Cancer Care: Young Adults

Jim Shannon Excerpts

Wednesday 8th June 2022 Westminster Hall

[Julie Marson (Hertford and Stortford) (Con)]

I beg to move,

That this House has considered cancer care for young adults.

It is a pleasure to serve under your chairmanship, Mr Paisley. Normally I would say that it is a pleasure to be here in Westminster Hall speaking on a particular issue but, of course, it is not a pleasure today. I wish I was not here raising the issue of cancer in young adults.

It is an issue that is horrible to confront and contemplate, but what I feel is nothing compared with what Simon and Andrea Brady feel. Every day they have to confront the reality of what happened to their daughter Jessica, who tragically passed away on 20 December 2020, aged just 27. They are here today because of Jess. I am here because of Jess. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) is here because of Jess, and the Minister is here because of Jess—I thank them both for that.

I pay tribute to Simon and Andrea. They are utterly determined in the face of their terrible loss to effect change in Jess’s name. I hope I can do justice to them and to Jess in supporting their call for that meaningful change. We are asking for Jess’s law—a practical change designed to save lives. Jess’s law would be that after the third contact with a GP surgery about a condition or symptom, a case should be elevated for review. After five contacts, it should be red-flagged and set procedures and guidelines should be followed, including a referral to a specialist.

We are clear that this should not be a tokenistic exercise, such as a simple, inconclusive blood test with the patient given an all-clear. The investigations need to be thorough and conclusive to make a real difference and to save lives.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this debate forward. I am moved by her plea on behalf of her constituents. I thank her for her dedicated efforts and for consistently raising the importance of cancer care for young adults like her constituent Jessica, who she has spoken about on a few occasions.

In Northern Ireland, trusts that run screening tests for certain types of cancer, such as breast, cervical and bowel. Does the hon. Lady agree—indeed I think she is asking for this—that it is time to introduce early intervention blood testing for those with symptoms of cancer to ensure early detection? Doing that would mean catching these cancers earlier.

Dialysis Care Outcomes

Jim Shannon Excerpts

Thursday 19th May 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered dialysis care outcomes.

I thank you for chairing this debate, Sir George, and thank those who are here to participate—they are colleagues, but also friends. I am pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place and am especially pleased to see the Minister in her place, too. I am not being condescending when I say that; I am encouraged because the Minister understands the issues very well. I look forward to her response—no pressure, Minister. We are pleased to have this opportunity.

I thank our guests in the Gallery, particularly Fiona Loud, who has been instrumental, through me, in achieving this Westminster Hall debate. I thank the Backbench Business Committee for allowing the debate. I applied for it some time ago, but the Queen’s Speech meant that those applications to the Committee fell. It was originally supposed to take place on the Thursday before recess, but we are having it at the same time, 3 o’clock, as it would have happened on that day.

Dialysis is an important issue to raise, especially at this time of rising daily costs that directly impact people who choose to receive their treatment in their own home. In a question to the Prime Minister yesterday, the right hon. and learned Member for Holborn and St Pancras (Keir Starmer) referred to Phoenix Halliwell and the cost for those receiving dialysis treatment at home. There might have been a bit of confusion around how the question was asked and how the answer came through—I know that others will speak to that—but it pinpoints a key issue for this debate, which is the impact of the cost of electric and energy on people receiving dialysis treatment at home. That is of particular concern to me and others at this time of rising costs. There are global pressures on the price of energy. This is not a debate on energy, but on what is happening to those who have dialysis treatment.

It is not just adults who are affected by this issue. Fiona and I spoke to the Minister beforehand; we appreciate that very much. It seems that not every postcode covers children. Local providers have discretion as to whether they reimburse the utility costs for children. I know that Fiona, who I spoke to beforehand, is concerned about that, and I certainly am. One person who contacted us said that her son has been on peritoneal dialysis since January. It used to cost £115 per month for combined usage, but it is now up to £350—a massive increase of 220%.

Although this debate covers a health issue, it also focuses on the predicaments of those people in the health system. We need to review that and think about it again, so that we can understand it better. It is important for those we are concerned about that we understand where the pressures are—financial pressures are coming from all sides.

Others will refer to this, but even on the warmest day of the year—we experienced the highest temperature of the year on Wednesday—a person receiving dialysis will feel cold. Cold weather puts even greater pressures on household energy costs, but people who receive dialysis at home are being very adversely affected by rising fuel and heating costs. I will refer to that later, but I wanted to put those two issues on the record. They have been brought to my attention and are of deep concern.

I know that this is not the Minister’s responsibility, but I will give some facts from Northern Ireland, where attempts are made for every patient to be given approval to receive dialysis at home at first. It does not always happen, because sometimes patients are sent to the renal department at the Ulster Hospital, which is my nearest hospital and which I have visited on a number of occasions over the years.

Analysis by the UK Renal Registry showed the rate of home dialysis in areas of deprivation at the end of 2020. Unfortunately, however, there was no data available for patients treated in Scotland. My colleagues and friends from Scotland may have some figures. Overall, the rate of home therapy was lower for patients from the more deprived areas of England, Northern Ireland and Wales. In England, 22.9% of patients in the least deprived areas were able to access home dialysis, compared with 15% in the most deprived areas. The rate of home dialysis for patients in Northern Ireland was 7.2% in the least deprived areas, whereas it was 9.8% in the most deprived areas. I am alarmed at these figures. If someone has a certain amount of income, it means that they have to pay for their energy. However, someone who is deprived is under pressure to ensure that the energy, electric and heating levels in their house are at a certain level, so the impact on those in deprived areas is much greater than it is anywhere else.

Those from lower socioeconomic backgrounds are affected by renal failure in the same way as anybody else, but they do not have equal access to home dialysis and the freedom that that choice offers. I look to the Minister, as I always do, for a positive response on how we can take things forward constructively in a way that can deliver for dialysis treatment patients across this great United Kingdom. We need to address this issue on a UK-wide basis, and greater equality must be achieved. I am my party’s health spokesperson, so it is always a pleasure to speak in these debates and to highlight issues that are brought to my attention by people such as my friend Fiona Loud from Kidney Care UK.

Kidney disease costs the NHS more than breast, lung, colon and skin cancer combined. It has a greater financial impact. It is estimated to cost £1.4 billion a year—equivalent to £1 in every £77 of NHS expenditure. That is a massive figure and a significant expense, with 21 people developing kidney failure every day and almost 30,000 people on dialysis in the UK. Unfortunately, it shows no signs of slowing.

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

Acute kidney injuries usually come about as a complication from another illness, and they are more deadly than a heart attack. As the hon. Gentleman said, research indicates that about 30% of acute kidney injury deaths could be prevented with better care or treatment. Does he agree that this is an area that requires urgent attention, looking at kidney disease outcomes in the round?

[Jim Shannon]

I thank the hon. Lady for those wise words, and I absolutely agree with her. She is right. We should never be guided entirely by finance, but we cannot ignore the financial implications. If we—by which I mean the NHS—could better use the moneys for early intervention, early diagnosis and early medical action, and reduce the cost, that would be beneficial to the NHS.

The clinical and cost benefits of home dialysis are well established, but despite 17 years having passed since the National Institute for Health and Care Excellence first highlighted its ambition for just 15% of patients to take advantage of home haemodialysis, as many as eight out of 10 dialysis patients are still treated in centre. That is a big challenge, but it is something I believe in, and I am confident that the Minister can embrace that challenge and give us some idea of how we can move forward in a positive fashion to deliver even better.

Some of those people will have successful transplants, although a transplant is only a form of treatment, not a cure. I have a particular interest in this matter because I have a nephew called Peter Shannon, born with a kidney the size of a peanut, or the wee nail on my finger. I remember when my boys were running about—obviously, young boys or young girls are always full of life, but he never had the energy. He was always a terrible colour—yellow, the colour of a bowl of custard—and he never really moved forward physically until he had a transplant at the age of 16. When he had that transport, his life transformed; if only that were possible for everybody, but it is not. I have been a great supporter of organ transplants all my life, and I am very pleased that the Government accepted the legislative change to make everybody a donor unless they opt out. I was always in favour of that legislation. In Northern Ireland, my party —the Democratic Unionist party—had perhaps not truly embraced it in the past, but it has now. I cannot say I am a pioneer in the party, but I am pleased that that legislation has also been endorsed by the Northern Ireland Assembly.

Many other dialysis patients will have no choice but to dialyse to replace their kidney function and to stay alive. The majority will do so three times a week at a hospital or clinic, every week for the rest of their lives, because once a patient starts dialysis, they are on it forever unless they receive a transplant. Across this United Kingdom there are nearly 30,000 people, from young to old, on dialysis. They come from all walks of life and are united by a remarkable strength and resilience to continue with this long-term, gruelling, life-saving medical treatment.

When dialysis is needed, in an ideal world the patient and their care team will consider and decide together whether to dialyse at home or in-centre. There are two forms of home dialysis therapy, with haemodialysis being the most common. Tubes are attached to needles in the arm or via a line to the neck, with blood passing through an external machine that filters the toxins and water from the blood before returning it to the body—it is almost like a cleansing process, but medically. Suitable patients can safely undertake that procedure themselves at home, carrying out sessions that meet their clinical needs to a routine that fits their lifestyle, including overnight while they sleep. In peritoneal dialysis, which is the other form of therapy, a catheter is placed into part of the abdomen via a surgical procedure.

Since its introduction in the 1960s, most dialysis care is delivered in-centre, with patients required to travel to a hospital three times a week for four hours of treatment. Many patients who dialyse in-centre benefit from the care of the UK’s excellent nephrologists, nurses and support staff, and from a sense of community with others receiving dialysis. However, that treatment is more intense over a shorter period of time, which might not suit everybody. It can be extremely draining, and it often leaves patients feeling physically exhausted as the body is pushed so hard during those treatments, and their toxin and fluid levels build up again immediately while they face a long wait until their next dialysis session. As a result, those patients must adhere to strict fluid and diet restrictions, and they must also travel to and from their dialysis centre, which is a time-consuming and often exhausting experience.

I visited the dialysis renal unit at Ulster Hospital in Dundonald some time ago. It is a new centre, and I met many of the people there. I knew two of those people personally. One was Billy McIlroy, who passed a few years ago. He went there for his dialysis treatment three days a week, which I know kept him alive. Another guy called David Johnson also attended that dialysis unit. He got a kidney transplant eventually, so his life changed greatly. I had already been given the details of what happens in dialysis, but actually seeing it showed the reality—it gave a physical understanding—of what those people were going through three times a week. For them, travelling from home and going home again was six hours of their day.

[Margaret Ferrier]

On that point, the impact of kidney disease and treatment on patients’ mental health is huge. Good mental wellbeing can make a big difference to a patient’s recovery and ability to withstand difficult treatment. Does the hon. Gentleman agree that ensuring patients have access to mental health support is paramount to improving outcomes, and that the NHS must be better resourced to provide that?

[Jim Shannon]

I thank the hon. Lady for reminding us all of that. We often focus on the physical aspects of this condition, as we should, but we must also remember the mental health and anxiety issues that come alongside it. Patients suffer with uncertainty about how they are going to feel the next day, uncertainty about their future health, and uncertainty about their personal and financial issues and their family. The hon. Lady is right to remind us of that point.

By comparison, home dialysis therapies offer flexibility and have been shown to have a positive effect on a patient’s health. When patients dialyse more regularly, they are more effectively replicating the natural function of the kidneys. Studies have shown that longer, more frequent dialysis sessions, undertaken at a schedule of the patient’s own choosing, achieve better results than a thrice-weekly in-centre schedule. People doing alternate-day dialysis have been shown to experience fewer symptoms, such as shortness of breath, high blood pressure and left ventricular heart damage. People on home haemo- dialysis have an up to 13% lower risk of death than those on in-centre haemodialysis. That shows that if people can do more home treatment, we can improve their longevity. NHS England has acknowledged the limitations of standard in-centre haemodialysis, and in particular the increased risk of hospitalisation or death after the weekly two-day break between in-centre sessions.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) is right about the importance of mental health. Depression is the most prevalent psychiatric illness in patients with end-stage kidney disease, and she made that point powerfully. One study shows that rates within the dialysis population vary from 22.8% to 39.3%. Wow—those are big figures, and they show what the condition does. Studies have also shown that depression is a significant predictor of mortality in dialysis patients. That is particularly important for younger people on dialysis, who report a lower quality of life than young adults in general.

People who have the choice of dialysing for as long as they need and at a time of their choice have freedom and control. They can also better respond to their body’s reaction at that time, in the comfort of their home and with the reassurance of their family around them. Home treatment probably addresses some of the issues of depression and mental health issues as well. It enables patients to have a life outside their dialysis schedule and hold down a job. It allows them to have a normal life and pursue the dreams and ambitions that should be the right of any person, young or old. I can attest to that through my nephew, Peter Shannon, who has had an organ transplant. I have seen his life change. He bought his first house just last week, incidentally, at probably the highest time for house prices in the whole United Kingdom.

In the last 18 months, covid-19 has exaggerated the negative impact of differences in dialysis care, and heightened the need radically to increase home therapy provision. Analysis from the UK Renal Registry has demonstrated that the relative risk of death associated with covid-19 among in-centre dialysis patients was much higher than that of the general population in England, especially among those of a younger age.

The UK kidney community has been calling for patients to be provided with greater choice in their dialysis care, recognising the need for increased awareness and education around home therapies and greater equity of access across the country. In the UK, however, the overall percentage of dialysis patients receiving home therapies has increased only from 3.4% in 2011 to 7% in 2022. Although that has doubled, it is a long way off the figure of 15%. It needs to double again, and I think, respectfully, that the Government should set a higher target.

In 2021, the NHS’s Getting It Right First Time programme recommended that a minimum of 20% of patients in every dialysis centre should be on home dialysis. It set that target, and NHS England’s Renal Services Transformation Programme is working to increase the provision of and access to home therapies, in line with recommendations made by Getting It Right First Time.

Although there are dialysis centres exceeding the target, which we welcome—it is not all negative; many are trying to achieve those targets and goals—GIRFT’s own report highlighted that 33 out of 52 centres in England have not yet met the target. Again, I respectfully ask the Minister—she knows I do this constructively; I just want to get the stats so that we can understand the problems and how to do things better—to tell us what has been done to increase the number of those 33 out of 52 centres that have not yet reached the target. The Getting It Right First Time target of a 20% prevalence rate for home dialysis compared to in-centre care could be transformative for patients, and could deliver considerable cost savings for the NHS at a time when they are desperately needed. We can do the treatment better, deliver the medication and dialysis better, and we can do it for a better price. That seems to me to be good value.

To address adequately the low uptake of home care, a review of dialysis reimbursement should take place to ensure that training and educational needs can be met, and to incentivise higher frequency dialysis at home, such as alternate day treatments to support all dialysis centres to meet the 20% target. What steps are the Government taking to reach that 20% target? It is essential that clinicians are offered the tools needed for them to meet the GIRFT targets in an effective manner, such as providing staff and patients with detailed, unbiased education to empower them to make informed decisions about their dialysis. I see it—as I often do—as a partnership, with clinicians working alongside Government policy and patients to do better.

One of the most pressing issues facing people who receive treatment at home rather than in hospital is the rising cost of fuel and energy. I referred to that at the beginning, and there are three points that I wanted to make. People receiving dialysis at home are at particular risk from rising energy costs. The figures that I cited, and the question asked by the Leader of the Opposition at yesterday’s PMQs, gives an indication of the issue. There seems to be an uncertainty, and perhaps a postcode lottery, as to where there is help for energy costs, but the figure that I gave of £118 per month for a child, or whatever it is, but that now costs £350, indicates that there is a way to go yet. Dialysis machines, with their high energy consumption, keep people alive. Dialysis treatment at home adds between £593 and £1,454 to utility costs per year, and that is before this year’s 54% energy bill rise.

One effect of dialysis treatment is that many patients frequently feel cold due to the associated anaemia and the process of dialysis, so they need to heat their homes more often and for longer during the year. When we feel warm, they feel cold. When we feel exceedingly warm, they might feel normal. There are not many times in the year in this great United Kingdom of Great Britain and Northern Ireland when we have Mediterranean heatwaves, so for the dialysis patient, feeling cold is almost an everyday occurrence. We do not want people to have to decide between giving up the freedom and independence that home dialysis gives them, and going into a hospital setting just to save costs. Again, I ask the Minister urgently to address that matter, because the barriers to employment for people on dialysis, posed by frequency and length of treatment, and the physical toll and intense fatigue, already compound financial insecurity for home dialysis patients.

The NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, but reimbursement is inconsistent across the country, and many patients receive no or very little financial support to pay for the additional costs of treatment. For most home dialysis patients, the £200 repayable relief on energy bills and council tax deduction will simply not be enough, and a special, specific provision is needed. It is regrettable that the spring statement was a missed opportunity for the UK dialysis community. Consistent reimbursement, longer-term capped tariffs for vulnerable groups and immediate financial support are urgently needed. Again, I look to the Health Minister and the discussions that she has with her Secretary of State for Health, and ultimately with the Chancellor, to ensure that we can deliver extra, specific financial help for those on dialysis treatment.

Many in the kidney community feel that their voices have been unheard in Westminster for too long, and when a friend from the kidney charity asked me to secure this debate, I was very pleased to do so. I think that today’s debate does two things. It raises awareness—that is No. 1—but it also directly asks the Minister to become involved and address some of the anomalies. I welcome the re-establishment of the all-party kidney group. Its work, led by the hon. Member for Bassetlaw (Brendan Clarke-Smith), aims to promote improvements in the health and care services that are available to improve the health of people with renal failure.

I call on the Minister to respond to calls from voices in the renal community to support them, and ensure that a straightforward, accessible system is in place to enable people on home dialysis to be reimbursed for the additional cost of utilities, as set out in the UK Kidney Association guidance. Would the Minister perhaps be agreeable to that request? If I may, I would ask for a meeting on behalf of the APPG—perhaps the chair of the APPG, our friend and colleague, would do that—because then we could look at some of those issues. Those who are involved in this debate might wish to attend that meeting as well. NHS tariff payments for home dialysis must be sufficient to cover all associated costs, including reimbursement for additional utilities usage that should and must reflect current price increases. Again, I look to the Minister to pledge to work with energy companies, and the Chancellor to develop capped tariffs for people on medical treatments at home, such as dialysis.

Renal units should proactively offer support to all patients undergoing dialysis, to build their confidence and ensure that they are dialysing in the right way for them at the time. Again, Minister, we need to address the low uptake of home dialysis by implementing a review of the dialysis reimbursement tariff—I think we referred to that in the discussion that we had outside the Chamber, and I look forward very much to the Minister’s response. We must also ensure that training and educational needs can be met, and incentivise higher-frequency dialysis at home, such as alternate-day treatments, to support all dialysis centres to meet the 20% target. Let us meet that target. Let us do it here and back home as well, and achieve the significant cost savings that home dialysis can bring.

I will close with this comment: it is vital that all renal unit staff receive updated training to build their home dialysis knowledge, in order to help find solutions to the issues facing patients, and so that information for patients about transitioning to home therapies is standardised and includes details on the practical and financial support available. I place on the record my thanks to all renal staff. They do magnificent work; they are saving lives and they are keeping people alive. It is wonderful, and we thank them for it. The support available should also include a consistent approach to utility bill contributions from the NHS, in order to ensure equality for every renal dialysis patient across this great United Kingdom of Great Britain and Northern Ireland. The Government must ensure that educational resources are also provided to local authorities and trusts, enabling them to respond appropriately to the needs of people in their area who want to choose home therapies.

Thank you very much, Sir George, for the chance to raise the issue of dialysis treatment and bring it to Westminster Hall in a way that, I hope, both raises awareness and lets people out there on dialysis treatment know that we in this House care for them—I believe we do—and that we are seeking change. I look forward very much to other contributions in the Chamber today, but I look forward particularly to the response from the Minister.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members who have spoken, and I thank the kidney charities that the Minister and everybody else referred to very much for what they have done.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) made some very pertinent points about depression, mental health and the psychological impact that dialysis treatment has on people. The Minister very kindly referred to that in her response, and she outlined the case.

The hon. Member for East Lothian (Kenny MacAskill) referred to the travel costs of taking children to the few centres, and he talked about the impact that has on families. He said that dialysis patients have higher levels of treatment. He also referred to prepayment meters, which can prevent people from accessing home dialysis treatment to start with. I know that is not the Minister’s responsibility, but the hon. Gentleman highlights an issue. We all know the Minister is very thorough, and that she will pass on the issues that have been brought up but are not her responsibility to the relevant Departments.

The shadow Minister referred to the two kidney patients she met yesterday. She also thanked the charities and referred to the 3.1 million people living with kidney disease in the United Kingdom. As we all did, she underlined the need for equal treatment, access and cost reimbursement across the whole of the United Kingdom.

I thank the Minister very much for her comprehensive, detailed response to the issues. She referred to the 11 renal networks and the regional care systems that feed into the transformation programme recommendations.

All hon. Members referred to rising costs. Energy tariffs are not the Minister’s responsivity, but perhaps she will be able to refer that to the right person, whoever it may be. Hon. Members also referred to proactivity and the need to reimburse people. As we were sitting here, Fiona Loud, who is in the Public Gallery, sent me a wee note that said that at least some of the people are getting their money. Perhaps people are taking note of the fact that this Westminster Hall debate is happening, because people are getting their money out—there is a commitment.

All NHS trusts must act and respond better. We need to address the reimbursement of moneys as soon as possible. The shadow Minister referred to that. It is great that the Minister and the Government are setting a target of 20% for home dialysis. We want to see that target achieved.

I welcome the chance to communicate with the Minister outside with the kidney charities, to understand better what the real problems are. We have to thank the charities for their campaigns. The reason I have knowledge is half the time because of them. Without them, none of us would be able to deliver the details, as the hon. Member for Rutherglen and Hamilton West has done.

I always look forward to the future. We bring forward issues to the Minister, and then we look forward to the response. The response we have listened to today sets out a programme of events, strategies and visions for the future. We want to see things improve. We will probably regularly come back to the Minister—I hope we do not have to, but we may have to. If we do, we will do that collectively in a positive fashion. In my life, I always try to do things positively. We bring things to the Minister and say, “Here’s where the shortfalls are. Here’s where we can do better.” What we heard today from the Minister has given us some heart, hope and confidence for the future. On behalf of all kidney charities, on behalf of the patients out there and on behalf of us all, we thank the Minister. I thank you, Sir George, as always, for the excellent way you chair these debates. I appreciate it very much.

[Sir George Howarth (in the Chair)]

I thank the Front Benchers and the Back Benchers for the constructive and consensual way in which this debate has been conducted. It is a model of how we should conduct all our debates.

Question put and agreed to.

Resolved,

That this House has considered dialysis care outcomes.

Smokefree 2030

Jim Shannon Excerpts

Tuesday 26th April 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Ms Nokes.

I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for securing this important debate. I well remember, as the hon. Lady will remember, that she had this debate in the main Chamber under the covid regulations. I was happy to assist in supporting her at that time, and my support is the same now.

As we turn our attention to the rebuilding of public health following the covid-19 pandemic, tackling smoking must be among our top priorities. Smoking is the leading cause of premature death, killing some 2,300 people in Northern Ireland each year—it is a devolved matter, but I think these figures are quite shocking—with 30 times as many suffering serious diseases and disabilities caused by smoking.

Ms Nokes, I have never had a wish to smoke. I can well recall the first time that I did, with my grandfather, back in the ’60s. He smoked Gallahers; there were no filters on them. I always admired my grandfather, and I said to him one day, “Granda, can I have a smoke of that cigarette?” I pestered and pestered him, and then, one day, he says, “Now, take one, and take a deep breath,” and I did. As a wee six-year-old, I was violently sick. I was green at the gills. In those days, we had—if I can say it—a po under the bed. I was sick into that, and I never had any wish, ever, to pursue the smoking of a cigarette ever since. It left a lasting impression. Maybe that is what we need to do for the young people of today. It is a bit drastic, perhaps, but none the less, it had a very sobering effect on me.

Achieving a smokefree 2030 would reduce the pressure on NHS services at a time when they are under the most severe strain in living memory. However, analysis by Cancer Research UK shows that at current rates of decline, Northern Ireland will not achieve the smokefree ambition of smoking rates of 5% or less until a decade after England—not until the late 2040s—with our most deprived populations not being smokefree until after 2050. We have really big issues to sort out in Northern Ireland regarding that.

While Northern Ireland and the devolved nations hold responsibility for our own public policies, the Government in Westminster maintain responsibility for important UK-wide policies. I therefore ask the Minister—as others have in relation to Wales—what discussions have taken place with the Northern Ireland Assembly and the Minister, Robin Swann?

There is substantial research supporting the implementation of health warnings on cigarettes and cigarette papers, and that is clearly under consideration in Canada, Australia and Scotland. Such warnings could be implemented by a simple amendment to the Standardised Packaging of Tobacco Products Regulations 2015. Tobacco manufacturers already apply print to cigarette papers, so that would be cheap and easy to implement.

Health warnings, such as “Smoking kills”, have been shown to be effective on billboards and tobacco packs, so why would they not be as effective on cigarette sticks too? Adding warnings to cigarette sticks is important because young people in particular are likely to initiate smoking with individual cigarettes rather than packs. Is that something that the Minister and the Government would be prepared to look at?

Cigarette pack inserts providing health information are not a new idea; they have been required in Canada since 2000. The health messages are effective, and research has been carried out in the UK which supports their use here too. The Government have already acknowledged in the prevention Green Paper that,

“there could be a positive role for inserts in tobacco products giving quitting advice”,

so, again, I look to the Minister for her thoughts on that.

All those measures would be cheap and easy to implement and would benefit all the UK nations. They would also support and reinforce the impact of other measures that require significant investment, such as behaviour change campaigns and stop smoking services. Although the Government opposed the introduction of the measures as amendments to the Health and Care Bill, they did leave the door open—I believe—to considering them when developing the next tobacco control plan. Does the Minister—or the Government—intend to do just that?

I have spoken before in this House about the use of licensing for tobacco retailers. In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the tobacco register of Northern Ireland, with a final deadline of 1 July 2016. That built on a similar scheme already in place in Scotland, and a scheme that was due for implementation in Wales.

Since 2018, we have seen the implementation of a tracking and tracing scheme, which requires every retailer to have an economic operator identifier code. Since leaving the EU—as the hon. Member for Harrow East mentioned—the UK has established and launched its own system, with Northern Ireland operating in the UK and EU systems. That makes it easy for all nations in the UK, including England, to not just implement a retail register scheme, but go further and implement a comprehensive retail licensing scheme. If the Minister can give us some thoughts on that, I would be very pleased.

Retail licensing is the obvious back-up to the tracking and tracing of cigarettes and would help tackle the illicit trade that gives smokers access to cheap tobacco. Those who sell illegal tobacco have no compunction about selling it to children too, so the illegal trade makes it not just less likely that smokers will quit, but more likely that children will start smoking. My hon. Friend the Member for East Londonderry (Mr Campbell), who is no longer in his place, mentioned that in his intervention on the hon. Member for Harrow East.

I await with interest Javed Khan OBE’s independent review, which is due to be published shortly. I hope it will address this important issue. England remains an outlier on that important measure, which could help tackle illicit trade and protect children from tobacco. We can and must address these issues collectively, bringing knowledge from the nations we represent. I am happy to support the Minister here at Westminster in taking this matter forward and, from a Northern Ireland point of view, it is important that we address these issues together. If we do so, I am confident that we will then deliver a policy that helps not only us, but the constituents we serve.

--- Later in debate ---

[Maggie Throup]

If I may, I will come to that later in my speech, but the hon. Lady makes a very good point.

On top of the measures, the NHS has renewed its commitment to tobacco treatment through the NHS long-term plan, delivering NHS-funded tobacco treatment services to all in-patients, pregnant women and people accessing long-term mental health and learning disability services until 2024. The Government also continue to explore ways to move smokers away from smoking and towards alternative nicotine products such as vapes, as highlighted by the hon. Member for North Tyneside (Mary Glindon). We know that the best thing a smoker can do for their health is to quit smoking altogether, but we also know how hard that can be. It remains the Government’s goal to maximise the public health opportunities presented by vapes while ensuring that such products are not appealing to young people and non-smokers. The hon. Member for Denton and Reddish made a very good point on this issue in his speech, and it requires balanced and proportionate regulation.

Despite the progress made so far, the Government acknowledge that we need to go further to achieve our ambition to be smokefree by 2030, which is why the Secretary of State for Health and Social Care asked Javed Khan OBE to lead an independent review into tobacco control in January this year. The Khan review is expected to be published next month and will make a set of recommendations to the Government. The review has two objectives. The first is to identify the most impactful interventions to reduce the uptake of smoking, particularly among young people. The second is to identify how best to support smokers to quit, especially in deprived communities and among priority groups.

Mr Khan has met hon. Members from both the all-party parliamentary group on smoking and health and the all-party parliamentary group for vaping, and he has carefully considered their views and proposals. Quite a number of members of those APPGs have expressed their approval of that route and how Javed Khan is getting into the depth of everything. Once the review is published next month, the Government will consider its recommendations, which will help inform both the upcoming health disparities White Paper and the new tobacco control plan, to be published later this year.

[Jim Shannon]

I thank the Minister for her response to this issue, and what she is saying is very positive. I am ever mindful that Northern Ireland has the highest rate of deaths due to smoking. Health is a devolved matter, and we are 10 years behind the rest of the UK on achieving our goals. What discussions could the Minister have with the Northern Ireland Assembly, and particularly with the Health Minister, Robin Swann, to enable us to catch up and achieve the goals and targets that the Minister has referred to?

[Maggie Throup]

The hon. Gentleman makes a very good point. The hon. Member for Arfon (Hywel Williams) also mentioned discussions with the devolved nations, and I am very happy to have discussions with my counterparts in the devolved health authorities.

As we have heard from my hon. Friend the Member for Harrow East and others, many in this room are supportive of a “polluter pays” levy. As they will be aware, tobacco taxation is a matter for Her Majesty’s Treasury, and the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. As part of the development of the tobacco control plan, the Department will also continue to explore and review with the Treasury the evidence base on the best options to raise funding in support of the Government’s ambition to be smokefree by 2030. As a number of Members asked, I am happy to meet the APPG to discuss funding matters and the levy in detail, while the Khan report is being published. I have met the APPG before and am happy to continue having those meetings.

Childhood Cancer Outcomes

Jim Shannon Excerpts

Tuesday 26th April 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

First, let me thank the hon. Member for Gosport (Dame Caroline Dinenage) for setting the scene so very well, and all right hon. and hon. Members who have made fantastic contributions here today. I share her concerns, as we all do. I am the father of three strapping boys and I have five grandchildren, and our worst fear is that something like this may come along. As politicians in this House, we have a duty to put in place a system that can ensure a quick diagnosis; the availability of testing; the availability of treatment and staff; and the best possible set-up to aid the child in their fight against cancer. I commend all the charities in this area, particularly CLIC Sargent, which does tremendous work in my constituency. I am ever minded of the survey carried out by the all-party group on children, teenagers, and young adults with cancer. It surveyed young people, parents and healthcare professionals, with 56% suggesting that better training for GPs on cancer in children and young people would make the biggest single improvement. I would like to hear the Minister’s thoughts on that. Research has also referred to clinical depression and anxiety among young people, with those with multiple GP consultations before diagnosis becoming clinically anxious. Again, I would like to hear the Minister’s thoughts on that and how we can deal with it more quickly. Having functioning GP services as the first line of defence in health is essential for outcomes in childhood cancer.

I agree with the Teenage Cancer Trust’s recommendation that the 10-year cancer plan should also commit to achieving access rates to clinical trials of 50% by 2025, as has been highlighted by others. The plan should look further than 2025—it should also look towards 2032. Again, I would like to hear the Minister’s thoughts on how we can achieve that. Clinical trials can significantly improve cancer outcomes for teenagers and young adults, but young people with cancer are currently not getting an equal opportunity to participate in and benefit from them. A recent trial for patients with acute lymphoblastic leukaemia showed that young people’s survival rates improved by 18% through involvement in this clinical trial. Given that success in clinical trials, perhaps we should give more opportunity to young people to participate in them. Trial availability is the major determinant of participation. If there are no trials available or existing for young cancer patients, there is no possibility of inclusion. Where trials do exist, there are often barriers to accessing them, such as arbitrary age eligibility criteria. What can be done to ensure that those who can and wish to be part of those trials can be part of them? There is also no data publicly available to show progress towards the commitment of the 50% by 2025, and again I look to the Minister for help on that.

The issue is clear: we need more support and more access to clinical trials if we are to win this battle against childhood cancer. There is no more worthy battle that we must fight and must win, and we look forward very much to the Minister’s response.

Health and Care Bill

Jim Shannon Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Edward Argar]

I paid tribute to my right hon. Friend the Member for Chingford and Woodford Green, but my hon. Friend the Member for Wealden (Ms Ghani) has also taken a keen interest in this issue. The Secretary of State and I will continue to work closely with others across Government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.

On Lords amendment 29B, the Government are committed to improving workforce planning and are already taking the steps needed to ensure that we have record numbers of staff working in the NHS. In July 2021, the Department commissioned Health Education England to work with partners on reviewing the long-term strategic trends for the health and regulated social care workforce over the next 15 years. We anticipate the publication of that work in the coming weeks.

[Jim Shannon (Strangford) (DUP)]

Will the Minister give way?

[Edward Argar]

Very briefly, as I am conscious that we have limited time.

[Jim Shannon]

If the right hon. Member for South West Surrey (Jeremy Hunt) were to pursue the matter, my party and I would be minded to support him. Although I understand from the figures in the press today that there are significant numbers of new nurses coming into the NHS, there is still a large shortfall. Will the Minister confirm for Hansard in the Chamber today that every step is being taken to recruit the nurses needed to address the issue of workforce safety?

[Edward Argar]

The hon. Gentleman is right to highlight the work we are already doing, which I will address in a moment, and the number of nurses we have recruited. I believe we have now recruited 29,000 or so en route to our target of 50,000 more nurses by the end of this Parliament.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

The Father of the House is quite right that the crux of the problem is that there is a shortage throughout the country not of dentists but of dentists taking on NHS work. The contract is the nub of the problem, which is why work is under way to reform it. We will shortly announce some short-term changes and some longer-term reforms, which will hopefully help my hon. Friend’s constituents.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that dentists are now determined to turn their practices wholly private as they cannot make ends meet with NHS prices, will the Minister pledge to review NHS payments to stop the haemorrhaging of NHS dentistry provision?

[Maria Caulfield]

The hon. Gentleman is correct that the units of dental activity payments are a perverse disincentive. Sometimes, when someone needs more extensive work, their dentist is paid the same as they would be for, say, one or two simple fillings. That is the nub of the problem and we are currently in negotiations on the matter.

Ockenden Report

Jim Shannon Excerpts

Wednesday 30th March 2022 Commons Chamber

[Sajid Javid]

Yes, I can give my hon. Friend that reassurance. I can add that Donna Ockenden, in doing her work, looked at cases from Wales as well. The issue that my hon. Friend has raised has also been raised by my hon. Friend the Member for Montgomeryshire (Craig Williams), and I can give them both that assurance.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement, for the obvious compassion that he has for all those involved, and for his support of the Ockenden report. I want to place on record my sympathy with all those parents who still grieve their loss, and for whom no report will never, ever soothe the pain. Will the Secretary of State confirm that the report into this dreadful spate of deaths will be made available to all hospital trusts across the United Kingdom, including Northern Ireland, to ensure that lessons are learned and that the 84 recommendations of the Ockenden report and any mechanisms of prevention can be understood and put in place UK-wide?

[Sajid Javid]

Yes, I can give the hon. Gentleman that assurance. We are more than happy to reach out to the Northern Ireland health service and to work proactively with it on improving maternity services in Northern Ireland.

Health and Care Bill

Jim Shannon Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

I intend to call the Minister at 5 o’clock to give him 10 minutes to wind up. We have not got long, so will Members please keep their contributions as short as they can?

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Mr Deputy Speaker, to speak in this debate. I am pleased to follow the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Congleton (Fiona Bruce). I thank them both for the contributions.

It will be no surprise to the House that I am here because I abide by the absolute view that both lives matter—the unborn child and the mother. I know that many people believe that if someone is anti-abortion, they are anti-woman. I am not—I never have been, never will be and it is not the case. I believe in life and helping people. My career and all my life have been based around that, and I will continue as long as God grants me the strength to do so.

The Minister referred in his introduction to the fact that the regional devolved Administrations will make their own decisions. They can make that decision in Scotland and Wales, but we cannot make that decision in Northern Ireland, because the Government made it here. They took that decision away from us, and I am particularly concerned about that.

I have several concerns about the approach adopted during the pandemic in relation to so-called telemedicine to access abortion, which was recognised at the time as short-term. Without a face-to-face appointment, there is no confirmation of how many weeks pregnant a woman is, which makes a difference to the experience of an abortion at home. As reported in the summary of consultation responses, women who had experienced an abortion said that information should be provided on

“how inaccurate dating of pregnancy may mean increased pain and bleeding”.

A woman whose pregnancy is later than 10 weeks could find herself unexpectedly passing a mature baby at home, which could lead to significantly more complications. I understand that those advocating for the Lords amendment argue that complications have decreased since the pandemic, but I question the evidence, given that the Government and the Minister’s Department say that

“data on complications is incomplete”

and they are working on reviewing the system of recording abortion complications.

I am also persuaded by the concerns about the increased possibility of a woman finding herself pressurised at home to have an abortion that she does not want, as other hon. Members have said. There is a well-known link between abortion and domestic violence. Indeed, the BBC published a survey a few weeks ago reporting that 15% of those surveyed said they had felt pressured into ending a pregnancy. How are we protecting those women? How can doctors know that they are really speaking to a woman who is voluntarily calling about an abortion, or even that they are speaking to the right person at the other end of the phone?

There are many differing and strong views on this subject on both sides of the House, but I question whether the women who find themselves coerced into an abortion from their home, or who have found themselves bleeding unexpectedly at home or having an abortion much later in their pregnancy than they expected, would agree that telemedicine abortion is a positive step in women’s health. I doubt that they would.

I have recently been vocal regarding the need for face-to-face GP appointments. I have been inundated by constituents who simply have no confidence that a diagnosis by picture or telephone call is safe. I have constituents whose cancer has been undiagnosed because the GP was unable to see first hand what would have been clear in a face-to-face appointment. I believe that face-to-face appointments should be available.

I find it difficult to understand how pills to end life—to take away life—in a painful manner for the mother can be given without seeing someone to assess what cannot be seen on the phone. The signs and movements that an experienced GP can see that point to a deeper problem cannot be discussed in the two minutes allocated to such phone calls and I am fearful that the duty of care that we are obliged to discharge will continue to be missed. I am diametrically and honestly opposed to this legislation, because as I said at the outset, both lives matter. Lives could have been saved if abortion had not been available on demand.

I will vote against the permanent extension of this ill-advised scheme today and urge hon. Members on both sides of the Chamber to join me. It is a step backwards rather than forwards in providing adequate support and care for women, and it further normalises the practice of abortion as a phone call away rather than as a counselled decision under medical care, which is what it deserves to be. I, my constituents and my party are clear that this is a massive issue. I fully and absolutely oppose the Government in what they are putting forward today, for the safety of both mothers and the babies, because I am about saving lives, not destroying lives.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I rise to speak on the subject of the health services safety investigations body and on abortions. I begin by making a couple of declarations: I am a now non-practising doctor, my wife works as a doctor, and I am a member of the Royal College of Physicians and the Royal College of Psychiatrists.

On the HSSIB, I will keep it brief. I hugely thank the Minister for supporting the Lords amendment and ensuring that we have those safe spaces for doctors. That is critical for the body to work and for us to learn from it. Hopefully, we can undo some of the harms of previous atrocities and what has happened to previous doctors, as has been referred to.

On abortion, it is important to say that I wholeheartedly support and believe that women should have access to safe and legal abortion services, but the regulatory framework around them is complex and it is a sensitive area. As is clear from the powerful speeches that I have heard from both sides of the House, it is also sensitive for hon. Members. Many of my constituents—on both sides of the debate—care deeply and correspond regularly with me about it; I care deeply about it too. I have looked after women who are contemplating having an abortion and I have looked after women who have had abortions, so although I have never carried out one myself—I am a mental health doctor—I have seen it from both ends.

--- Later in debate ---

[Wes Streeting]

My hon. Friend is absolutely right and she will know of our party’s ambitious commitments, outlined by my hon. Friend the Member for Tooting (Dr Allin-Khan), to ensure that patients receive guaranteed mental health treatment within a month. That would be revolutionary. It will require investment and require recruiting the people we need to help provide that care, but this country is living through a mental health crisis on top of everything else. This has been a deeply difficult two years for our country during the pandemic. Many people bear not just the physical scars and ongoing physical health consequences of long covid, but the grief, the loss and the injury to their mental health and wellbeing caused by this deadly pandemic. Many of those people who are suffering mental health crises are the very people who are still turning up for their shifts in the hospitals, still turning up for their shifts in the GP surgeries, and still turning up at work to help care for others even though they are in need of care themselves.

Lords amendment 29 does not commit the Government to hire thousands more doctors and nurses, although they should. It does not commit to new funding for the NHS, although it desperately needs that. It does not even commit the Government to finally publish the workforce strategy the NHS is crying out for, despite the fact that the NHS has not had a comprehensive workforce strategy since the Labour Government’s plan was published in 2003. All we are talking about today is an independent review of how many doctors, nurses and other staff the NHS needs for the future. That is not just a view put across by Labour Members: it is supported by many Members right across the House, including the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey, who is a former Health Secretary. It is not the first time that he has helped to unite the sector, although I remember the days when it was sometimes united in opposition to, rather than in support of, his proposals.

I will say this, actually: when the right hon. Member for South West Surrey took over as Chair of the Health and Social Care Committee, I was really nervous about the prospect of a former Health Secretary effectively marking his own homework, but on this issue, he has shown a degree of honest reflection and has genuinely contributed his experience to the debate about the future of health and social care in this country. Not only has he been honest about where he fell short, and where other Conservative Ministers may have fallen short, but he is determined to make sure that we improve the quality of the health and social care debate in this House. I very much welcome his contribution to the debate about the NHS workforce challenge.

[Jim Shannon]

Will the hon. Member give way?

[Wes Streeting]

How can I resist?

[Jim Shannon]

The shadow Minister is always kind in giving way. I want to back up his comments about the right hon. Member for South West Surrey (Jeremy Hunt). On Lords amendment 29, does the shadow Minister acknowledge that Macmillan Cancer Support said that it needs an additional 3,371 cancer nurse specialists? That would double the nurses by 2030, and it gives us a reason why we need to support Lords amendment 29 and why workforce safety is critical.

[Wes Streeting]

The hon. Gentleman is absolutely right. If I am honest, I suspect that the Minister and the Secretary of State for Health and Social Care also agree that Lords amendment 29 is needed. I suspect the truth is that they are not the ones blocking it. They are in a Treasury-imposed straitjacket from the Chancellor, preventing them from doing what they know to be necessary for the NHS, because the Treasury would rather stick its head in the sand and not acknowledge the scale of the challenge or the reality of the cost. It hopes that ignorance is bliss and that we can carry on as we are, and perhaps nobody will notice—even the 6 million people on NHS waiting lists.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am surprised that the hon. Member for Strangford (Jim Shannon) does not wish to speak. [Interruption.] Oh, he does. I hope he will be brief, so that the Minister will have time to answer the debate.

[Jim Shannon]

I certainly will make my points quickly. My first is on the organ transplant amendment, to which the Minister referred. I fully support the measure and have been asking for it for a number of years in the House, so I am pleased to see it moved tonight. Secondly, I am not sure whether the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) is going to push his amendment to a vote—[Interruption.] He is not, but if he did, he would have my support and probably that of my party, too.

Thirdly, I am pleased to lend my support to Lords amendment 29. It would create a national independent view of how many health, social care and public health staff are needed to keep pace with projected patient demand over the next five, 10 and 20 years. I wholeheartedly agree with Macmillan Cancer Support that the Bill will fail to address the biggest challenge facing the NHS and social care right now: staffing shortages and pressures. The Government need to take Lords amendment 29 seriously. The hon. Member for Ellesmere Port and Neston (Justin Madders) referred to it, too. We recognise that we need to address staff shortages as soon as possible. I have referred to Macmillan and their request for an additional 3,371 cancer nurse specialists to help address that issue.

I will conclude with this point. I understand that the Government may come back with all the justifications as to why this is not the right amendment—the Minister is a real good man; we all know that, and he responds well to all our requests—but I am content that it would begin to address the issue that our NHS workforce is disintegrating. One of my constituents is in a prestigious medical school here on the mainland. She went to do her rotation with a GP as part of the work she does. He told her, “Do any job but this.” I thought that was disappointing. He said, “It will consume your life. You will work long hospital shifts and you will not have a personal life.” This is a seasoned GP who simply cannot cope, so we must do something, and this amendment is a way forward. I therefore will support it whenever it comes to a vote.

Civil Proceedings

Jim Shannon Excerpts

Tuesday 29th March 2022 Commons Chamber

[Maggie Throup]

The right hon. Gentleman makes a very good point. We know that the pandemic has had a mental health impact not just on children and young people, but on people of all ages. That is why it is important that we are now living with covid and getting our lives back to normal, which is one way of helping restore that normality that we are so desperate to get back to.

The Government helped businesses at a time when many faced disruption, including through the coronavirus job retention scheme. We have also supported the self-employment income support scheme, which paid out more than £28 billion to nearly 3 million self-employed people and was one of the most generous schemes for the self-employed in the world.

[Jim Shannon (Strangford) (DUP)]

The legislation covers England, Wales and Northern Ireland. Will the Minister reassure me that full consultation has taken place with the Health Minister and the Economy Minister in Northern Ireland to ensure that what she is mentioning is endorsed by the Northern Ireland Assembly?

[Maggie Throup]

I shall come shortly to the specific parts of the extension that are relevant to Northern Ireland. I am sure that the hon. Gentleman will appreciate that we have had ongoing conversations with the devolved Administrations throughout the whole two years.

The Coronavirus Act 2020 also helped to ease the burden on frontline staff in our critical public services. For example, provisions in the Act have helped the courts and tribunal system to keep functioning throughout the pandemic by allowing thousands of hearings to take place remotely.

Lateral Flow Tests in Healthcare Settings

Jim Shannon Excerpts

Monday 28th March 2022 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I am delighted to have secured tonight’s Adjournment debate on an important topic for my constituents and people across the country. I feel driven to raise this point again because I do not believe that the Government are adequately considering the most vulnerable. Two weeks ago, I wrote to the Secretary of State on behalf of more than 50 hon. Members of this place and others. We were of all parties—this is not a party political issue but one of fairness and justice—and we were of one mind: that the charge for lateral flow tests would exclude many from a proper part of life in this country.

It is clear to everyone that the fight against covid-19 is not over. The rise of new variants and strains will continue. Researchers and healthcare professionals will develop and deploy new and more effective vaccinations and therapies. I think the Minister will agree that we have to learn to live with covid and that we will not eliminate it tomorrow, but living with it is a death sentence for many. Millions across the UK are clinically extremely vulnerable or have CEV relatives and friends in care homes and medical settings.

Protecting the most vulnerable has been a key aim of public health policy for two years, and that is right.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing forward the debate. I agree with him entirely. Does he agree that it is essential for testing to remain widely accessible for those who are face to face with the most vulnerable in society: the carers, who have been at the forefront of protecting all of us across the United Kingdom of Great Britain and Northern Ireland over the last two years? Lateral flow tests are still worth the cost, and they must continue to be available free for all vulnerable people and their carers.

[Mr Sharma]

I thank the hon. Member for that important intervention. I am sure that the Minister took note of his concerns.

We all know that we are experiencing and facing an increasing cost of living crisis, and earlier this month the Foreign Secretary agreed that the escalating crisis in Ukraine will only drive inflation higher, so in the midst of the most serious cost of living crisis for a generation, with a national insurance tax rise and with covid remaining a global threat, it would be wrong to add a further burden on to families wanting to stay safe from covid and visit friends and families in care settings. The introduction of charges for lateral flow tests risks introducing a serious cost on many for visiting their closest family when those visits mean so much to visitor and host.