the hon. Gentleman—perhaps the Minister might take note of this as well—that in Northern Ireland a new mole mapping and melanoma service has been introduced in my local South Eastern Health and Social Care Trust? It is a nurse-led, two-year pilot project that offers an advanced mole mapping technique for specific patients identified by the clinical team as being at higher risk of developing melanoma skin cancer. I suggest that that should be a standard for everyone not just in my trust area but everywhere else, so that we do not have a postcode lottery. Would the hon. Gentleman be interested in that pilot scheme? If so, maybe the Minister will take note.

[Bob Seely]

I thank the hon. Gentleman for yet another excellent intervention, and I completely agree. In fact, I will come to those points now.

The Isle of Wight is a specific hotspot for skin cancer. I think it has the worst skin cancer rates in the United Kingdom, primarily as a result of certain factors. First, we still have a very white population, and the paler your skin, the more likely you are to develop melanomas. Secondly, we have an ageing population, and melanomas are cumulative. Thirdly, we have a very outdoors lifestyle on the Island, with golf, sailing, a lot of community activity and a lot of gardening. For the Isle of Wight’s retirement community especially, to be out in the sun aged 60 or 70 doing activities such as sailing, which is very harsh on the skin because of the interaction of sun and water, encourages melanomas. Fortunately, we have one of the best dermatology centres in Britain at Newport’s Lighthouse clinic, and I thank its doctors and staff for doing an excellent job. I have been there myself in the past couple of years, and I know what a great job they do.

In the NHS long-term plan, the Government committed that the proportion of cancers diagnosed at stages 1 or 2 will rise from about half to three quarters of all cancer patients, meaning that some 55,000 more people a year should survive cancer for at least five years after diagnosis.

Pilot schemes in various parts of the country are trying to improve the diagnosis of skin cancers and melanomas. One option to improve this still further is what, on the Island, we call Zoe’s law, but it would effectively be a change of practice within the NHS. Eileen, Zoe’s mum, and her family are doing it in memory of Zoe, and it would require all moles and skin tags removed from the body to be tested for melanoma. I am not expecting an off-the-cuff answer from the Minister on this point, but I would very much like her to write to me so that I can pass on her comments to Eileen and the rest of Zoe’s family. If that cannot be done now, I would like to know why not.

I would also like to know what more could be done in future, because thousands of people are needlessly dying every year. Skin cancers kill more slowly than many other cancers and are certainly more treatable than cancers such as lung cancer and pancreatic cancer. Eileen said Zoe thought of everyone before herself. When Zoe was dying, she said, “The most important thing is that other people do not have to go through this”—she left two young kids.

The idea of testing all removed moles and skin tags is potentially very popular, and a petition started by the family has now reached some 35,000 signatures. Tanya Bleiker, the previous president of the British Association of Dermatologists, recommended that all skin lesions, even if removed for cosmetic reasons, as Zoe’s was, should be sent for histopathological testing to confirm that they are benign—the hon. Member for Rhondda (Chris Bryant) also made that recommendation—because they might be deep rooted in the skin. Mr Ashton, one of our consultant dermatologists on the Isle of Wight, explained to me on Friday that innocent-looking moles can sometimes be the most deadly. They might look benign on the surface, but underneath they are malignant and hide melanoma.

I urge the Government to set out further plans on raising awareness of moles, as this is relatively easy to do. If I understand correctly, including this in nurse training and general practitioner training, especially in sunnier parts of the country along the south coast—places like Cornwall, Devon, the Isle of Wight and Hampshire—could be exceptionally valuable.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Helen Whately)]

I commend my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this debate, and on telling us Zoe’s story so powerfully. It is a truly heartbreaking story of a young mum of just 26 with so much life ahead of her. It was harder still to hear because Zoe did the right thing and asked her GP about her mole, yet her skin cancer was not diagnosed until so late that she died just 55 days later. I pay tribute to Zoe’s family, including her mum, Eileen, who have campaigned to stop other people going through what they have gone through, and to Zoe herself. When I looked earlier this evening, more than 34,000 people had signed the petition.

Like Zoe’s family, as cancer Minister I want to stop people going through what they have been through. I want us to get better at preventing, diagnosing and treating cancer. Although we cannot remove the risk of skin cancer in its entirety, we can raise awareness of the things that increase the risk and help people take steps to protect themselves. Most skin cancers are caused by exposure to the sun. Getting sunburnt increases the risk—especially getting sunburnt as a child—as does using sunbeds. Those who have fair skin are at greater risk. As my hon. Friend told us, the lovely sunshine of the island he represents has its downsides, as does the healthy outdoor life that he describes.

As well as raising awareness of risks, we need to raise awareness of early signs and symptoms, and then what to do. We in Government are doing that. For instance, the NHS “Help Us, Help You” campaign has used TV advertising, social media and regional press to get the message out to people to get worrying signs checked out. We know that some people delay getting a check. That campaign has particularly sought to overcome those fears. If you are worried, it is always better to get checked out. Most people will get the all-clear, but the sooner you get a check, the better, because an early diagnosis improves the chances of successful treatment.

I know that Zoe did the right thing and asked her GP, which brings me to the importance of accurate diagnosis. For Zoe’s specific case there has been a full investigation locally, and I know the findings have been acted on. Specifically, teledermatology is now offered by all GPs on the Isle of Wight, and is increasingly available across the NHS. It involves a specialist medical photographer taking a detailed photograph of a skin lesion to check it for signs of cancer. That is a step on the path to more tests to confirm whether someone has cancer or is given the all-clear that no further tests are needed.

On the role of teledermatology, almost £1.5 million of our elective recovery funding has been allocated to seven cancer alliances to pilot self-referral for cancer symptoms, including skin cancer symptoms. I heard my hon. Friend’s argument for Zoe’s law to require all moles or skin tags removed to be tested for melanoma. I also heard him saying that he was not expecting an answer here and now, which I appreciate. I can assure him that I will take his argument away, look into it and then write to him with a full response on his proposal. I will also take away the suggestion from him and from other hon. Members about looking at the broader education of other people who might be able to spot something that might be an early sign of skin cancer. I recognise that people may not be able to see their back or the back of their head, for instance. Indeed, there may be opportunities to look at wider education. For sure, raising awareness overall of skin cancers and of what a person should do if they have a sign or a symptom will indeed mean that more people will know what to look out for.

[Jim Shannon]

I commend the Minister for her very positive answer and for what she said in relation to the nine centres across the United Kingdom, which is where the hotspots are. In an intervention on the hon. Member for Isle of Wight (Bob Seely), I referred to a pilot scheme in my trust area, the South Eastern Health And Social Care Trust, which seems to be having some good results. I always believe that the exchange of ideas is good for us all. It helps us to see what is being done here and it might help the Minister to know what we are doing back home.

NHS Industrial Action: Government Preparations

Jim Shannon Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

We have already been clear that we would be very happy to meet the unions, and I understand that a meeting is being organised, but let me reiterate the point about what exactly the Royal College of Nursing is asking for: an uplift that is 5% above RPI inflation. Uplifting pay for all staff—this is based on 19.2%, within the agenda for change—would cost approximately an additional £10 billion. The hon. Member for Rhondda (Chris Bryant) talked about things like test results; the £10 billion that we would spend on such an uplift is £10 billion that would come out of the NHS budget. That is £10 billion that we would not be able to spend on hugely important issues such as tackling the elective backlog.

[Jim Shannon (Strangford) (DUP)]

I was on the picket line with NHS staff in Newtownards in my constituency this morning. I do not expect to be reprimanded for that, by the way—I am quite sure I will be okay.

I want to ask the Minister a positive, constructive question. All the men and women want who were on the picket line at Ards Community Hospital in Newtownards this morning is a wage that helps them to survive. The women and men I talked to this morning are not surviving; they are visiting food banks. It is not just the nurses: it is the porters, it is the ward staff, it is everyone. Will the Minister and the Government go just that wee bit further to get a settlement?

[Will Quince]

I understand why the hon. Gentleman is asking that question, and I am sorry to sound like a broken record, but we accepted the independent pay review body’s recommendations in full. As a result, more than 1 million NHS workers were given a pay rise of at least £1,400. For newly qualified nurses, it was a 5.5% increase. Those on the lowest salaries, whom the hon. Gentleman referred to, are seeing a pay rise of up to 9.3%. Again, that is on top of 3% last year, when public sector pay was frozen.

Nobody wants to see industrial action go ahead. My message to the unions is “It’s good to talk—let’s talk. I know the meeting is being set up. Let’s do all we possibly can to avoid industrial action this winter.”

NHS Workforce

Jim Shannon Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. This is the tragedy of where we have got to on social care in particular. The Government have allocated half a billion pounds to alleviate pressure this winter, but not a penny of it has reached social care providers. Not a penny of it is currently being worked in action to try to deal with delayed discharges. I have no doubt whatsoever that one reason why it has taken so long from that commitment to getting money to the frontline is the constant churn of Ministers that we saw over the summer. The absolute circus that we saw in the Conservative party has had a direct impact on the competence of effective Government in this country. We now have ineffective Government, so even when the Government seek to do the right thing and allocate the resources, they cannot get the money out the door far enough because Ministers seem to change week in and week out.

[Jim Shannon (Strangford) (DUP)]

I commend the shadow Secretary of State for what he is saying. When it comes to staffing issues, one thing should clearly be done. Does he agree that part of the reason why we rely so heavily on agency staff is because our NHS staff have migrated to agency working, where there is less pressure, so the Government should spend less money on agency workers and give our NHS staff greater support and appropriate pay so that they can stay in the NHS?

[Wes Streeting]

I strongly agree with the hon. Gentleman. I will come shortly to talk about industrial action, but this should be at the heart of the Secretary of State’s thinking. The demands from staff trade unions, whether on pay, terms and conditions or the wider pay machinery, should be seen not just as a negotiation with staff unions but as a retention issue. We are losing staff faster than we can recruit them in some places—especially in areas such as midwifery—and if we lose the staff that we have, even Labour’s plans to undertake the biggest recruitment in the NHS’s history would not be as effective as they would be if we kept staff in the service today. That is why I urge the Secretary of State to treat those NHS staff with respect, get their representatives around the table, and negotiate a solution.

I am aware that the situation in the NHS in Northern Ireland is the worst that we see throughout the United Kingdom. The shadow Secretary of State for Northern Ireland, my hon. Friend the Member for Hove (Peter Kyle), visited NHS services in Northern Ireland only recently. I have no doubt that we need to get effective governance back up and running again in Northern Ireland as well. I urge the Government to discharge their responsibilities in that area, too. Certainly, when Labour was last in government, I do not remember Labour Prime Ministers taking such a complacent, lackadaisical or indeed absent approach to the governance of Northern Ireland. I hope that we can see a breakthrough of the deadlock so that the people of Northern Ireland get the Government they deserve in Stormont, as well as the United Kingdom getting the Government it deserves here in Westminster.

Waiting lists were already at a record 4.5 million before the pandemic. Ambulances were taking longer than is safe to reach patients in an emergency before the pandemic. Patients were waiting longer than four hours in A&E before the pandemic. The 18-week guarantee for elective treatment had not been met for four years before the pandemic, and more patients have waited longer than two months to start their cancer treatment every year since 2010. From the moment the Conservatives entered power, things began to deteriorate. It is not just that the Conservatives did not fix the roof while the sun was shining; they blew off the roof and ripped up the floorboards, and then they wonder why the storm did so much damage.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 6th December 2022 Commons Chamber

[Helen Whately]

After hearing the hon. Member’s point, I should think that he therefore welcomes the fact that we have set up integrated care systems, which bring together health and social care. The £500 million discharge fund that I have mentioned is allocated to local areas to be pooled into the better care fund and spent jointly between local authorities and the NHS. Funding is an important part of this. In the autumn statement, social care received a historic funding settlement of £7.5 billion over the next two years. That is important, as well as ensuring that the NHS and local authorities work together hand in hand.

[Jim Shannon (Strangford) (DUP)]

5. When his Department will publish the 10-year cancer plan.

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

Earlier this year, we held a successful call for evidence on a new cancer plan, which received 5,000 responses. We are now considering those responses and how we can best support the diagnosis and treatment of cancer patients. I will be in a position to update the House shortly.

[Jim Shannon]

I thank the Minister for her response, but it has been five months since July, when the 10-year cancer plan was due to be published, and 10 months since February, when the war on cancer was announced. While the Government have delayed, cancer patients have faced unacceptable waiting times for diagnosis and treatment. Performance over the past five months has been the worst on record against the target of a 62-day wait between the GP referral for suspected cancer and the first treatment. I ask the Minister respectfully: does she agree that we in this House and the people of this country now need a long-term, ambitious plan to reduce waits and ensure that cancer patients in this country have the best outcomes possible? Will she set out a timeline—not just say “shortly”—for delivering such a plan?

[Maria Caulfield]

As the hon. Gentleman knows, I cannot comment on what is happening in Northern Ireland, because health is a devolved matter. I can only update him on what is happening in England. We are not waiting for a cancer plan to start on the backlogs: that is why this Government are investing £8 billion over three years to clear the elective backlog. We are seeing record numbers of patients. Cancer treatments continued throughout the pandemic, but we are seeing a higher number coming through than usual. Despite the increase of more than 129% in patients getting urgent GP referrals since September 2019, 91% of patients in England are receiving their treatment within 31 days of the decision to treat, compared with just 87% of patients in Northern Ireland in June. We are very committed to reducing cancer waiting times. I suggest that the hon. Gentleman may wish to speak to the Minister in Northern Ireland as well.

World AIDS Day

Jim Shannon Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

I beg to move,

That this House has considered World AIDS Day.

I declare an interest as the vice-chair of the all-party parliamentary group on HIV and AIDS and honorary patron of the British HIV Association, and of course as someone who is personally affected by these issues.

I thank the Backbench Business Committee for granting this debate to mark World AIDS Day. Every year, on 1 December, the world commemorates World AIDS Day. People from around the world unite to show support for people living with and affected by HIV, and remember those who lost their lives to AIDS. At 5.30 pm, I, among the community in Brighton, will read out the names of all the people who have died of AIDS in Brighton in the 40 years since the first death, as we do every year. Vigils such as that will be happening up and down the country: in London, in Birmingham, in Manchester, in Oxford, and in other places.

This year’s theme is “equalise”. It is a recognition of the health inequalities that still affect far too many children, men that sleep with men, transgender people, drug users, sex workers and people in prison. Those are the populations most affected by HIV and AIDS in their respective countries; different countries might have different, more focused populations, but those are the groups. Fundamentally, however, the groups that are most at risk are people who are marginalised from healthcare, and that is what we need to equalise—that is what we need to sort out.

This year marks the 40th anniversary of the death of the former Hansard reporter Terry Higgins, who died of an AIDS-related illness on 4 July 1982, and the creation of the now well-known Terrence Higgins Trust. On behalf of the APPG, I thank the Terrence Higgins Trust, not only for the work it has done over the past 40 years but for the work it keeps doing, pushing for us to have no new transmissions of HIV by 2030. That seems a remarkable target, but it is within our reach; it will help the estimated 106,000 people living with HIV in England that we know of. The work of the Terrence Higgins Trust, along with the National AIDS Trust and others, continues to lead the way, and I am delighted that the two organisations are working closer together. I hope that collaboration continues.

Ahead of World AIDS Day in 2018, four years ago now, I spoke in this Chamber about my own diagnosis. I said then that World AIDS Day was

“deeply personal to me, because next year I will be marking an anniversary of my own”.—[Official Report, 29 November 2018; Vol. 650, c. 492.]

Now, of course, it is 14 years since I became HIV-positive. It has been a long journey, from fear to acceptance and to today, where I now play a role of advocacy, knowing that my treatment keeps me healthy and protects any partner that I might have, preventing me from passing on the disease. Since then, further developments have taken place in the fight against HIV/AIDS—many of them positive, but there have been some setbacks, which I wish to talk about in a bit.

We have, of course, a HIV action plan in England, setting clear goals and milestones for achieving our target. Similar plans are set to be launched in Scotland and Wales—we hope they will come quickly. Last year’s HIV action plan for England sets out how we will achieve an 80% reduction in HIV infections by 2025, building to the end of transmissions by 2030. First, that plan will prevent new infections by expanding and improving HIV prevention activities, investing £3.5 million in a national HIV prevention programme up to 2024, and ensure that PrEP—pre-exposure prophylaxis—is expanded to all key groups. Secondly, it will scale up HIV testing in high-risk populations where uptake is low, and ensure that new infections are identified rapidly, including through the expansion of opt-out testing in A&E departments in areas of very high prevalence of HIV. That testing will be backed by £20 million over the next three years.

Thirdly, the plan will ensure that, once diagnosed, people rapidly receive treatment. When I was first diagnosed, you waited until your CD4 count was below 200, which is when you can start to get infections and AIDS can start to be diagnosed. At that time, we did not know whether the drugs would cause continuing side effects; now, as soon as someone is diagnosed, they go on the drugs, because we know that they have very few side effects. Of course, each person has to get the combination that is right for them, because everyone reacts differently, but we have a good array of drugs with which to do that. That means that very quickly—within a matter of months—new people who are diagnosed can be undetectable, and can effectively go about their life without fear or favour. That is a remarkable change in those 14 years.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman, and commend him for his stance and leadership in this House—and, indeed, outside of this House—when it comes to HIV/AIDS and how to live with it, as he does. In Northern Ireland, which he did not refer to, the Public Health Agency has responsibility for this area. Its hope and ambition is to reach the target of eliminating HIV transmission by 2030, and it seems confident that it can do so, because of the PrEP that he has referred to. It is good sometimes to mark and record the things that are going well.

[Lloyd Russell-Moyle]

It is remarkable. If we achieve that 2030 target in this country, and if we then achieve a roll-out of it globally—that is a lot of ifs—HIV will be the first disease that we have rolled back via treatment and prevention, rather than vaccines. It would be a world leader, and hopefully a pioneer in how we can treat and test other diseases, particularly with mass testing, which I will come on to in a second.

If all that happens, we will meet the 2030 target, but—as we always say—the Government need to do more. To start with, they need to expand opt-out testing. That has been trialled in areas with very high prevalence—that is, Brighton, London, Manchester and Blackpool. Not all of London was originally included in the opt-out testing, but it took the decision to expand that to all hospitals in London, sharing out the money. Remarkably, that has shown that, in non-high prevalence areas, the percentage of people coming back with an HIV-positive test is still significant. The argument, therefore, is to roll that out to all areas.

Over the past 12 months, we have seen real successes in opt-out testing in England. That happens when somebody is already having their blood taken in A&E and the vial is sent off for an additional test. We are testing for HIV and hepatitis B, unless someone opts out. No one is forced to do this, but I understand that very few people opt out.

The pilot’s results have been astonishing. In just three months, 102 people were newly identified, and 70 people were identified as having dropped out of treatment. If someone drops out of treatment, they are a risk not only to themselves, but to the wider community. Those people have been brought back into treatment and that has saved lives. The results are clear: opt-out testing is working.

On a side note, it is also possible to test for syphilis with the same vial. However, it was not possible to expand this to syphilis, because syphilis testing is paid for by local authorities, not by NHS England, and the local authorities were unable to identify where people were from, because hospitals are not coterminous with local authorities and it was too complicated. That seems ridiculous. We need the Government to sit down with local authorities or to provide for that through central funding. If we are taking the vial, we can run it through the same machine. If the only reason stopping us is bureaucratic, I do not see why we cannot do this. We should test people routinely for as many things as we can, if we know that it will help people’s lives. We know that there is a spike in syphilis in certain key populations.

If this vital programme is eventually expanded to all towns and cities with high prevalence, it will be a game- changer. Where London has expanded the programme, it has already been worthwhile financially in areas that do not have very high prevalence. The programme should also be expanded to sexual health clinics to ensure that everyone going to one is tested for HIV. This may be a surprise to many, but that is not always done routinely and it is not an opt-out system. Actually, an HIV test is becoming less, not more common, because more sexual health clinics are moving to online services. Online services have some great advantages, but one downside is that they require people to collect a vial of their blood, which often does not happen, or does not happen effectively, so HIV test rates are lower. We need to ensure that, when people attend a clinic, it is routine and there is an opt-out system. Some clinics do this already, but it is not universal.

I spoke about the HIV prevention drug, PrEP, in 2018. We have a come a long way since the PrEP impact trial. To remind colleagues, PrEP, which is a pill that people take daily, contains two of the three drugs that someone with HIV would have. In fact, I have now been reduced to two because the latest evidence shows that, when someone gets to “undetectable”, the drug load for people who have HIV can be reduced to, effectively, just the PrEP load. The drugs will not be exactly the same as I take for PrEP, but some people can maintain on those as well. So this is also about new interventions that can reduce the costs and the amount of drugs that we are providing.

PrEP prevents HIV and the pill is covered by NHS England, but thousands are still missing out. They are struggling to get PrEP appointments because of under-resourced sexual health services. That is laid bare in the latest report from the National AIDS Trust, the Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network. Due to the fragmentation of services in England, the drug PrEP is paid for by NHS England. That is a real milestone for the NHS, and I congratulate the Government on getting that out eventually, after our interventions.

Anyone who is currently sexually active should be tested by sexual health services every three months, and anyone on PrEP should be tested every three months. In theory, therefore, there is no additional resource for sexual health services for someone on PrEP, because the only people on PrEP should be those who are sexually active, or drug-injecting users who should also be tested, and so on—we should not give it to people who do not need it. But our sexual health services in this country rely on balancing the budget through the fact that people do not attend as regularly as they should. Therefore, that limits the places for PrEP appointments and limits the people who can get access to the drug that the NHS is paying for, even though they are entitled to it and should be offered that level of service.

Awareness of PrEP is far too low and it cannot be given out by GPs, pharmacies, community or maternity services. That means that the burden is solely on local government-funded sexual health services. We all know what is happening with local government and probably do not need to go there today—that is a whole other debate.

If we are going to meet our 2030 target, it is vital that everyone who is at risk of acquiring HIV and who wishes to access PrEP can do so as a key tool in completely and effectively preventing new HIV transmissions when it is taken as directed. Over the past two years, the all-party group on HIV and AIDS has published three important reports. We published “Increasing and normalising HIV testing across the UK”—which I just touched on—and “Nothing about us without us”, which addresses the needs of black, Asian and minority ethnic communities in the UK. Those communities are some of the hardest-hit by HIV in this country and are the least likely to have HIV testing done routinely. The roll-out and trial of the saliva HIV testing, which the Terrence Higgins Trust did two years ago and last year, was particularly effective in those communities. It was seen as less invasive, more private, easier to get hold of and possible to do through online and postal services. The Government should consider whether that process should be normalised nationally or provided cheaply and accessibly.

Our other report, “HIV and Quality of Life—What do we mean? How do we achieve it?”, was published today, and my colleagues have been launching that in Brussels with our partners in Europe. Those reports have been made possible only through the evidence provided by the strong HIV sector that we have in the UK. Its continued insights and hard work are appreciated.

The latest data, however, is not quite as positive. There were 2,692 people diagnosed across England in 2021. That is up 0.7%, from 2,673 in 2020. Some might say that is a small amount but, in 2022, there was a fall of 0.2% and, in 2019, there was a fall of 33%. We are clearly plateauing and there is a danger that we are starting to get more diagnoses. That might be positive because we are delving down to the hardest-to-reach areas, but we need more evidence on why that has plateaued and why it is creeping up before we can be sure that that is something to celebrate, rather than to be worried about.

To keep on track, it is vital that we use every lever available to end HIV transmission and to ensure that we do not plateau, as the numbers show. As I said, we can end transmission by 2030 and I strongly believe that the UK will be one of the first countries to do so. We are a world leader. At the beginning of the week, I spoke to our London NHS colleagues, who said that it is the first time in their career that people have been phoning up from around the world to say, “How are you doing the opt-out testing? How are you doing the PrEP roll-out? We want to learn from you.” That is remarkable and we should be deeply proud of that. The head of UNAIDS came to London and Brighton and we showed her the HIV testing vending machines that we have in Brighton. She said, “I thought that I would never learn anything for the developing world from a rich country. I was here as a courtesy visit, but I have seen what you are doing and how we can roll that out to parts of Kenya and Uganda, and community settings around the world, with HIV testing vending machines that run using solar panels”.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate, and to follow the right hon. Member for Romsey and Southampton North (Caroline Nokes). She and I seem on many occasions to be on the same side in debates in the Chamber and in Westminster Hall. I commend her on her work to promote the values, aspirations and concerns of women in this House, this country, and the world.

I also commend the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on setting the scene so well. I do not think that I have ever missed a debate on HIV/AIDS in the Chamber or Westminster Hall, and I came along to contribute, and to support him. I commend him, as I said in my intervention; he has been a shining light to many who suffer from AIDS across the whole United Kingdom of Great Britain and Northern Ireland, and he has contributed in an exceptional way today. Well done to him.

As the hon. Gentleman said, the global theme for this World AIDS day is “Equalise”. I thought to myself, “That is exactly what we should try to do.” We should not only make sure that everyone in this great United Kingdom has access to PrEP, which he referred to, but ensure the same access to medication and treatment across the world. He outlined that point very well, and I fully support it. Let us replicate what we do here across the world.

On World AIDS Day, UNAIDS asks that we take four actions. The first is to increase the availability, quality and sustainability of services for HIV treatment, testing and prevention, so that everyone is well served. The second is to reform laws, policies and practices in order to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations, so that everyone is shown respect and is welcome. The hon. Gentleman addressed that very well. The third action is to ensure the sharing of technology, so that communities in the global south and the north have equal access to the best HIV science. Lastly, communities should be able to make use of and adapt the “Equalise” message to highlight particular inequalities that they face, and should be able to press for the action needed to address those inequalities.

STOPAIDS got in contact with my office before the debate. It informed me that the UK, which has provided some £15 million a year to UNAIDS for the last five years, has cut its funding by more than 80% to just £2.5 million this year. I concur with the hon. Member for Brighton, Kemptown that that is a worry, and I think that concern will be expressed by others in the Chamber, too. Even though the Minister does not have direct responsibility for the issue, perhaps he will speak about that. The cut jeopardises work that supports some of the most marginalised. The Government and our Ministers should uplift that funding, even if just slightly, to ensure that charitable organisations are fully funded to do their work.

I want to outline what we are doing in Northern Ireland through the Public Health Agency, which I mentioned in an intervention on the hon. Member for Brighton, Kemptown. I want to mention its achievements, even though there may have been a slight increase in the number of those with HIV; the issue is how we combat that. I think that what it has done is excellent. Its 2022 annual surveillance report on sexually transmitted infections, which is based on data from ’21, showed that there were 76 newly diagnosed cases of HIV in Northern Ireland in 2021. That is a 12% increase from 68 diagnoses in 2020, but—this is the key—more HIV testing was being done. Almost 80,000 HIV tests were carried out in Northern Ireland in ’21, which is a 21% increase on the approximately 66,000 done in 2020. The PHA said:

“We are making great progress towards eliminating HIV transmission by 2030. Frequent HIV testing, the offer of PrEP to those most at risk of HIV, together with prompt treatment among those diagnosed, remains key to achieving this.”

So there is more testing, more contact, and fewer people getting AIDS. That is an example of what we are doing in Northern Ireland, and I commend the PHA for doing that so very well.

In 2019 in Northern Ireland, 40% of those newly diagnosed with HIV were gay and bisexual men. In comparison, 52% of cases involved heterosexual contact. There is a stereotype and an assumption that all people with HIV or AIDS are gay or bisexual, but the stats clearly dispute that. As the right hon. Member for Romsey and Southampton North said—this applies to Northern Ireland as well—there must be greater awareness that not only gay men get AIDS. It has impacted the lives of many women, too. Unfortunately, many of the people represented by those 52% of cases in Northern Ireland are ladies. The right hon. Lady outlined the point exceptionally well. It is good that we have it on record that the disease needs to be tackled head-on, always. The HIV strategy must reflect the fact that more heterosexual people get HIV than gay or bisexual people. A new strategy is clearly needed—one that takes on board the figures, and helps us to understand the issues even better.

In Newtonards in my constituency, the Elim church, which is very active, has had an incredible strategy for Swaziland in southern Africa. It has helped to build hospitals, health clinics, schools and other buildings, which has provided jobs. It has also actively helped to address the AIDS epidemic in Swaziland. Those things need to be done proactively and positively. I commend the Elim church and mission in Newtownards as an example of what can be done where there is the will and understanding, not through their own efforts alone but working collectively with others to reduce the number of people in Swaziland who have AIDS.

There are many orphans in Swaziland whose parents died due to AIDS, and some of them were born with AIDS through no fault of their own, and the Elim church and mission actively works with them. They come to my constituency every year as part of the church’s missionary work, and I have never failed to be moved by their singing and joy. They are receiving treatment and medication, too.

Northern Ireland has only one HIV charity, Positive Life, which I commend for how well it does for us in Northern Ireland. Positive Life attends the Democratic Unionist party conference every year, and I make it my business to thank the charity every year for its tremendous work to promote a positive future for people living with or affected by HIV in Northern Ireland. It provides free rapid testing for those who are concerned that they might have HIV, and it offers support along the way. We are all indebted to Positive Life in Northern Ireland, and to all the other charities that play an invaluable role in battling HIV and making the stereotypes and stigma a thing of the past.

The Public Health Agency has a clear strategy for those in Northern Ireland who have AIDS, whether through transfusions, activities or whatever it may be. I am pleased to say that the positivity not only in Northern Ireland but elsewhere encourages me and gives me great hope. The hon. Member for Brighton, Kemptown is an example of that positivity, for which I commend him. I also commend the Minister in anticipation of his answers, which I hope are along the lines we expect.

Accountability in the NHS

Jim Shannon Excerpts

Wednesday 30th November 2022 Westminster Hall

[Sir Mike Penning]

I thank the hon. Member for his intervention. We have seen during covid that, actually, when things get really bad, Ministers can step in and Prime Ministers can step in, but when we talk about individual cases, they cannot.

In the case I am referring to, I ended up writing to the Minister, to be told to go to the ombudsman. I got fobbed off by the ombudsman, after we had been to the trust three or four times. I then wrote to the Minister again—this is over the course of years—to be told to take legal advice. This particular person has now been told, “Go back to your GP and get them to re-refer you if you’ve still got problems.” He has problems because they did not do the operation properly in the first place, and it has had a massive long-term effect on this gentleman’s quality of life.

That is not the only case. I have been here for nearly 18 years, and I worked for a Member of Parliament for many years before that. In every constituency, this sort of case is brought before the MP. I have another example. Last summer, in the middle of heatwave in July, when the temperatures were unbelievably high, a very vulnerable young lady was brought in for a scan at my local hospital. She is the most vulnerable young lady. Her mother cares for her 24/7. She has carers in. She is a wheelchair user or bed-bound. She was left on a trolley in the heat for five hours when her ambulance did not arrive.

When I contacted the trust and said, “What happened there?” it blamed the ambulance trust. When I contacted the ambulance trust, it said, “No, it was cancelled by the trust—it was their fault.” I do not care whose fault it was. It was the NHS’s fault that this happened to a very vulnerable young lady. She had no drink and no food. She was very, very ill. The ambulance trust said that the return journey was cancelled because she was so poorly on the trolley—well, she was so poorly because she had been left there for five hours!

Trying to get to the bottom of what happens within the NHS when something goes wrong is so difficult. We have seen terrible situations in maternity services and in trusts around the country. These problems need to be addressed early on, instead of the drawbridge being brought up and people having to go through a massive complaints procedure where they have to complain three times before going to the ombudsman, and then the ombudsman will say it is out of time, and if they are not careful, they cannot go to court because that is out of time too. Is that the way we want our NHS to be seen by the public, who love the NHS?

The NHS sees the NHS as a single entity. As MPs—and I was a shadow Health Minister for four and a half years—we understand that it is not a single entity. It is a set of silos where everybody passes the buck back and forth. What we need is joined-up thinking. When Members like myself write to Ministers about these issues, the answer is not to say, “Nothing to do with me, guv” and pass it down the line to the ombudsman or a lawyer. That surely costs more money and does not put the NHS in a particularly good light with my constituents who have had their operations botched

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. He talks about silos, and I want to give him an example of that in my constituency. Many people await their care packages in order to be released from hospital and get better at home. On the other hand, there are people waiting urgently for hospital beds who cannot get one. Does he agree that there must be greater communication between trust managers and social care workers to ensure efficiency of care in the community, which would free up hospital beds and allow people to be treated quicker? In other words, we should do away with the silos and get things co-ordinated.

[Sir Mike Penning]

I completely agree with the hon. Gentleman. I know that right next to my constituency, my hon. Friend the Member for Watford (Dean Russell) goes to Watford General Hospital and looks at the boards to see whether people can medically be discharged, but they cannot because there is a lack of joined-up thinking.

This is different. This is about the need for the NHS, when it may or may not have made a mistake, to address it full-on at the start. It should not draw up the drawbridge, with people having to go through the long, drawn-out procedure of making complaints and going to the ombudsman. For a Minister to say to a colleague and fellow MP, “Perhaps this person needs to take legal advice,” is not the attitude we should have towards people who have done the right thing. The NHS has said that they should have an operation, and the NHS has mucked up and botched—I use that word under privilege. At the same time, the person’s life has been detrimentally affected for years and years to come.

I know the Minister is not the Minister responsible, but because we are all constituency MPs, I guarantee that before he was in his position, people were at his surgeries or wrote to him to say, “This happened to me within the NHS. What can you do to help me do something about it?” Somewhere along the line, perhaps the short debate we are having today will nudge the Department of Health and Social Care and the Government —I was a Minister in several Departments—to look at ministerial oversight.

Covid-19: PPE Procurement

Jim Shannon Excerpts

Thursday 24th November 2022 Commons Chamber

[Neil O’Brien]

The people who came through the high-priority route were not politically connected people, except in the sense that they were being referred by MPs across the House. I do not know the exact details of the north-east supplier that the hon. Gentleman mentions. If he gets in touch, I will be happy to take that up and provide him with a full explanation of what the issue was with that bid for a contract.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for the answers he has given. There was a heavy use of direct award contracts to purchase PPE items. As of April 2021, £371 million had been paid for PPE direct award contracts in Northern Ireland. Does the Minister agree that, in hindsight, there should have been better insight into the supply chains of this PPE, where it came from and who was making it, given the reports that PPE contracts were given to Chinese firms using labour schemes?

[Neil O’Brien]

The hon. Gentleman always makes constructive suggestions, and today is no exception. He knows that we have an ongoing inquiry into the lessons that can be learned and a dialogue with the Health and Social Care Committee about many of these issues. Given its heritage, Northern Ireland was an important supplier of textiles and PPE equipment. Inevitably, given the global balance of production, a lot of items did come from China, as he says, but as part of the lessons learned, we should be thinking about domestic supply.