Hospice and Palliative Care

Jim Shannon Excerpts

Monday 13th January 2025 Commons Chamber

[Mr Kohler]

I agree with the hon. Lady, and I will be coming to those points.

Today is not about rehashing the arguments made that Friday, but to allow Members time to discuss and reflect on this separate, but inextricably linked subject. It is not the last word on hospice and palliative care, but an important step in forging a consensus that I hope will unite us, no matter where we ultimately stand on assisted dying.

I began by referencing the crisis in hospice funding. Before I proceed further, I echo what the hon. Member for Spen Valley said and thank the Health Secretary for the £100 million in capital and digital moneys he announced last month. It will make a profound difference to the sector’s current financial position. I have been asked by individual hospices and Hospice UK to convey their genuine gratitude. In a similar vein, the Government’s recently announced commitment to extend the children’s hospice grant by a further year is deeply appreciated and equally vital to maintaining levels of service in this heartrending, but profoundly important part of the hospice movement. However, these are only short-term fixes and fail to provide the long-term funding and certainty critical to securing the future of the hospice movement.

Currently, only one third of hospice funding is provided by the Government, with the rest coming from charitable sources. That leaves hospices vulnerable to increased cost pressures, as can be seen in a recent Hospice UK survey, which found that at least 20% of hospices had cut services in the past year or were planning to do so. Becca Trower, the clinical director of the wonderful St Raphael’s hospice, which provides excellent care to residents in my Wimbledon constituency, was unambiguous when she told me:

“We have a funding crisis and we need to protect our hospice.”

Last year, that meant that St Raphael’s was forced to strip £1 million from its £6.5 million budget by ending its hospice at home service that provided vital care, advice and support to patients and carers in their own homes. It was a virtual ward, in fact, but not one that fitted within the NHS definition of such, which would have attracted the separate integrated care board funding available for such initiatives. In just one month, the cuts to the service directly impacted 26 patients, many of whom spent their last days taking up valuable hospital beds, dying in the one place they did not want to die and putting further pressure on the NHS. When the Government are aiming to move medicine into the community, it makes no sense for hospices to be forced into a position that achieves the opposite.

That contradiction is mirrored in the current funding settlement, where the Government have given with one hand and taken with the other by increasing employers’ national insurance contributions. The refusal to exempt charities will exacerbate the challenges confronting hospices. The amazing Shooting Star children’s hospice, for example, provides wonderful support for families in my constituency. It estimates that the change will add another £200,000 to next year’s cost base.

Hospices need certainty. Doubts over funding undermine morale and sap energy, making the recruitment and retention of staff another huge issue for the sector. To address these problems, the Government need to introduce a consistent, reliable funding mechanism that reflects the rising costs of care. Hospices consequently need to be included within the NHS’s much-anticipated 10-year health plan. In parallel, staffing needs must be addressed in the next NHS long-term workforce plan.

It should not be forgotten that hospices provide a variety of services in addition to palliative care, including emotional, psychological and spiritual support, as well as physio and occupational therapy, practical support, complementary therapies, respite care and bereavement services. Much of that is beyond the clinical, and not something that the NHS can be expected, nor can afford, to provide. That is why no one I spoke to in the hospice movement thought that hospices should be subsumed within the NHS. They provide a complementary service that extends well beyond the clinical, and to which a charitable funding model is more effective and appropriate.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman on setting the scene so well. One of the concerns that I and others in the Chamber have is the impact on the workers in hospices. It is not just about the financial implications, which are all part of the overall issue, but burnout. Staff are working long hours. They are volunteers in many cases, and they do that because it is what they are committed to. Does he share my concern that burnout in hospice care will have an impact on the NHS in the long term?

[Mr Kohler]

I agree with the hon. Member. We need more palliative care specialists and we need more training, and there is a real danger of burnout.

It is not just hospices that provide palliative care. When talking to specialists within and beyond the hospice sector, I have been struck by their commitment to giving patients a good death and their frustration that so many do not receive one. A palliative care doctor recently told The Guardian:

“I sometimes see patients…who come into hospital in unspeakable agony and want their lives to end. It is not because their pain cannot be prevented, but because they are not getting the care they need.”

A local oncologist told me:

“Demand for services is simply outstripping supply. The majority of patients are not getting their end of life care wishes met. The specialist palliative care teams are very good but there are not enough of them and they do not have adequate resources.”

Huge regional inequalities exist in the provision and quality of services due to the vagaries of the current funding model. The Health and Care Act 2022 included for the first time a statutory duty for ICBs to provide palliative care. However, it did not include a minimum standard of core provision, leaving it to what each ICB considers appropriate.

Freedom of information requests submitted by Hospice UK in 2023 found that adult hospice funding consequently ranged from just 23p to £10.33 per head of population across different ICBs. For children’s hospices, the variations were even starker. Research from the amazing charity Together for Short Lives found that spending per child with a life-limiting condition varied from an average of £531 in Norfolk and Waveney to just £28 in South Yorkshire.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate and to follow the hon. Member for Hartlepool (Mr Brash). I thank him for his personal story. Personal stories tell the story of the debate we have in front of us. During the last debate on assisted dying, the dire straits of our palliative care system were rightly put under the spotlight, so I am pleased to see this debate to address the system and the lack of funding.

I will refer to two charities in Northern Ireland that I have had contact with. One of them is Northern Ireland Hospice. It has highlighted that the Government fund approximately 30% of service costs, so the majority of its income relies on the good will and generosity of voluntary donations and other fundraising activities. That means 70% of the funding to provide its specialist palliative care for over 4,000 infants, children and adults with life-limiting conditions in Northern Ireland comes from the funding raised by volunteers. We owe a lot to Northern Ireland Hospice and its volunteers.

The people of Northern Ireland are incredibly generous when it comes to charitable giving, but when we take into account the cost of living crisis and the fact that it naturally reduces what people can give—it is a fact of life—we can see the concerns of the hospice sector. Indeed, when Northern Ireland Hospice believed that its funding would be cut by health trusts last year, it announced that it would have to cut the number of beds available in children’s hospices from seven beds all week round to six beds Monday to Friday and only three at the weekend, which represents a massive change in what it is able to do. That is not the news that we want to hear. It does not mean that fewer children need hospice facilities, but that costs have risen, the ability of fundraisers has decreased, and the Government have not enabled health trusts to make up the difference. Although I have underlined the situation in children’s hospices, the issue is replicated in adult care in every corner of the UK. The hon. Member for South Antrim (Robin Swann) is here. He is a former Health Minister of Northern Ireland, and whenever Northern Ireland Hospice needed help, he was able to allocate funding to get it over that hard patch. I thank him on the record for all that he did to make that happen.

Funding for palliative care is simply not sufficient. I referred to burnout when the hon. Member for Wimbledon (Mr Kohler) very kindly let me intervene earlier. Medical staff whose loyalty and passion for the job keeps them in post, doing overtime or working unpaid to provide cover, are exhausted and unable to carry on. Marie Curie says that one in four people will die without the right care and support. Far too many people are dying in avoidable pain, in poverty, and alone. By 2048, the need for end of life care will have risen by up to 25%, so the challenge for tomorrow is even greater than the challenge for today—over 730,000 people will need care every year. We know that that crisis is looming, and now is the time to make changes for our loved ones and our constituents. Like other Members, that is what I am asking the Minister to do.

--- Later in debate ---

[Stephen Kinnock]

The Government announced a commission on the future of adult social care. A separate commission was announced by my hon. Friend the Member for York Central (Rachael Maskell) on palliative care. We will certainly monitor the findings of that commission very closely.

We will set out details of the funding allocation and distribution mechanisms for both funding streams in the coming weeks.

[Jim Shannon]

In my contribution, I made the House aware that the Northern Ireland hospice has to cut its beds from seven to six for five days of the week, and at the weekend, there are only three. The Minister knows that I respect him greatly. It is all very well to have capital money available, but there has to be money to run the system and provide beds. Otherwise, we can buy beds, but might not be able to keep them and run a service. There must be something seriously wrong with what he is putting forward.

[Stephen Kinnock]

As I said in a previous answer, hospices face a range of pressures that financial contributions from the Government will help to ease. The funding will, of course, have a knock-on impact on hospices budgets in the round.

In spite of the record-breaking package that we have announced, we are certainly not complacent. There is more work to be done, and through the National Institute for Health and Care Research, the Department is investing £3 million in a policy research unit on palliative and end of life care. The unit launched in January 2024 and is building the evidence base that will inform our long-term strategy. A number of hon. Members requested a long-term strategy and plan, which is sorely missing after 14 years of Conservative neglect and incompetence. I agree that we need a long-term plan, and assure Members that conversations are taking place between my officials and NHS England. The research needs to be based on evidence and facts, which the unit will help us to get.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 7th January 2025 Commons Chamber

[Andrew Gwynne]

My hon. Friend raises an important point. As part of the Government’s health mission, we are producing a five-point plan for prevention, and alcohol harms is one of those areas. I hope to be able to update her and the House in due course on the actions we will be taking to drive down the prevalence of alcohol harms and other addictions, because they are costing lives and causing misery in communities. That is why this Government are determined to tackle these public health problems.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answers. While there are community addiction services for those over the age of 18, worryingly, across this great United Kingdom, those under the age of 18 are succumbing to alcohol addiction, too. There does not seem to be any provision for them. May I ask the Minister genuinely and helpfully what provision there will be for those under the age of 18, because addiction problems are rising among the younger generation?

[Andrew Gwynne]

The hon. Gentleman raises an important point. This Government are committed to having the healthiest generation of children ever. That means we will have a concerted effort on a whole range of health issues that determine the health and wellbeing of young people, which will hopefully ensure that they become healthy adults as a consequence. Alcohol harms are certainly one of the considerations we will be looking at.

NHS Backlog

Jim Shannon Excerpts

Monday 6th January 2025 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on bringing forward this debate, and on being so consistent and assiduous on this issue. I understand that she will come on to the Lib Dem manifesto, which a lot of us in this Chamber, whether Lib Dem or not, can agree with. In Northern Ireland we have the health and social care board, which has been working on various strategies to reduce the backlog, but the scale is truly significant. Does the hon. Lady agree that, collectively, England, Scotland, Wales and Northern Ireland should look at all the recommendations and bring them together so that this great United Kingdom of Great Britain and Northern Ireland can benefit collectively?

[Helen Morgan]

The hon. Gentleman always makes an excellent contribution to our debates. He is right that we should look at best practice in Northern Ireland and the devolved nations, as well as in England, to get the right solutions for the problems that we face. I hope colleagues will forgive me as will not take any more interventions because we are tight on time and a lot of people want to speak.

We have reached a point where patients suffering heart attacks are being advised to find their own way to hospital. How can that be acceptable? Once patients get into A&E, they are confronted with the brutal reality of the backlogs. The reality means that only half of patients arriving at A&E in Shropshire were seen within four hours in November. The statistics are shocking, but individual people with serious problems suffer as a result—people such as my constituent with a pericardial effusion, who was deemed fit to sit and left in a chair for more than 24 hours before finally being taken on blue lights to receive the care she needed.

Staff in this situation are so overworked that the standard of care that they give is below what they would like to provide. The patient’s dignity is compromised, and staff are being driven from the service because they are unable to provide the care that they desperately want to. Until the Government put a plan in place to solve the workforce crisis, there is a risk that these scenes will continue to happen. In my local hospital trust alone, a total of 854,839 hours of nursing shifts went unfilled in the 12 months to October.

Liberal Democrats are calling for a qualified clinician in every A&E waiting room to ensure that anyone whose condition is deteriorating is treated more urgently. We are also calling on the Government to publish accessible localised reports of ambulance response times so that the delays that blight places such as North Shropshire and other rural areas can finally be addressed.

A key reason for the emergency backlog is that every day, around 12,000 hospital beds are filled with patients who could leave if they had a care package in place. That is the equivalent of around 26 hospitals being out of action every day. That is why Liberal Democrats have been banging the drum for social care. Without capacity in the care system, beds will remain blocked, A&Es will stay clogged and ambulances will continue queuing outside hospitals.

I am pleased that the Government have finally listened to our call for cross-party talks to fix a broken care system, and I look forward to constructively engaging with them throughout that process, but we cannot afford to wait three more years for this plan to be enacted. I hope that the Government will reconsider their timescale and get the review done as soon as possible, so that the care sector can see the long-term cross-party commitment to reform that it so drastically needs.

Part of solving this issue is supporting preventive measures, which stop people needing secondary care in the first place. I recently visited the North Shropshire charity Energize and saw the work of its Elevate programme, which works to improve fitness, balance and co-ordination in elderly and frail patients. It has had some amazing achievements: I met a gentleman suffering from Parkinson’s who had been falling five times a week before he started his programme, and who is now falling only once a week. Of course, it would be great if he did not fall at all, but I am sure everybody would agree that that is a huge improvement. It is estimated that for every £1 invested in that programme, £26 is saved, so it is an area where we can really make a difference to the crisis in the NHS.

Few backlogs have as much impact as those in cancer diagnosis and care. Nationally, the target of 85% of patients receiving treatment within 62 days has been missed every month since December 2015. At my local hospital trust, fewer than two thirds of patients began treatment within the 62-day target. Improving this situation is integral to increasing survival rates. It is also key to restoring patient faith in the NHS, stopping cases like that of my constituent, whose family felt completely failed by the NHS after he waited almost a year for treatment after first presenting with bowel cancer symptoms. Could the Minister clarify whether the Government remain committed to meeting the cancer waiting time targets this Parliament, as promised in their manifesto, and whether those targets will be included in their new national cancer strategy?

To achieve that improvement, we need to address key workforce issues, notably in radiology, where there is a 31% shortfall of consultants across the country. Again, in rural places such as Shropshire, it is recruitment and retention issues that have caused the sharpest problems. Throughout 2024, it became normal in Shropshire to wait months for cancer test and scan results, with patients in my constituency only receiving their results after their next scan was due to have happened. I am pleased to report that under new management, this backlog is now in the process of being cleared. However, that is happening due to overseas outsourcing, which is not a sustainable long-term solution for this country. We need to retain, recruit, and retrain more radiologists and ensure that enough modern equipment is in place across the country so that no one has to wait too long or travel too far to get the scans that they need. Will the Minister address whether that will also be part of the national cancer strategy?

We cannot talk about backlogs without talking about mental health. According to the Darzi review, 1 million people were waiting for mental health services by last April, over 340,000 of whom were children—children whom we as a nation need to protect, because they are our future. Waiting times for child and adolescent mental health services are shocking in every constituency in the country; from ADHD diagnoses to anxiety, depression and eating disorders, far too many people are not getting the urgent support that they need. A headteacher of a school in north Shropshire told me that in recent years, nine students at his school have lost a parent to suicide, yet there are no community mental health services in the town.

Along with the Government, Liberal Democrats would introduce a mental health professional in every school. However, we are also calling on the Government to improve early access to mental health services, and to cut mental health waits by establishing mental health hubs for young people in every community and introducing regular mental health check-ups at key points in people’s lives when they are accessing the NHS, so that we can pick up those problems and intervene early.

Meanwhile, GP surgeries are also struggling to handle the growing pressure being exerted on them. More than a million patients who tried to contact a GP last year could not get through. If patients cannot access primary care, they seek help elsewhere, or they do not seek help at all; in both cases, this creates further problems down the line. In Shropshire, we have lost 14.3% of fully qualified GPs in the past eight years. A young constituent of mine had to wait seven weeks just for a telephone consultation—a wait that would have been even longer if they had wanted an in-person meeting. Liberal Democrats would give everyone the right to see a GP within seven days, or within 24 hours if it was urgent, using 8,000 more GPs. If we can improve primary care, we can reduce backlogs across the health and care system.

Yet the Government have pledged to increase national insurance charges that could cost GP surgeries the equivalent of 2 million appointments a year. This hike will also hammer pharmacies, with more than a third of pharmacy owners now worried that their business may not survive the winter. If pharmacies close, backlogs will simply increase elsewhere. If we can keep them open and improve services such as Pharmacy First, we can reduce pressure across the system. We would like the Government to commit to removing the increase in employer national insurance contributions to support these crucial community services, so that fewer people end up in hospital and more people are treated in the community, where they will get better and quicker treatment.

Meanwhile, in dentistry, where practices will also be hit by the national insurance rise, there is not so much a backlog of care as an absence of care. Some 6 million adults in the UK are not registered with an NHS dentist and, in places like Shropshire, it is becoming almost impossible to find one, with increasing numbers of practices handing back contracts that have become unsustainable. One of my constituents has been trying to register with an NHS dentist for five years, while another pulled out his own tooth with a pair of pliers.

The Labour Government must show that they understand the problem better than the Conservative Government, whose solution was to introduce golden hello payments. They have been in place in Shropshire for years and they have not achieved the desired outcome. With that in mind, will the Minister outline the Government’s plans in relation to the new patient premium and offer assurances to dentists that any changes will be communicated, so that practices can plan and prepare to best serve their patients? NHS contracts need to be reformed so that we can end the use of the term “dental desert”, end DIY dentistry and guarantee access to people who are in pain.

In conclusion, the Liberal Democrats believe that people should be able to take control of their own lives and their own health. That means everyone should be able to access the care they need, where and when they need it. We welcome much of today’s announcement on elective care, and we welcome today’s announcement on social care, but we are concerned that the decision to hike employer NICs could worsen the crisis in the NHS. Hitting GPs, hospices, dentists and social care providers with higher taxes makes no sense. The Treasury is giving to the NHS with one hand, but taking away with the other. We also want much faster action on social care. As I said, I look forward to engaging constructively with the Minister to come up with the consensus we need, but we cannot afford to wait until 2028 for improvements to be made.

The Conservatives’ legacy on the NHS is that it is on its knees. The Liberal Democrats understand that there is no magic quick fix to change that, but to give people the care they need and deserve we must look at the measures needed for the whole service, giving equal priority to both heart attacks and hip replacements.

Health and Adult Social Care Reform

Jim Shannon Excerpts

Monday 6th January 2025 Commons Chamber

[Wes Streeting]

That is an excellent question. Having put in place funding to ensure that there are 1,000 more GPs on the frontline before April, and having announced just before Christmas a significant uplift for general practice, I hope that in the first six months of this Government, we have sent the strong message to people who aspire to long careers in medicine that general practice has a huge role to play in the NHS in the 21st century. It is an exciting place to be, but I recognise that we have to fix the front door to the NHS to make it more attractive. The situation is even worse than my hon. Friend has described, because when the Conservatives left government, there were qualified GPs unable to find jobs, at a time when patients were unable to find GPs. We got to work on that issue within weeks of taking office, and we will do more over the next 12 months.

[Jim Shannon (Strangford) (DUP)]

It is good to hear the latest announcements on overhauling the increasingly costly care for older and disabled people, and I very much welcome what the Secretary of State has said. I understand that this will happen through a three-year review, and that we will be clearer on the plan to introduce this in 2028. Health is devolved to Northern Ireland, but thousands of care packages in Northern Ireland are not fulfilled. What can he do to assist Northern Ireland in achieving its goals? Goals that are set here for England and the United Kingdom need to be in place in Northern Ireland as well.

[Wes Streeting]

The ministerial team and I have enjoyed working with counterparts in the devolved Governments over the last six months, and we will continue to do that. Thanks to the decisions that the Chancellor took in the Budget, we see significant investment in health and care services here in England, and the Barnett consequentials will create a rising tide that will lift all ships across England, Wales and Scotland. I might even say that all roads lead to Westminster. I say this to Scottish National party colleagues: down the road to Westminster lie the resources for the SNP Government, so they do not have an excuse not to act.

Hospice Funding

Jim Shannon Excerpts

Thursday 19th December 2024 Commons Chamber

[Karin Smyth]

As the hon. Gentleman knows, this Government have allocated an extra £12 billion in this year for the health and care sector. The full allocation to cover the entire area of health and social care will be announced in the new year.

[Jim Shannon (Strangford) (DUP)]

It would be churlish of anybody in this Chamber not to welcome the money that the Government are setting aside. I thank the Minister and the Government for that announcement, but what discussions has the Minister had with Cabinet colleagues to secure exemptions from national insurance contribution hikes for hospice workers? I think of Marie Curie—I spoke about that charity yesterday in Westminster Hall, and the Minister probably has a Marie Curie in her constituency. We know what that charity does. Unlike the mainstream NHS, it will not be exempted, yet it carries out the end of life care that the NHS simply cannot provide. Further, what help will be provided to carers in the community? The withdrawal of their service would leave the care system decimated.

[Karin Smyth]

The hon. Member makes an excellent point about carers and their support. We made announcements about that in the Budget, and we will make more general announcements about allocations in the new year.

Community Pharmacies: Devon and the South-west

Jim Shannon Excerpts

Tuesday 17th December 2024 Westminster Hall

[Rachel Gilmour]

I agree that we need to do that as often as possible. I will move on to the workload. This is not a typical example: along with prescriptions, in Tiverton and Minehead each pharmacy conducted 398 flu vaccines on average during the 2023-24 season, higher than the national average of 355.

If Members are unfortunate enough to need their blood pressure checked, they can go to a pharmacy. Across the UK, 930,000 hypertension blood pressure checks are undertaken in just one year. With public health as a driving mission for the Government, I would hope that this was something they could support wherever it takes place. Pharmacies also offer a range of other clinical and public health services, including providing flu and covid-19 vaccinations, and if further services were to be commissioned from community pharmacies in the context of sustainable core funding, the sector could do even more to improve access to primary care.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this debate forward. She has touched on the issue of funding. In Northern Ireland, we have already made that commitment as it is a devolved matter; an additional £15 million has been set aside for community and GP pharmacies, with extra money beyond April 2027. We all want to achieve what the hon. Lady wants, but does she agree that to achieve that the Government and the Minister have to invest accordingly?

[Rachel Gilmour]

I do agree. In addition to delivering formally commissioned services, pharmacies provide an alternative point of contact for the public for informal clinical advice. The 2024 pharmacy advice audit found that the average pharmacy carries out around 22 informal consultations per day, which is the equivalent of 1.3 million informal consultations taking place in community pharmacies every week.

Musculoskeletal Conditions

Jim Shannon Excerpts

Tuesday 17th December 2024 Westminster Hall

[Sonia Kumar (Dudley) (Lab)]

I beg to move,

That this House has considered the diagnosis and management of musculoskeletal conditions.

I am grateful for the opportunity to have this debate. As chair of the all-party parliamentary group on osteoporosis and bone health, and as an advanced practice physiotherapist and first-contact practitioner, musculoskeletal health is my speciality. I am here to discuss the provisions needed to improve the diagnosis and management of MSK conditions.

My experience as an advanced practice physiotherapist is very much autonomous. I do not think many people know that physiotherapists work from paediatrics all the way to elderly care—from nursery all the way to palliative care. Most people do not know the work of a first-contact practitioner, which is a new service in which physiotherapists work with GPs to diagnose, assess and refer to secondary care, if needed. I was part of that vital service at Dudley Group hospitals, so I declare my interest as working on the bank there.

MSK physiotherapists work not only across hospitals and primary care but also in tertiary care. They work in fracture clinics, rheumatology, pain management and A&E. Not many people realise what we do. MSK physiotherapists are the specialists and experts in musculoskeletal diagnosis. That could include referring people for X-rays to look for suspicion of fractures or for MRI scans to look for sinister pathology, a differential diagnosis, masqueraders that look like Pancoast tumours, metastases or spinal or multi-joint cysts. Along with ultrasounds, guiding injections and prescribing, the scope of physiotherapists has expanded year on year, to a point where they are now specialising and moving their practice on to do simple surgeries, such as carpal tunnel releases.

I look not only from a diagnostic point of view but at the importance of managing MSK conditions, including in respect of rehabilitation.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. There have been some worrying trends in the press in the last six months, in relation to children as young as 11. Does she agree that the NHS plan for change over the next five years is necessary, given that children as young as 11 are being diagnosed with arthritis? We need help and guidance for those whose lives might be impaired from an early age right through to older life, and who need coping mechanisms. The importance of this debate cannot be underlined enough.

[Sonia Kumar]

I agree with the hon. Gentleman. I have worked in paediatrics where many patients get diagnosed late and suffer with late onset. That affects their whole life from the beginning, including their ability to get involved with physical activity and to build relationships, or their mental health and sleeping patterns. Getting an early diagnosis is one of the solutions I want to put forward. I would like the Minister to consider involving physiotherapists from early on, at nursery stage, to find out why we are not picking up MSK conditions from a really young age so that we can provide health and wellbeing from day one.

Dental Healthcare: East Anglia

Jim Shannon Excerpts

Wednesday 11th December 2024 Westminster Hall

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I beg to move,

That this House has considered dental healthcare provision in East Anglia.

It is lovely to see you in the Chair, Mr Dowd. I am grateful to colleagues from East Anglia for supporting this debate and, I hope, making some interventions. I am also grateful to the Minister for Care for coming yet again to Westminster Hall, because this is not the first time that we have had a debate on dentistry in the east of England, and in East Anglia in particular. The reason for those numerous debates is the significant problem of access to NHS dentists in particular, but also to private dentists.

Peter Aldous, who I am sorry to say lost his seat at the recent election, was a doughty campaigner on the issue. I pay tribute to him for the numerous debates he brought forward. Most recently, in September, the hon. Member for Norwich South (Clive Lewis), who is not here today, held a debate on the topic. Time is short, so I will not focus on the need as much as I normally would, but the Minister has been here before and knows very well how significant the need is for increased access to NHS dentistry in East Anglia.

I will give highlights, however, because the Secretary of State for Health and Social Care has described Norfolk not only as a dental desert, but as the “Sahara of dental deserts”. The Minister—the noble Baroness, Lady Merron—confirmed in the other place on 25 November that the Norfolk and Waveney area has

“the worst ratio of NHS dentists to patients in England”.—[Official Report, House of Lords, 25 November 2024; Vol. 841, c. 479.]

In my last debate in this forum, I was shocked to report that in Norfolk and Waveney the ratio of dentists per 100,000 population was 39, when the national average was 52. Now I have to update those figures, because the Secretary of State has recently confirmed that the figure of 39 has dropped to 36 per 100,000 of population, while the national average has increased to 53. It is getting worse, not better.

The data from this month is even more concerning. The British Dental Association confirms that there are 3,194 NHS dentists in the east of England, which are the statistics we previously used. BDA’s further analysis last month reveals that that equates to just 1,096 full-time equivalent dentists in NHS roles. If those figures are run through the population, there are 17 full-time equivalent NHS dentists per 100,000 population in the east of England. Those are truly shocking figures.

The issue can be sliced and diced in another way. The amount of money that the Government spend on people’s mouths in the east of England makes for sobering reading. The national average is £66 per mouth spent on dental treatment by the NHS. In the east of England, that figure is just £39. What is it? Is it that our fillings and dental work are cheaper in the east of England, or are we doing less? It is not due to less demand; we have the greatest demand. We had more than 1,000 people presenting in the past year at NHS A&E with significant dental problems. I believe I am right in saying that dental concerns are the single biggest reason why primary school children present at hospitals.

[Jim Shannon (Strangford) (DUP)]

On that critical point, dental care must start in primary school. When I was at school—that was not yesterday, of course—they came in to check the children’s teeth. We had that the whole way through, but that process is missing today. Does the hon. Gentleman think that primary school should be the first stage of response?

[Jerome Mayhew]

This debate is about the east of England, not the east of Northern Ireland, but I will take the hon. Gentleman’s intervention anyway. He is right that we learn our oral hygiene habits as children. It is primarily the responsibility of parents to look after their children’s oral health, as well as their general health; that has always been the case, and that should always remain the case. However, we recognise, as did the last Administration, the increasing role of primary schools in reinforcing the role of parents.

Puberty-suppressing Hormones

Jim Shannon Excerpts

Wednesday 11th December 2024 Commons Chamber

[Wes Streeting]

I can certainly give my hon. Friend that assurance. We want all trans people, in fact all people in our country, to receive timely access to safe and effective healthcare. We want to improve services for trans people specifically, because we recognise the extent to which they have been let down. I emphasise that young people who have been in receipt of puberty blockers with a valid prescription for the six months prior to 3 June and 27 August respectively can seek continuation of their prescriptions. There are risks that would be associated with an interruption of those prescriptions, which is why we have taken that approach. I know that I speak for the Government as a whole in saying that whether it is access to healthcare as in my case, access to a wide range of public services, or indeed safety on our streets, this Government are committed to improving the lives of trans people so that they can live with the freedom, dignity and respect that any of us in our country would expect for ourselves.

[Jim Shannon (Strangford) (DUP)]

I very much welcome the Secretary of State’s statement. It is never easy to deliver a policy decision that has so much effect on people, and I admire him for his diligence and his courage. He will be aware of the findings of the Cass report, which found that the change in practice from psychological and social support to drugs was based on no good evidence. In the light of medical professionals highlighting that puberty blockers by definition disrupt a crucial natural phase of human development, does the Secretary of State believe that we must extend the ban from temporary to permanent, not only to protect our children, but to prioritise mental health and the support that they so desperately need?

[Wes Streeting]

I am grateful to the hon. Gentleman for what he said. These issues weigh heavily on my conscience. On what he says about the safety and efficacy of puberty blockers, the simple fact is that we just do not know enough. That is why building the evidence base and research is important. I want to ensure that young people with gender incongruence and dysphoria are receiving the best quality healthcare to improve their safety, welfare and wellbeing as children, and that they live long, healthy and happy lives as adults. That is the basis on which we are taking decisions, and we are approaching the issue with care and sensitivity, as I know my counterpart in Northern Ireland also does.

Lobular Breast Cancer

Jim Shannon Excerpts

Tuesday 10th December 2024 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered the treatment of lobular breast cancer.

It is a pleasure to see you in the Chair, Ms Vaz. I secured this debate in memory of my constituent, who was also my close friend, Heather Cripps. I welcome Heather’s husband David and her sister Jenny to the Public Gallery. I will come to Heather’s story shortly, but I also want to welcome to the Public Gallery my mother-in-law Cressida, who survived lobular breast cancer 22 years ago, as well as several others whose lives have been touched by lobular breast cancer. Many of them have provided me with briefings in preparation for the debate, for which I am grateful.

I met Heather in 2016 when, as someone who had pretty much never run for a bus before, I was roped into a free 5 km parkrun at 9 am on Saturday mornings in Dulwich park. Heather was a serious runner, and running was a huge part of her life. She took pity on me and decided that her inexperienced local MP needed a friend to run with, and she became that friend. We worked out that we lived close to each other, and it was not long before I was picking her up to go to the parkrun, and we would run together most weeks.

Heather was a dedicated public servant, spending her whole life working in the Home Office. It is a testament to her professionalism that she never spoke with me about the content of her work. What she did speak about as we ran was her family, her husband David and two precious daughters. Heather was an amazing mum. She spent so much of her time thinking about what her girls would enjoy, planning birthday parties and holidays and, earlier this year, plotting a trip to Wales to culminate in the surprise collection of a new puppy.

In 2020, at the height of the covid-19 pandemic, Heather started to get terrible back pain. For several months this was treated as a musculoskeletal issue. She was given pain medication, but it got worse and worse. Eventually, she was diagnosed with stage 4 invasive lobular breast cancer. The back pain was the result of the cancer having spread to her spine. For three years, chemotherapy held the cancer at bay but, when Heather came to Parliament almost exactly a year ago to campaign on lobular breast cancer, she mentioned to me that she once again had back pain, which she thought could be the cancer recurring.

[Jim Shannon (Strangford) (DUP)]

The hon. Lady brings forward a very personal story. In this House, we know that personal stories are always the hardest to tell, but the ones that have more impact. I commend the hon. Lady for what she is doing today. We would all say that, but we mean it.

[Helen Hayes]

I thank the hon. Gentleman—who is my hon. Friend—very much indeed for that intervention.

Heather died in St Christopher’s hospice near her home on 30 August. She was 48 years old. Shortly before she died, Heather’s daughter, who was due to start secondary school in September, visited her mummy in the hospice, so that she could see her in her school uniform. In that unbearable heartbreaking detail is why we must do better on lobular breast cancer: better on awareness of symptoms and better at research into treatments.

The heartbreak of Heather’s story and the impact on her family and friends is sadly replicated for too many women and their loved ones throughout the UK. Lobular breast cancer is the second most common type of breast cancer, accounting for 15% of all breast cancers, and 22 women a day are diagnosed with lobular breast cancer in the UK. It behaves differently from other forms of the disease, mostly strikingly because it does not cause lumps, and it is often completely invisible on a mammogram.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for her story on behalf of her dear friend and for leading the debate. We have been very privileged to hear contributions from courageous hon. Ladies to my right and to my left, who have told their own personal stories, which contribute to this debate. It probably also humbles us to have those contributions. Every person who has come here today to make a contribution will have an example of someone they love who has been affected.

Westminster Hall is a great place, as the Chamber would be, to raise awareness and to discuss these matters. I am sure that many will not be fully aware of this insidious brand of cancer, or of its specifics. I am personally grateful to be able to give one example, but also to discuss these issues.

As my party’s health spokesperson, these issues are incredibly important to me. Indeed, they are important to us all; we are all here for the same purpose and it is vital for us all to be here. I know that we will all have had some journey experiencing cancer within our family or close to home. Not long ago, I met in my office a constituent of mine who was diagnosed with lobular breast cancer. I think that, whenever we meet someone who has come through that journey and thankfully is on the other side and alive today, we thank God, as the hon. Member for Maidstone and Malling (Helen Grant) did. Ultimately—I say this respectfully to everyone here —that is where the power lies for healing: with our God.

The hon. Lady explained that there is not enough research into the specifics of this cancer, let alone more access to medication that lessens the impacts of the suffering. Perhaps the Minister will have an opportunity, through civil servants, to check what research and development there is on this specific lobular cancer to help save more lives, make lives better and give people hope for the future. Ultimately, in this House, we are tasked to give hope—not because of our words, because our words are not important—to those out there who face this reality of what the future will hold for them.

Invasive lobular breast cancer is the second most common type of breast cancer. It is also known as invasive lobular carcinoma. Around 15 in every 100 breast cancers are invasive lobular breast cancer. The most recent figures show that, in 2016, 6,765 people were diagnosed with lobular breast cancer in England, including 6,754 women and 11 men. There may be those who think that it is not a disease that can affect men; but although it is a very low number, it still does. My hon. Friend the Member for Wokingham (Clive Jones) is one of those survivors. I think we should thank God that he is here today as well. It is important to note that, although it is less common for men to get this form of cancer, they are still able to get it and it can impact them just the same.

There were 7,566 cases of female breast cancer diagnosed during 2018 and 2022 in Northern Ireland. On average, there were 1,513 cases per year. I want to put the figures and stats on record because they illustrate clearly how critical, dangerous and invasive this cancer can be. In Northern Ireland, the breast cancer incidence rate was 156.7 cases per 100,000 females. The odds of developing female breast cancer before the age of 85 was one in eight. It is clear that there is a major concern in Northern Ireland and throughout this great United Kingdom.

This specific type of cancer often goes undetected, as it spreads in straight lines, as opposed to lumps. Furthermore, although the cancer grows slowly compared with other cancers, the tumours can be large by the time they are detected. In addition, some 3.75 million people will be diagnosed with this cancer in the next 10 years, which is why it is important to discuss it, so I thank the hon. Member for Dulwich and West Norwood for securing this debate.

[Carla Lockhart (Upper Bann) (DUP)]

I associate myself with what we have heard in this very powerful debate. I commend the hon. Member for Dulwich and West Norwood (Helen Hayes), and I commend the family who are sitting in the Gallery. Cancer is a thief in many homes, and I commend them for their bravery.

Does my hon. Friend the Member for Strangford (Jim Shannon) agree that, across the UK, we need more investment, more research and more clinical trials, and that it is for this Government to step into the breach and do just that?

[Jim Shannon]

My hon. Friend is right. We are fortunate that Labour has set aside £26.3 billion for the NHS. We have to recognise that commitment, and I hope the Minister will be able to tell us that money will be set aside for the very invasive disease to which my hon. Friend refers.

ILC currently has no specific treatment and, for those who have been diagnosed, it behaves very differently from the more common type of breast cancer. As we look ahead to the next 10 years, it has been great to learn more about the Lobular Moon Shot Project, which has been supported by this Government, the last Government and hundreds of Members. Everyone in this room supports it, everyone in the Gallery supports it, and everyone outside this room supports it too.

The project was set up in 2023, which is fairly recent. At my age, the years go incredibly fast, but 2023 feels like yesterday. The project seeks to lobby the Government to secure the research funding needed to understand the biology of lobular breast cancer. The project has stated that a major research package is estimated to cost some £20 million over five years, but it has not been prioritised as it should have been. I reiterate what the hon. Member for Dulwich and West Norwood said, and I ask that the research is prioritised. The Minister may not be able to tell us about everything that is happening, but we need to hear that commitment.

Some fantastic charities undertake amazing work to support those living with breast cancer, and I have met them both in Westminster and at home in my office, and their work is instrumental in helping people to cope with the physical, mental and emotional side of dealing with a cancer diagnosis. One person will have the cancer, but their family and friends are also affected, as the hon. Lady said.

With this type of cancer, there is a risk of recurrence or spread. Up to 30% of early-stage primary patients will experience spread to their organs, which can be a number of years after the initial diagnosis. This highlights again the need for greater research and funding to ensure early detection and to prevent the cancer’s spread.

The shadow Minister spoke in a debate this morning about research undertaken between Birmingham University, Newcastle University and Queen’s University Belfast. He was talking about rare autoimmune rheumatic diseases, but Queen’s University Belfast has partnerships with other organisations to try to find cures for cancer. Many universities across this great United Kingdom of Great Britain and Northern Ireland are carrying out research, and the Government’s approach to that is vital.

I have gone on a bit longer than I had hoped, but there is more work to be done on researching most cancers. Breast cancer, and specifically lobular breast cancer, impacts the lives of thousands of people every year. It is time to do more as a collective. Today, collectively, Members on both sides of the Chamber are committed to trying to find a cure and trying to find hope for those who have cancer, and who will hopefully survive it, and for their families as well, by undertaking the important research into this awful disease. We are also committed to making men and women across the country aware of the warning signs.

I look to the Minister and her Labour Government, which is my Government—whether you are a Labour person or not, it is our Government and they are trying to do the best they can, and I think they deserve support for their commitment to do so—with sincerity and honesty, perhaps beseechingly, to ensure that the devolved nations are not left behind in terms of a strategy. I look forward to action from the Minister and to her replying to all the requests.