Health Inequalities: Office for Health Improvement and Disparities

Jim Shannon Excerpts

Wednesday 26th January 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Bootle (Peter Dowd) for setting the scene. He is a man known for setting the scene well, and we appreciate his contribution—I think every one of us will have been heartened by what he has said today. I wish to make a contribution as my party’s health spokesperson. I am pleased to be here to discuss the evident disparities and inequalities in our health system, both on the mainland and back home in Northern Ireland. I know the Minister is not responsible for health in Northern Ireland, but I will give examples that will hopefully spur those who speak in this debate.

We must ensure that everyone has access to efficient healthcare. I will speak about three groups of people: those with mental health issues, those who are homeless and those with addictions. The Office for Health Improvement and Disparities officially launched in October 2021, as part of a restructuring of health bodies in England and throughout the UK. I am pleased that the OHID will co-ordinate local and central Government to initiate improvements in public health. The purpose of the OHID is clear. If it delivers on that purpose, everyone present will be more than pleased because many of the issues would be addressed.

I thank the Government for listening and learning from the lessons of the pandemic, and that information has now been taken ultimately to improve our health service. The Minister has said that our Government have three priorities to work on. The first priority is preventing poor mental and physical health. One in four people in the UK—25% of the population—and 19% of adults in Northern Ireland suffer from poor mental health, so that should be prioritised. The second priority is addressing health inequalities. Health is devolved, but this must be a priority for the Department across the whole of the United Kingdom. The third priority is working with partners within and outside Government to respond to the wider health determinants. These partners also have a responsibility for public health outside England.

I will talk about addiction issues and why it is so important that we address them within this campaign and policy, which the Minister will reply to shortly. In Northern Ireland, and in my constituency in particular, alcohol and drug-related indicators continue to show some of the largest health inequalities monitored in Northern Ireland, with rates in the most deprived areas five times those of the least deprived areas for drug-related mortality, and four times those for alcohol-related mortality. I suspect that other hon. Members will also state those mortality figures for people with drug or alcohol addiction issues. The inequality seems to be, unfortunately, in the areas where people have a poor quality of surroundings and less money, and therefore they are the ones we need to focus on because of the high risk of mortality that is prominent.

The King’s Fund has ascertained that health inequalities are avoidable and depend on people’s access to care; the quality and experience of care; behavioural risks to health, such as smoking and drinking; and wider determinants of health, such as housing circumstances and social factors and decisions. All these things combine to put pressure on people. Crisis, an organisation that campaigns to end homelessness, has contacted me in relation to tackling the disease of disparity. That is quite a term: the disease of disparity. Yes, it is a disease and it needs to be addressed. People who are homeless face some of the poorest health outcomes in society.

Some of the statistics are as follows. People experiencing homelessness are three times more likely to be diagnosed with a severe respiratory health issue. I did not know that until I got that information from Crisis, but it is a fact. The average age of death among homeless people is 46 for men and 42 for women, as the hon. Member for Stockport (Navendu Mishra) referred to. In this day and age that is totally unacceptable. We must address that issue. At the same time, I read in the papers—I do not know whether it is true—that people are living longer. Will someone who is homeless live longer? They will not, and therefore that must be addressed. I hope the Minister can respond to that.

Finally, a recent study found that people facing homelessness in major cities, such as Belfast or London, have levels of frailty like that of a 90-year-old. Again, that is another combination of issues. The barriers blocking greater equality for our health service are just astonishing, and these have only been exacerbated by the pandemic. It is about time that we started prioritising, and that starts with everyone being given the same allowances to access our truly admirable NHS.

Lastly, it is time for the OHID to monitor the provision of commissioned services for those who are socially disadvantaged and cannot access sustainable healthcare. I urge the Minister to commit to producing guidance and support on what actually works in the provision of health and social care services. I believe our duty in this House is to speak up for those who need speaking up for. Today, I am doing just that.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on bringing forward this extremely important debate. It has been really interesting and, with many people contributing, it has been quite rounded. The hon. Gentleman spoke passionately and knowledgeably about the issue, as did other Members. We have probably done the issue a disservice by having only an hour and a half to debate it. I look forward to further debates.

It is time to shift the centre of gravity of the health system from treating disease to building good health. To do that, we have to focus on the people and places who face the worst health outcomes. That is why on 1 October 2021, we launched the Office for Health Improvement and Disparities. The mission of OHID is to improve the health of our country so that everyone can expect to live longer in good health, and to break the link between people’s background and their prospects for a healthy life.

OHID is doing that by working with the rest of Government, the healthcare system, local government and industry, to bring together expert advice, analysis and evidence in policy development and implementation. As a number of hon. Members mentioned, covid has shone a light on the poor underlying health of certain groups in the population, the depth of health disparities and the implications for our health, economy and society.

Health disparities across the UK are stark. As the hon. Member for Bootle highlighted, in the borough of Sefton, where his constituency is located, the life expectancy deprivation gap is 11.8 years for women and 12.5 years for men. Health disparities can be driven by a range of factors, including education, income, employment and early years experiences. Therefore, OHID aims to systematically tackle the top preventable risk factors for poor health by looking actively at the evidence on health disparities and the ways in which we can go further to address them.

The new Health Promotion Taskforce, which was set up by the Prime Minister, will drive and support the whole of Government to go further in improving health and reducing disparities, because many of the factors most critical to good physical and mental health are the responsibility of partners beyond the health service. This new Cabinet Committee, now chaired by the Secretary of State for Health and Social Care, brings Departments together around the objective of reducing ill health and health disparities. It also provides a new opportunity to work together actively on the most important health issues and agree new ways to address them collectively. I hope that helps reassure colleagues that the new taskforce is at the top of Government, and is determined to bring all Departments together to tackle this agenda.

[Jim Shannon]

In my contribution, I referred to the contact that I have had with Crisis on homelessness. Will the contact that the Minister has referred to include those groups? They have the facts. She will have heard what I said about the disparities between those who, like us, live in a well-off area, and those who do not and have not got a home. Homelessness is deadly.

[Maggie Throup]

I reassure the hon. Gentleman that tackling homelessness is a high priority for this Government.

As hon. Members have mentioned, the Government will shortly publish a landmark levelling-up White Paper that will set out bold new policy interventions to improve livelihoods and opportunities in all parts of the UK, and to reduce the disparities between different parts of the UK. Poor health is stopping people accessing quality education and jobs with good career prospects, limiting their career progress, and undermining local prosperity and the general wellbeing of communities across the UK. Of course, it would be wrong of me to pre-announce the contents of that important White Paper.

Tackling health disparities promotes economic prosperity by increasing productivity and reducing strain on public services, including the economic cost of preventable ill health to the NHS and the welfare system. To address those issues, we are investing in tackling the key contributors, such as obesity and smoking. We are also investing £500 million to transform Start4Life and family health services.

Skin Conditions and Mental Health

Jim Shannon Excerpts

Tuesday 25th January 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Gainsborough (Sir Edward Leigh) on securing this debate. I want to focus on that issue of major importance to which he referred: mental health. As my party’s health spokesperson, I am keen that these issues are addressed. Skin is always completely visual. For young people in particular, looks can seem like the most important thing, which is why it is crucial that we recognise skin conditions that are normal and those that are not. We have 4,000 skin cancer deaths annually in the UK.

The reason I am interested in this subject is that my second son was born with psoriasis. He had to have cream three times a day. The doctor told us that although he would grow out of the psoriasis—and he did—he would then develop asthma. He did develop asthma, but he is now married to Ashleigh, and they have two boys, Austin and Max—life has changed for him. I remember that when he was at school it was terrible for him; all over his skin was a rash. My wife was the person who looked after him, but that is what happened.

In Northern Ireland, in my constituency alone, we have 2,713 people who suffer from inflammatory skin disease. It is really important that the issues are taken onboard. Some 4,351 people develop skin cancer each year, and around 300 of those cases involve malignant melanomas. It is crucial that there is special psychological care to deal with the impact of skin problems, to help people to cope and to ensure that the condition does not worsen. The right hon. Member for Gainsborough referred to the fact that 18% of people suffering with skin conditions have received some form of psychological support—that is really important. They have to learn how to live with it, as well as learning how to deal with it. As I have said before, young people are growing up in a world where looks seem like everything, and we must do more for them.

Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Jim Shannon Excerpts

Thursday 20th January 2022 Commons Chamber

[Sir Robert Buckland (South Swindon) (Con)]

It is a pleasure to address the House in a debate on an issue that has great resonance with and importance to many people and families across the country—the continued detention of autistic people and people with learning disabilities under the civil provisions of the Mental Health Act 1983. I am grateful to the National Autistic Society and Mencap for working with me in the run-up to the debate.

Remember, these are people who have committed no offence. They are not even alleged to have committed offences. They have been detained for what is still defined as a mental disorder. They have done nothing wrong. Here are some bald statistics relating to the use of powers under the 1983 Act. At the end of November 2021, there were 2,085 people with autism or a learning disability in in-patient units; 1,234 of them were autistic people, 200 of whom were under 18—they were children. The average length of detention is 5.4 years, some people having been detained for more than 20 years. In September 2021 there were 3,620 reported instances of restrictive interventions, and 595 of them involved children. Those interventions involved physical and, very often, chemical restraint. Those are not the complete figures, because there was data for only 31 out of 55 NHS providers and four of 16 private providers, so the real figure will be higher.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. and learned Gentleman on bringing forward this debate on an issue that is massive in his constituency and mine. The number of detentions under the 1983 Act seems to decline with age, but there seem to be significantly higher numbers of cases among children and young adults. Does he agree that there is a better chance of rehabilitation and wellness when mental health issues are dealt with properly from as young an age as possible than when there is long-term detention with no counselling or rehabilitation?

[Sir Robert Buckland]

I am grateful to the hon. Gentleman for his intervention. He has a long-standing interest in autism issues, in Northern Ireland in particular. He is right that if there is early intervention, more can be done to prevent a lifelong condition such as autism becoming a co-morbid mental health condition. I will explain that in a little while.

Behind the statistics are real-life stories of people whose lifelong conditions have led to the system, however well-intentioned it might be, ascribing a lower value to their quality of life. That implicit judgment, I believe, runs through everything from the continued lumping together of autism and learning disabilities with mental health conditions, which in many cases is wholly out of date and inappropriate, to the discriminatory and unjust application of “do not resuscitate” guidance to people with these conditions. Those are abuses in plain sight.

Furthermore, the profound sense that the system is, in effect, making assumptions about the life of people with learning disabilities in particular has been exacerbated by the use of DNRs during the covid pandemic. Not only do we need to stop new orders being issued inappropriately to people with learning difficulties, but existing inappropriate DNRs need to be retracted. I ask the Minister: when will the Government act on the Care Quality Commission review recommendations about better staff training and family involvement in decision making about care and treatment?

It is no longer good enough for people with learning disabilities to be discharged from hospital with a form in the bottom of their bag, effectively having signed away their rights about the end of their own life. That is what we are talking about; I cannot put it more bluntly than that.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

My hon. Friend makes a good point. The most vulnerable people are being prioritised. The UK Health Security Agency and NHS Test and Trace currently deliver an average of more than 70,000 PCR kits and 970,000 LFD kits a week to adult social care settings. In recent weeks, as demand has increased due to the omicron wave, Dudley, like other local authorities, has provided tests to key workers to enable them to keep working.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her response. The Government have recently announced that self-isolation will be cut to five days, given a negative lateral flow test. Has the Minister come to an assessment on the impact that will have on demand for lateral flow tests, given the struggle many have faced trying to obtain a box of them in recent weeks?

[Maggie Throup]

As we look at policy and amend it like we did last week, it is right that we make sure that we can fill those requirements. I reassure the hon. Gentleman that we can, and we have increased the procurement of lateral flow devices. This month, we will get another 750 million lateral flow devices into the UK for January and February.

Midwives in the NHS

Jim Shannon Excerpts

Monday 17th January 2022 Commons Chamber

[Siobhan Baillie (Stroud) (Con)]

In late November, midwives, doulas, families and healthcare professionals across the country marched in their thousands. They powerfully set out their concerns about the issues they face, and 100,000 people signed a petition to ensure their voices are heard. It is both a privilege and a daunting prospect to be standing here to try to represent their views.

Before I continue, I declare an interest. I am pregnant and, although I was hoping people would think I had eaten too much Christmas trifle, I realise I am now struggling to hide the bump. God willing, there will be a summer bundle of joy to give me additional sleepless nights over and above the ones that are normal for an MP. This makes me a current case study for maternity services, with literal skin, blood and placenta in the game.

So far, I am one of the lucky ones. The service I received from the Stroud and Gloucestershire midwifery teams during my first pregnancy was world class. It is testament to Gloucestershire’s commitment to local expectant mothers that I not only received consistent care during my first pregnancy but I have the same midwife again. I thank them all, and Jan Partridge in particular. Her name should be enshrined in Hansard, as she is a legend not only in my household but in many others around my community. I know parents across the country feel the same about their own midwifery teams for their help during one of the most frightening, painful but special moments of life.

I stood on a manifesto promising to make the UK the best place in the world to give birth, with personal, high-quality support. I sincerely hope that we can make that a reality. The March with Midwives manifesto sets out demands, which include: listen—they seek an urgent consultation to understand the steps required to address the immediate crisis; fund—an immediate appropriate restorative pay rise for midwives and financial support for student midwives; enable—to make it possible for self-employed midwives to work, thus putting 250 experienced midwives immediately back into the workforce and providing flexibility; and reduce—provide a £5 million crisis fund to charitable organisations for the provision of breastfeeding support and antenatal education, to reduce the pressure on midwifery staff.

The manifesto is wide-ranging, but it does highlight a number of important concerns. All the briefings that I have been sent and everything I have read indicate that many things lead back to staffing levels.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate; the number of MPs here is an indication of its importance.

In the Royal College of Midwives annual survey, over half the midwives surveyed said they were considering leaving their jobs. Fifty per cent. said they would leave the NHS next year. Of those who were leaving, eight out of 10 said that they were concerned about staffing levels—the very thing that the hon. Lady has referred to—and that they were not satisfied with the quality of care that they were delivering.

Does the hon. Lady agree that urgent action must be taken today to support those midwives considering leaving the NHS, so that they feel able to do their jobs to the best of their ability?

[Siobhan Baillie]

I thank the hon. Gentleman for his intervention. Staffing issues are absolutely crucial and I want to pose a number of questions about them.

Vaccination Strategy

Jim Shannon Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

Those who are clinically extremely vulnerable or immunosuppressed have already been offered a booster, so they have already received four doses. As I said earlier, at the end of last week the JCVI determined that at this stage it was not appropriate for others to have a booster or a fourth dose.

[Jim Shannon (Strangford) (DUP)]

The Titanic Exhibition Centre, which is the largest vaccination centre in Northern Ireland, is to close on Sunday 16 January. Has the Minister made an assessment, in her Department, of the impact that the closure of mass vaccination centres will have on the booster process throughout the United Kingdom of Great Britain and Northern Ireland?

[Maggie Throup]

As I understand it, the location of vaccination sites in the devolved nations is the responsibility of those nations. I can only speak for England in that regard, so the hon. Gentleman may wish to take the matter up with the Minister of Health in Northern Ireland.

Access to Radiotherapy

Jim Shannon Excerpts

Wednesday 12th January 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate, Mr Davies, and also a pleasure to follow the hon. Member for Rhondda (Chris Bryant). We in this House are very blessed that he is here today because he had early treatment and was able to respond to it. I spoke to him personally at the time, and I know that others did. We are very thankful to God that he is here today and able to participate in this and many other debates in the House on a regular basis. We thank him for that.

I also thank the hon. Member for Easington (Grahame Morris) for setting the scene. We are greatly indebted to him for his leadership, for his interest in this subject matter and for every occasion on which he comes forward. We are also indebted to the hon. Member for Westmorland and Lonsdale (Tim Farron) as well. We are all on the all-party parliamentary group on cancer together, so we have regular contact with one another and with others as well. I give credit to both hon. Gentlemen for their leadership and contributions, and to others on the APPG for bringing this forward.

It is nice to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place. I always look forward to the Minister’s contribution. I believe that we will get a response that helps us to address the issues that we are raising today. I believe that we are greatly blessed to have the Minister in her place; she has a particular interest in this subject matter and is eager to secure change.

The debate today is about change; it is about making sure that we can move forward. I probably cannot even quantify—the hon. Member for Easington might be able to—the number of times we have asked about radiotherapy services. We have asked about these services before, met the Minister before and sent letters before, but we do not seem to be getting to where we want to be. That is what the hon. Gentleman said in his introduction. That is where we are.

There is a staggering backlog of an estimated 47,000 people missing a cancer diagnosis in the UK, and Macmillan estimates that the backlog of those waiting for a first treatment stands at 32,000 in England alone. Only last week in my constituency—this is not the Minister’s responsibility, to be fair, as it is a devolved matter—I met someone who was eagerly seeking an early meeting with a consultant and doctor about cancer. It is so important that she gets that; she is very worried about her circumstances. When I became aware of them, I was also concerned. We need to address that issue.

Radiotherapy in particular is one of the mainstays of cancer treatment. Modelling suggests that between 40% and 50% of people diagnosed with cancer should receive radiotherapy as part of their treatment. If it is part of their treatment and they cannot get it, we have a severe problem. The difficulty lies in workforce shortages, to which the hon. Member for Easington referred. They remain the biggest challenge facing the NHS and access to radiotherapy today. The Chancellor’s October Budget, unfortunately, missed a key opportunity to tackle this issue. Can the Minister give us some indication of the discussions that she has had with the Chancellor about what can be done to address the shortfall?

Macmillan Cancer Support says:

“The pandemic has both laid bare and exacerbated the terrible strain the cancer workforce has been under for many years.”

I know that the pandemic has exacerbated that incredibly. It is frustrating to know that the waiting lists that we had in 2019 are the waiting lists of 2021—and now 2022. It is essential that the budget for Health Education England is confirmed immediately, ensuring an increase in funding to train the cancer workforce that the NHS desperately needs.

Too few cancer patients have full access to a cancer nurse specialist, which is crucial in reducing costs and improving patient outcomes. It is very clear that in the reform of the NHS priority must be given to training these nurse specialists and ensuring that the funding is there to pay them for the extra responsibility that they take on and for the workload that they take off their colleagues, the doctors. Perhaps the Minister could give us some idea of what is going to happen in relation to that issue in the reform of the NHS.

Again, I am deeply grateful to Macmillan Cancer Support for the information that it has sent me. It estimates that in order to help meet the Government’s NHS long term plan, we need an additional 3,371 cancer nurse specialists, which means doubling the number of cancer nurses by 2030. In introducing the debate, the hon. Member for Easington mentioned that issue and I mention it again now, not simply to repeat it but to underline gently the importance of having those nurses in place. It is a major ask but not an impossible one, or at least it should not be impossible.

How do we get those nurses? First, we get the finance in place. An estimated total of £124 million is needed to train the next generation of cancer nurses by 2030. Again, what has happened in the discussions that the Minister has hopefully already had, or will be able to have, with the Chancellor? That process must begin with bursaries, which give the incentive and encouragement, if it is needed, to enable not just young students but mature students—those with mortgages and debts to pay, and perhaps children to care for as well—to be able to take the step into nursing. I make that comment because of a particular example that I know of. The dream of one of my constituents was to go into nursing. She worked in a shoe shop and her husband worked in landscaping; both of them had low-paid jobs. When she made the decision to follow her dream and go into nursing, she simply could not make ends meet, which is why bursaries are important.

I know this girl personally, so I know that she has endless compassion. She worked to become an intensive care nurse. She is a clever lady who wanted to make a difference in this world, but simply could not do so. She went into care work during covid and is making a difference in a nursing home, but will she ever become an ICU nurse, as she wanted? She thinks not, but I would like to think that the differences we make in this place and the decisions that we take will enable people such as Sarah to do the good that they want to do in the world, because there are many people out there who just love to help other people. We in this House—you, Mr Davies, and the rest of us here—are MPs who wish to help people; indeed, that is our job.

In 2020, the all-party parliamentary group for radiotherapy reported that a fifth of radiotherapy machines were older than their recommended lifespan of 10 years. NHS England must ensure a sustainable future so that machines are upgraded on a rolling basis and when they need to be. That process must be continuous, so we need an action plan to make it happen. Again, I ask the Minister a question: what has been done to address the need for that additional investment? Unfortunately, it is a fact that this comes down to finance.

Additional investment in radiotherapy would be best spent on upgrading existing machines and software rather than on increasing the overall number of radiotherapy machines or centres. Cancer Research UK has said that even if new centres were built, it would be very difficult to find the staff to run them. We need a co-ordinated and strategic plan that considers all the potential issues for the future, especially in rural areas such as the one that the hon. Member for Westmorland and Lonsdale represents. As he often says, in rural areas staff shortages are often the most severe that they are anywhere.

In the long term, consideration must be given to introducing innovative technology to transform care. For example, there are a limited number of magnetic resonance linear accelerators, or MR linacs for short, in the UK. They significantly increase the precision of analysis and therefore the effectiveness of treatment, which is really important. The Government must consider how to manage funding over a long term, to expand access to MR linacs and other cutting-edge technologies. That also includes purchasing new radiotherapy technology to evaluate its efficacy as a cancer treatment.

I will finish with this comment: the fact is that much greater investment is needed. We should remember that radiotherapy is used for half of cancer treatments, so it is critical for addressing cancer. Cancer affects many people and we need to give radiotherapy the priority that it deserves, getting the nurses and the equipment in place urgently. Unfortunately, there are literally millions of people whom radiotherapy can save and thereby extend their life. It seems to be agreed by all those who have spoken in this debate, and I believe that it will also be agreed by all those who will speak after me, that we must do all that is possible to do in this place in that regard.

Access to GP Appointments

Jim Shannon Excerpts

Wednesday 12th January 2022 Westminster Hall

[Theresa Villiers (Chipping Barnet) (Con)]

I beg to move,

That this House has considered access to GP appointments.

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

GPs are at the heart of our health service and our communities, and I thank them all for their dedicated work. They have been at the frontline of one of the most successful vaccination programmes in the world, thanks to which we have some of the lightest covid restrictions and one of the most open economies. Family doctors have also delivered an incredibly rapid adoption of new digital means to interact with patients when lockdown meant that it was vital to be able to give health advice without vulnerable patients having to visit a surgery. This is quite a switch for a health service that just a few years ago was still using about 9,000 fax machines.

Phone or digital consultations are here to stay, and for many they are a great way to get help from their GP, but not for everyone. In particular, many elderly people, people with learning disabilities or other cognitive impairments and those with language barriers may not be able to cope easily with digital communication. They may find anything other than a face-to-face meeting difficult. It is vital that these vulnerable people can still see their doctor, and there has been some real progress in recent months. There are now more appointments in general practice than there were before the pandemic, and, judging by the latest figures, about 65% of those were face to face.

[Jim Shannon (Strangford) (DUP)]

I was interested when I saw this issue on the agenda for Westminster Hall. I am interested in lots of things that are debated in Westminster Hall, but this is one in which I have a particular interest. Does the right hon. Lady agree that for many people who are not comfortable about describing their symptoms over the phone, or eloquent enough to do so, it is essential that they can request to see their GP without having to prove to the receptionist the reason why they need to?

[Theresa Villiers]

That is of course correct. Phone calls are important in triaging and assessing the extent to which a face-to-face meeting with a doctor is appropriate, but it is essential that those who need face-to-face appointments are given them.

We are seeing some progress, and this has been delivered at the same time as millions of booster jabs. I give credit to GPs, NHS England and Ministers for that recovery in general practice, but it remains the case that many of us will have heard from constituents about problems in getting in to see their GP. I thank the 19,302 people who signed the online petition on Parliament’s website expressing concern about this.

Eye Health and Macular Disease

Jim Shannon Excerpts

Tuesday 11th January 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current Government guidance and that of the House of Commons Commission. I also remind you all that you should have a covid lateral flow test before coming on to the parliamentary estate, and give one another plenty of room when entering and leaving the Chamber. I call Jim Shannon to move the motion.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of eye health and macular disease.

Thank you, Ms Nokes. This is a very important issue. I suppose all issues are important, but this one is very important, as I shall illustrate in my speech. I place on the record my thanks to the Backbench Business Committee, as always, for agreeing to schedule this debate, and to the Macular Society, which is working with Fight for Sight and Roche pharmaceuticals in the Eyes Have It campaign group—we say “The Ayes have it” in the House many times, and the eyes have it literally this time—for its support in securing the debate.

I thank all the hon. Members who are here for taking the time to discuss this important issue. I have spoken to some of them, and they will all bring their individual comments and contributions to the debate. I am very pleased, as always, to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place, and it is a particular pleasure for me and for all of us to see the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) in her place. We look forward to her response as well.

As someone who had glasses from a young age—eight years old—and who has had diabetes for the last 15 years, I can say that eye health is a matter of great personal import, as well as a constituency issue that affects a huge swathe of my constituents. Every day, 250 people start to lose their sight. At least half of all sight loss is avoidable. That is the key issue in this debate, because if sight loss is avoidable, the question is what steps we take to ensure that people do not lose their sight. With that in mind, I look forward very much to the Minister’s response.

More than 2 million people have sight loss, and 350,000 people are registered blind or partially sighted. Age-related macular degeneration is the leading cause of blindness in adults, leading to 50% of blindness. The hon. Member for Great Grimsby (Lia Nici), when we spoke last night, told me that she herself has this. Therefore the contribution from the hon. Lady, out of everyone in the House, will be particularly poignant and relevant to the debate.

I was shocked to learn that more people in the UK are living with macular disease than with dementia. We hear lots of stories—I am not saying we should not, by the way—about dementia, but just to give an idea of the magnitude of the subject of this debate and its importance, there are more people with macular disease than there are with dementia. Macular disease is a particular risk for the nearly 4 million people in the UK who, like me, are living with diabetes. I have long been instructed that poor control of blood sugar and insulin levels can damage the blood vessels of the eye, causing fluid retention in a condition called diabetic macular oedema. About one in every 14 people with diabetes develops DMO, which will result in a noticeable loss of vision.

Why should this topic be flagged as urgent for every Member of the House? Well, the issue is not just the physical health problems but the financial costs. The cost of eye conditions to the UK economy has been estimated at £25.2 billion per year, and without action, that is forecast to rise to £33.5 billion per year by 2050, so there is clearly a financial equation to this issue. It is about prevention and about reducing the costs for the health service as well. But cost is not the only important factor. The fact is that it is an awful thing to lose one’s sight and—for many people—one’s independence. Members across the House will know—perhaps through their own experiences or those of a loved one, or perhaps through the stories shared by their constituents, which we see in our constituency offices each and every day—the impact that sight loss can have. Loss of vision can have an impact on quality of life by undermining patients’ ability to live and work independently. For example, I recently met a member of the Macular Society, Bryan, who was diagnosed with age-related macular degeneration in 2012 and told me that something as simple as catching a bus can become very challenging.

Sight loss can also have a profound impact on emotional wellbeing. Sight is considered by many people to be the most important sense. Patients with macular disease, who are at risk of losing their sight, report feelings of isolation, shock, anger, anxiety and hopelessness. Those feelings may grow as individual sight deteriorates, with patients increasingly cut off from the world as they had previously experienced it. Losing one’s eyesight makes one particularly lonely; those who lose their eyesight do not know what is happening around them. I often think that, of all the senses that one could lose, eyesight is—with no disrespect to those who have lost other senses—the most important.

At the same time, macular disease can put pressure on the family members, friends or neighbours who act as carers for people with macular disease. This means that, although macular disease is more common among older people, its effects can be felt across the working-age population as well. Such feelings are understandable.

Without treatment, sight loss can be rapid. For example, wet age-related macular degeneration—wet AMD, where blood or fluid from abnormal blood vessels leaks into the macula, causing scarring—can cause significant sight loss within a matter of weeks. That is why this is so urgent. It is vital that patients are diagnosed and treated as quickly as possible. Can the Minister tell us what has been done to achieve the early diagnosis of AMD? It is so important that sight loss is addressed urgently. Other hon. Members in the debate will reiterate what I am saying shortly.

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

In 2018, the Royal College of Ophthalmologists found that there was a need for an extra 230 consultants and 204 staff and associate specialists over two years. Does the hon. Gentleman agree that recruiting and retaining staff in the ophthalmology workforce needs to be a primary consideration?

[Jim Shannon]

I certainly do, and I thank the hon. Lady for that intervention. That was one of my points; the Minister has heard it said there, and I will not repeat it. The importance of having the staff in place, to which the hon. Lady referred, is one of the asks in this debate. How can we address that? If we have the staff in place, we can address the issue of eyesight loss earlier.

We are all aware of the demand for NHS eye-care services over recent years. Ophthalmology is now the busiest outpatient specialty in the NHS, with some 7.9 million attendances in 2019-20. That gives one an idea of the magnitude of the issue. That is why this debate is important, and why today we need to look to take things forward. Waiting times have been made worse by the covid-19 pandemic—we understand that. The pandemic has meant that some patients faced a waiting time of up to six months to access care. We know that the wait can be a matter of weeks, but if patients have to wait six months for a diagnosis and medical response, their eyesight can deteriorate significantly in that time. Up to 22 people a month may suffer severe or permanent sight loss as a result of delays to follow-up care. Can the Minister tell us what we can do to address those issues, and what has been done to catch up on that in the pandemic?

[Paul Howell (Sedgefield) (Con)]

Does the hon. Gentleman agree that we have seen massive innovation in the NHS during the covid pandemic? It has been able to deliver huge treatment gains. Does he agree that it is also important that the science of things like macular deterioration is picked up and taken forward? A company called PolyPhotonix, in my constituency, has developed an amazing solution that needs to be driven through to end state. I encourage the Minister to visit the company, because we are very close to making a major difference to treatment both in and out of hospital.

[Jim Shannon]

The hon. Gentleman has, I think, passed on that information to the Minister. It is important that we see where innovation has moved forward. PolyPhotonix, the firm to which the hon. Gentleman referred, can bring beneficial and positive changes to those with eye issues. I thank him for that intervention, and I look forward to the Minister being able to visit the company.

Care for patients with diabetic macular oedema was deprioritised during the pandemic, and delays have led to a doubling in the number of patient with DMO losing between one and three lines of vision. It is very important that that issue is addressed. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to staff shortages, and again I look to the Minister to see how we can address that issue.

We know that, as with other areas of healthcare, there are inequalities in eye care. Some parts of the population are not accessing regular sight tests, even if they might be eligible for them for free on the NHS. Can the Minister tell us what can be done to ensure that people are accessing that care? I know that the pandemic has changed many lives, but how do we address that? It is about solutions, not about negativity, but we have to say these things in the introduction to the speech so that we can look to the changes that we wish to see.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate my hon. Friend on securing the debate. We are coming up to the winter Olympics, and if there was a ski slalom for getting Westminster Hall debates, my hon. Friend would win the gold medal every single year. Given the localised comments that he has very appropriately made about the need for people to get their testing done, it is often the case that when the reminders come through for an ophthalmology appointment, they are overlooked. It is important that people take them up and any problems are identified very early on.

[Jim Shannon]

How pertinent that intervention is. I will give a couple of examples now that I was going to give later because they are pertinent to this. The opticians and ophthalmologists in Strangford and Newtownards town have told me of two occasions in 2021 when people who went for their test were sent straight away to the Ulster hospital in Dundonald because they had a tumour. They had no other ailments, but their ophthalmologist or optician spotted something early on. They say the eyes tell the health of the whole body, and I think they do. In that case, two lives were saved, and there are probably many others.

[Margaret Ferrier]

Following that point, it is really important to use the available data effectively in understanding the level of serious eye issues experienced across the UK. Does the hon. Gentleman agree that streamlining data sharing across all health care providers should be mandated?

[Jim Shannon]

It is always important to have the data on health issues. The Minister, the shadow Minister and hon. Members will know that. If you have the data, you can respond to where the problems are. The hon. Lady is right; we need to have that data in place.

In 2018, the APPG on eye health and visual impairment took evidence from the charity SeeAbility. People with learning disabilities, including children in special schools, are much more likely to have a sight problem, but much less likely to access NHS sight tests. Last night, in a different debate on the welfare cap, the right hon. Member for Hayes and Harlington (John McDonnell) referred to those who will feel the pain of the welfare cap, but those with disabilities will feel it more. That is very real when it comes to health issues and it is why this issue is so important.

With that in mind, the APPG and SeeAbility asked for sight testing and glasses dispensing facilities in all special schools, which has now been taken forward by NHS England. That is excellent news and it shows that sometimes—hopefully all the time—APPGs and their partners can bring about changes. This will reach around 130,000 children and help to address and prevent avoidable sight issues and reduce the need to use hospital eye clinics.

The commitment by NHS England to reform must continue as these children have an equal right to sight. We will all follow matters closely, and I would like to see the rest of the UK following Northern Ireland. The excellent work by the Ulster University Centre for Optometry and Vision Science in special schools has also shown the same need. When we see that issue being addressed, it is good news. Let us all look at the opportunity for reform in England and in the devolved nations and seek to improve sight testing for adults with learning disabilities in the community too.

There are targeted schemes with optical practices in every area. Unfortunately, Minister, at the moment we see a patchwork across the UK. In some areas the service is good and in other areas it is not. We need to act across the board in all postcode areas to see the level of care and attention that we seek in today’s debate.

The health inequalities experienced by people with learning difficulties justify more attention. People with learning disabilities are dying of avoidable health issues at least two decades before their peers. We cannot have people living without good sight and even going avoidably blind because national health services overlook their needs. That cannot happen and should not be allowed to happen.

I have outlined the issues, but I want now to look at the good news; the positive, glass-half-full news about how we make the changes to address those issues, including improving the quality of life for people with macular disease and the pressure on family and friends that inevitably comes with that.

With rapid and appropriate treatments, whether those are pharmaceutical treatments, laser treatments or surgery, we can do the job better, working alongside opticians. They are keen to be involved, and to address these issues. As my hon. Friend the Member for East Londonderry (Mr Campbell) said, when a person gets an appointment from their optician, they should go to it: it is so important that they do so, and we want to make sure that people do that. So many cases of sight loss could be either treatable or preventable.

As the UK builds back from the covid-19 pandemic, there is an opportunity to transform eye care services, increasing capacity to deliver rapid and appropriate treatment for macular disease and other causes of sight loss. NHS planning guidance for 2022 focuses on tackling elective care backlogs. Minister, what has been done to address those backlogs? I understand that there are many backlogs—we know them all too well. We need to deliver 110% of pre-pandemic elective activity, but we must also support the NHS to transform services for the long term, to ensure there is enough capacity to treat patients who start to experience sight loss. Improved integration of eye care services must also be a priority for integrated care systems as they move towards implementation. That should include supporting lower-risk patients to be treated in the community, freeing up specialist service capacity for those patients who need it most. At the same time, as the hon. Member for Rutherglen and Hamilton West said, data sharing needs to be improved, for example through the electronic eye care referral system. That is just one example of what could be done to ensure that everyone has the information they need to improve the quality and timeliness of care.

We must also ensure that the NHS is making use of the most innovative treatments—the hon. Member for Sedgefield (Paul Howell) has referred to one of them—especially those treatments that help people living with sight loss to manage their condition as independently as possible, with less frequent need for hospital visits. If we can reduce hospital visits and improve care, we will reduce costs and improve long-term health. We must invest in the workforce we need to deliver current and future eye care. I am very pleased to note that the Government have already confirmed that the process to appoint a new national clinical director for eye care has begun. I hope that this role will provide much-needed leadership and drive forward a transformation of NHS eye care services, including improved integration, better use of data and expansion of the workforce, which I believe is essential to provide the high-quality care that will, in turn, deliver better outcomes for patients. That national clinical director should therefore be appointed as a matter of urgently, and I look to the Minister and to Government to give us a clear timetable for making that appointment.

To ensure accountability and transparency, the national clinical director for eye care should report to a single Minister with responsibility for eye care services across primary, secondary and community care. The role of that individual is critically important for outlining a strategy and moving forward. Sight loss is widespread, and its implications are significant for the NHS. The cost of sight loss to the public purse cannot be ignored, but it is most important for the patients whose lives will be irrevocably altered by a diagnosis such as macular disease. Timely access to appropriate treatment could quite simply be the difference between someone losing and keeping their sight. We want to ensure that people can keep their sight, so it is vital that we do all we can to ensure that every patient can get the treatment they need, when they need it—the earlier the better. When it comes to sight, every day matters. Every appointment is essential, and that principle must underpin our approach to the necessary changes to macular eye health in this post-covid world.

I thank the Minister again for offering her time. People will say, “Well, that’s her job”, but she comes here with a passion and an interest in this issue. It makes it much more pleasurable for me introducing this debate, and for other Members as well, that we have a Minister who can respond positively. I welcome the opportunity to continue these discussions following today’s debate—I know that the Minister is always agreeable to doing so. In anticipation of their speeches, I also thank all of my colleagues, right hon. and hon. Friends and Members, in this Chamber. Working together, we can and will achieve.

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[Ms Lyn Brown (West Ham) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.

I thank the hon. Member for Strangford (Jim Shannon) for securing the debate on this neglected topic. Not for the first time, my comments will echo those of my right hon. Friend the Member for Hayes and Harlington (John McDonnell), because today I will focus on the damage that refractive eye surgeries can do to health. In particular, I would like to talk about my constituent, Darren Clixby.

Like many of us, Darren had lived much of his life needing glasses or contact lenses for short sight. As many people have, he heard the messages about laser eye surgery, and its promise to make life easier and better. He also heard the statistics that are bandied about regarding the rarity of serious complications, so he paid his money and went for it in January 2009, but I am sorry to say that the damage immediately after the surgery was awful.

Darren was in tremendous pain. He could not open his eyes at all until the following day and, when he did, his vision was unrecognisable. It was filled with sunbursts coming from light sources, with halos arounds them, with images that overlapped and with many floaters, which are small objects that persistently stay in the vision no matter where someone looks; I have loads of them in my eyes.

Having such damaged vision was distracting, disorientating and very distressing. Darren could not function. He had been told that this was merely a temporary effect and that it would go away after surgery, so he took sick leave and he persevered in that hope. The weeks passed, then the months, and the problems with his vision simply did not go away. Understandably, Darren became increasingly distraught, anxious and depressed. At check-ups, he was told time and again that it was temporary. He was fobbed off with steroid eye drops, which did nothing.

He was then offered another procedure with the same company, using an alternative refractive surgery technique, then another, via a private referral to Moorfields Eye Hospital, and then another. Darren has now had five separate refractive eye surgeries, four of which were to correct the damage of the first. None of these operations have helped. In fact, Darren believes they have just made things worse.

All of this time, Darren’s mental health was deteriorating. He found his work as a solicitor increasingly impossible because of the psychological damage that resulted in a diagnosis of severe depression and anxiety, which remains 13 years on. He resigned from his job and endured 18 months out of work. Even now, after getting a new legal role, he has found it difficult to continue and he had to resign 18 months after starting that job. Eventually, in 2012, Darren had to stop the process of repeated surgeries, and disengage to protect what was left of his mental health. It has taken him many years to come to terms with what has been done.

[Jim Shannon]

I thank the hon. Lady for sharing what surgery can be like. I have a diabetic constituent who asked a consultant if laser surgery would be appropriate. Unfortunately, as a result of that surgery he lost his eyesight in its entirety. Today, he has no sight in either eye. When it comes to surgery, the hon. Lady is absolutely right and I thank her for the reminder that it does not always work. People need to be careful and aware of that.

[Ms Lyn Brown]

Darren now believes that there is nothing that can be done significantly to repair the damage to his sight. He has uncomfortable, dry eyes every day of his life, which become far worse after reading or concentrating for long periods. He cannot see clearly in low-light conditions or drive after dark. Even crossing the road can be dangerous because it is hard to judge the distance between cars.

Darren believes that he was not fully informed about the risks before his surgery. He has no trust in what little regulation or self-regulation exists via the General Optical Council and the General Medical Council. This was a private, elective procedure that Darren paid for. Surely to heavens, the company that performed the surgery should be responsible for the best possible aftercare, and for making it right. In 2017, Darren again contacted the company responsible for the original surgery. It was made absolutely clear that it would offer him nothing. Effectively, it told him to go away, to stop being a nuisance and to stop getting in the way, frankly, of it making more money.

As always, the NHS has been left to pick up the pieces after poorly regulated private medicine has failed. I ask the Minister how much is this costing the NHS across the country? It would be good to know. Does she have any information to hand on that? We need to create a system where patients are genuinely informed about the real risks; a system where there is proper recourse to a regulator when things go wrong, and where private companies are held responsible for their failings and the cost.

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[Steven Bonnar]

That is so surprising. This Prime Minister is known for his consideration of others.

I put my thanks to Tuite Opticians on the record, not only for having me, but for its tremendous commitment to the wider community of Coatbridge for over 30 years.

[Jim Shannon]

I thank the hon. Gentleman for his positive contribution to this debate. The other good thing about going to an optician, is that if he has any concerns, he can refer the patient on—it does not necessarily have to go through the GP. I did that when I went to my optician in the Cathedral Quarter in Belfast to get all the tests necessary and ultimately was given the all-clear. An optician can put someone’s mind at ease.

[Steven Bonnar]

I thank the hon. Member for his intervention. He is absolutely right. The optician can highlight so many things. We know the burdens across the NHS, particularly on our GPs and this can lighten the load. However, as he correctly outlined, unfortunately, in England, Wales and Northern Ireland, the situation can sometimes be difficult. Optical practices are not so fortunate in that there is no governmental support and provision for free eye tests for the general public.

In England, a typical eye examination costs between £20 and £25 for all, except children, the elderly or people registered as partially sighted or blind. Having a monetary value attached to an eye examination would undoubtedly deter those unable to afford the crucial health test and endanger their long-term health and hamper the early prevention tactics that so evidently work. This in a country where health care should be free at the point of need is unacceptable. I believe it is unacceptable to administer a charge. The rest of the UK should follow suit. We have heard repeated calls for a national strategy—the example set by Edinburgh should be followed. Scottish citizens do not have to pay to have their eyes examined. Seeing is a privilege that so many of us will struggle to appreciate, but ensuring that there is universal access to eye tests means that those who require them do not have to think of any cost ramifications.

Scotland not only leads the way in the universal accessibility of eye tests but is the first country in the UK to enable access to important treatments for macular disease. Treatment depends on the type of AMD. Dry AMD accounts for 80% or 90% of cases. There is no treatment, but vision aids can help reduce the effects on day-to-day life. Wet AMD, which affects 10% to 20% of sufferers, may require regular eye injections and, very occasionally, as we heard from the hon. Member for Great Grimsby, a light treatment called photodynamic therapy, to stop vision getting any worse.

The other nations of the UK are missing a trick not only in determining new treatment methods for macular disease, but when it comes to understanding the importance of addressing such issues in terms of the impact on the wider health and social care system.

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

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking the hon. Member for Strangford (Jim Shannon) for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend the Member for Darlington (Peter Gibson), who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend the Member for Great Grimsby (Lia Nici). We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from the hon. Member for East Londonderry (Mr Campbell), we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

[Jim Shannon]

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

[Maria Caulfield]

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend the Member for Sedgefield (Paul Howell) about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend the Member for Hendon (Dr Offord) asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by the hon. Member for West Ham (Ms Brown) about her constituent, Darren, and those raised by the right hon. Member for Hayes and Harlington (John McDonnell). I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

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[Jim Shannon]

First, I thank each and every one of the right hon. and hon. Gentlemen and Ladies who have made a contribution. The hon. Member for Sedgefield (Paul Howell) referred to the innovative company in his constituency, which I think can help. The hon. Member for Darlington (Peter Gibson) clearly outlined the issues for those who are blind when it comes to obstacles such as street furniture, e-scooters and so on. He also referred to the strategy in his constituency.

I thank the hon. Member for West Ham (Ms Brown) so much for what she said. It was a reminder to us all that corrective surgery, unfortunately, does not always work. She referred to its being regulated. The hon. Member for Hendon (Dr Offord) referred to his own personal experience and to how he has better vision today because of the steps that were taken. He also referred to the eye strategy for the United Kingdom. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to the data. Data is critical to all health issues. My hon. Friend the Member for East Londonderry (Mr Campbell) referred to the fact that people must attend their optician appointment. The right hon. Member for Hayes and Harlington (John McDonnell), in a significant contribution, referred to the longer-term investment that is needed. He also said, “Listen to clinical and medical advice and don’t listen to the salesperson.”

I think every one of us was moved by the contribution from the hon. Member for Great Grimsby (Lia Nici). It was a real step-by-step story of the hon. Lady’s situation, and we thank her for all that she said. She referred to modern technology, buy-in by employers and computer advances.

The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), in a significant contribution, referred to what is done in Scotland. I wish that we in Northern Ireland perhaps had something similar to Scotland. That is something for us to look at as well. The hon. Member for Gillingham and Rainham (Rehman Chishti) referred to a public campaign being needed. The hon. Member for Denton and Reddish (Andrew Gwynne), in a very good contribution, referred to some people waiting more than a year for treatment. He pointed out that all ages are affected, and it is good to remember that it is not just people of a certain generation; it is younger people as well. Waiting times have soared, and people have been let down.

The Minister, in her response, has been incredibly helpful, as she always is. She understands the issues and understands the concerns of each and every one of us here. We said to the Minister—I think the right hon. Member for Hayes and Harlington also spoke about this—that if we could have a meeting with her, we would certainly do that. In relation to AMD, diabetes and glaucoma, a national eye care director is being put in place. There are certainly significant programmes. The issue is to ensure that those programmes are available across the whole United Kingdom, in every postcode. The Minister is committed and certainly very positive, and we look forward to working with her, all of us together.

Question put and agreed to.

Resolved,

That this House has considered the matter of eye health and macular disease.

Surgical Fires in the NHS

Jim Shannon Excerpts

Thursday 16th December 2021 Westminster Hall

[Christina Rees (in the Chair)]

I remind Members that they are expected to wear face coverings when not speaking in the debate. That is in line with Government and House of Commons Commission guidance. I also remind Members that they are asked by the House of Commons to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre on the estate or at home. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of preventing surgical fires in the NHS.

It is a joy to see you in the Chair, Ms Rees, for the third time this week, and to be here myself to make a contribution to the debate. I am pleased that other hon. Members are present: the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar); the shadow Minister, the hon. Member for Ilford North (Wes Streeting); and the Minister. It is no secret that I am very fond of the Minister. She and I have worked together in the House on many health issues, and I very much look forward to her response. This topic is of significant importance, so I am glad to see other Members in the Chamber to make what I am convinced will be significant contributions.

As Members are aware, health has been my portfolio in this House for quite some time—almost 10 years—which means I have been exposed to some of the more challenging issues to face the healthcare system across the United Kingdom. Today’s discussion is about one of those: surgical fires in operating theatres. It is certainly one of the most concerning issues that I have come across in my time in this House. Did I know much about it? I probably did not, but once it was brought to my attention in this place and back home in Northern Ireland, where it is a devolved matter and the responsibility of a Minister in the Assembly, I became aware of it.

I spoke to the Minister present before the debate, and she has some of the questions in my speech from my staff and others. I very much look forward to her response to the questions that I will pose today. First, however, I pay tribute to the work of the expert working group on the prevention of surgical fires, who brought the matter to my attention and whose report on the prevention and management of surgical fires I recommend to the Minister and all Members of the House. It is a thorough and detailed report, which encapsulates the issues that we will discuss in the debate and gives the Minister and her Department the opportunity to respond, I hope in a positive way.

I had the pleasure of chairing the parliamentary launch of the working group’s report in November last year. I am sure that their report and campaign will feed into much of the debate—it certainly will through my comments, and I am pretty sure it will through those of other hon. Members as well.

I want to underline what we mean by surgical fires and the serious dangers they pose to patients and clinicians alike. A surgical fire is a self-descriptive name: it is a fire that occurs during surgery in an operating theatre. In order for a surgical fire to occur, three elements must be present: the ignition source, the fuel and the oxidiser. Ignition sources include electrosurgical units, fibre-optic light sources and lasers. The fuels regularly include alcohol-based skin prepping agents that have been used in excess or applied inappropriately. The oxidiser is simply an oxygen-rich environment in which nitrous oxide is present, alongside the oxygen. Those are the three ingredients, or the three elements that are the reason for surgical fires. I do not believe that it is impossible to address the issue, through the Department and the Minister’s response, so that we can ensure that such fires do not happen.

The statistics, which the people working in the background have gained from across the whole United Kingdom, highlight just how worrying this matter is. The report states:

“Injuries caused by a surgical fire most commonly occur on the head, face, neck and upper chest.”

By and large, that is where operations focus on, and a fire can leave victims with debilitating pain and lifelong physical and psychological scarring—I will later give the example of someone whom I met in this House at a presentation that we did some time ago. A surgical fire can also cause harm to operating theatre staff, who are exposed to similar risks. It can affect not just the patient on the table who is having the operation, but the staff, so there is a dual responsibility for safety—obviously for the patient, but also for the staff.

Like so many members of the public and those of us present for the debate, I had absolutely no idea that surgical fires posed a threat to patients across the United Kingdom, and I was unaware of the extent of the injuries that they can cause, so I am extremely pleased that this subject is being debated, even though we are in the graveyard slot. We are going into recess after today, so most Members have probably left. That is unfortunate, because others had wished to participate but could not stay. The omicron variant has also been part of the problem, and that is perhaps the case for the shadow Minister who was originally going to participate in the debate but could not do so. We are ever mindful that although we may be small in number, the debate is none the less important, and we want to put that on the record.

Today’s debate is about raising awareness about the seriousness of surgical fires and pushing for the next steps to ensure that they no longer happen. Ultimately, that is the goal of the debate—to ensure that precautions are taken so that surgical fires do not happen. What I will outline in my contribution will helpfully enable the Minister and her Department to take the necessary action.

I am sure that many Members will be asking the same question that I did when this issue was first brought to my attention: how common are surgical fires? That is a question that many of us ask. The reality is that nobody knows entirely, but the expert working group sent out a freedom of information request to trusts, health boards and relevant bodies across the United Kingdom. Although there were significant discrepancies across all organisations, the NHS England acute trusts and Welsh health boards stated that they recorded some 96 surgical fires between 2010 and 2018. The report states:

“A search of the National Reporting and Learning System (NRLS) data from between 2004 and 2011 identified just 13 reported surgical fires.”

The important point is that, by comparison,

“NHS Resolution claim to have been notified of 631 clinical negligence claims relating to surgical burns to patients”

between 2009 and 2019. NHS Resolution also claims to have paid out £13.9 million

“in damages and legal costs on behalf of NHS organisations.”

The data that some of the trusts and health boards hold as their evidential base indicate to me that the issue is bigger than many people thought. The fact that some £13.9 million has been paid out in damages and legal costs emphasises that point with a strong evidential base. I am sure that the figure is still a stark underestimate of the scale of the problem, and not all incidents will have been recorded. I suspect the number of claims could be bigger than 631, and that does not even account for all the near-misses that may have occurred in operating theatres across the United Kingdom.

According to a survey by the Association for Perioperative Practice, which is one of the largest membership organisations for operating theatre staff, almost half of its members have personally witnessed a surgical fire—again, an evidential base to prove that this issue is like picking at a scab, because the evidential base and examples are far-reaching and quantitative. There is no question but that there is a clear and obvious discrepancy in how surgical fires are reported, which raises questions about the true number of such incidents.

One of the key questions is what reason is behind the large discrepancy in reporting and why the number of surgical fire incidents that occur each year cannot be accurately quantified. The answer is quite simple: it is not mandatory for trusts to report these events when they take place. I am astounded that that is the case. There is evidence to show that £13.9 million was spent in pay outs for damages and legal costs, and that there were 631 fires. How can it be possible that it is not mandatory to report when someone is set alight during surgery? It is bound to be a fairly dramatic situation. These figures do not even cover the near-misses that must occur on a regular basis.

As the Minister may know, over the past year I have tabled a few parliamentary questions, asking the Government to provide an answer about the number of surgical fires that occur every year, but each time they have been unable to do that. I find it concerning that the Government accept that surgical fires are an issue within the NHS but they still do not know the true scale of the problem. Such is the magnitude and severity of this issue that I would have thought the Government might respond. I say that very respectfully, which is my way of doing things, Ms Rees; when I ask questions, I ask them both to get the answer and to improve the situation. That is probably why I always see the glass as half full, rather half empty. I look to the Minister for a response on that.

The Government are still not monitoring or reporting issues that threaten the safety of patients in the UK. This is also a structural problem that requires proper education and training, and puts in place the necessary protocols to mitigate and reduce the risk as much as possible. One would assume that trusts across the country all have protocols in place to prevent such fires from occurring, but I am sad to report that that is not the case.

According to research by the expert working group, which examined specific protocols and training programmes addressing surgical fires in local NHS trusts, only a limited number of trusts across the UK actually have surgical fire protocols. I think it is vital that they should have them, but many rely on general fire safety guidelines, where there is often no mention of surgical fire risk and prevention processes. Again, I look forward to the Minister’s response about what protocols and safety measures can be put in place.

According to a survey by the Association for Perioperative Practice, over half the respondents reported not having surgical fire protocols to date, while almost two thirds reported that their organisation did not provide training courses or education for operating theatre healthcare professionals on preventing surgical fires. Again, there has to be a clear change of focus among healthcare professionals to ensure that this issue is addressed.

A third of respondents reported receiving training and education, and that training included both high-risk management courses and more generic fire safety training, which was more reactive than preventative. I am a great believer in early diagnosis and preventative measures, rather than reactive measures, so I hope that as a result of this debate we will have measures put in place to address those issues. The training is clearly not adequate for the seriousness of the danger at the moment. The lack of prevention and management protocol is completely unacceptable and represents a clear and present danger to all patients who undergo surgery in the NHS.

It is truly astonishing that surgical fires are already recognised as a safety concern in other countries. I will give examples of those, because if other countries can see the risk, difficulty, impact and severity of this, then I know that our NHS, which we all treasure and love, can deal with the issue equally well, if not better. Yet there is insufficient guidance about how to prevent and manage surgical fires in the UK.

In the United States, the Food and Drug Administration already provides a list of specific recommendations on reducing the incidence of surgical fires. These include conducting a fire risk assessment at the beginning of each surgical procedure, which seems to be logical. Again, maybe the Minister can give us some indication of whether that is a procedure that the NHS will adopt. Those recommendations also include additional safety procedures such as planning and practice on how to manage a surgical fire, including how to use carbon dioxide fire extinguishers. Are those things available in the NHS? They should be, so if not, is there an intention to put them in place? As a result of introducing the necessary protocols, educational tools and reporting systems, the number of surgical fires in the United States has dropped by 71% since 2004. By putting the right strategy and safety measures in place, we reduce the threat. That is my goal today, and that is the approach we should be trying to emulate within the NHS.

The expert working group’s report made a number of recommendations on the prevention and management of surgical fires. I do not intend to read out the entire report—even though I have three hours, I do not want to put people to sleep when they want to go home—but I want to highlight four of its key recommendations. First, professional associations should explore the value of a national awareness campaign for healthcare professionals. Secondly, education on surgical fire prevention should be mandated in the surgical and perioperative education and training syllabus. Thirdly, NHS England should explore how to evolve the procurement process for sanitation products, in order to reduce surgical fire risk and encourage procurement of proven surgical fire-safe technologies. Fourthly, NHS England should explore the development of a standardised patient safety alert system that aligns the processes and outputs of all bodies and teams, and ensure that they set out clear and effective actions for providers to take on safety-critical issues. If I were to ask for nothing else today, I would ask for those four recommendations to be acted on, because that would be a massive step forward.

It is clear to me, as I hope it is clear to other Members, that effective education and training are the primary means of preventing the incidence of surgical fires. Despite some form of fire safety training being mandatory for all NHS staff during their induction and ongoing employment, that training does not address the unique features involved in preventing or extinguishing a surgical fire. The response to different kinds of surgical fires can differ, as can an individual’s role, depending on who is present at the time. I know that the past year and a half—almost two years—have been extremely difficult due to covid, and that the NHS, the Minister and the Government have other priorities, but this is about prevention. It is about making sure that surgical fires do not happen again, and it is logical to try to do so: it would have stopped that £13.9 million from being paid out in damages and legal fees. Meanwhile, preventative measures and effective management strategies require additional education and training, and the absence of such training currently acts as a barrier to eliminating incidents of surgical fire and ensuring an appropriate response.

As I have highlighted, providing detailed guidance and encouraging the individuals who constitute the perioperative team to consider their role in surgical fire prevention has led to a statistically significant decline in the incidence of such fires in the United States. Their incidence has fallen by 71%—wow! I did not do the mathematics, but if we brought that 631 down by 71%, it would be approximately three quarters of that number. It is clear to me that surgical fire training should be made mandatory across the NHS and the private sector, and should be updated at least every two years. Again, I refer to those four asks: we need to make sure that those matters are taken on board, so that we have a proper system in place for the future as well.

Despite education being an essential method of preventing surgical fires, it is no use if it is not mandated, and if we still fail to tackle the institutional failure to truly record the scale of the problem. Following discussions with the expert working group and others, I call on the Minister to instruct the Centre for Perioperative Care to investigate the possibility of making surgical fires a never event, meaning that they never happen again. We would like to see surgical fires made a never event as part of the CPC’s work on redeveloping the national safety standards for invasive procedures to ensure they remain fit for purpose.

Classifying surgical fires as a never event would require mandatory reporting of incidents or near misses, while also mandating essential education for surgeons and other perioperative staff across all NHS trusts. Even without knowing the details of surgical fires, the name itself suggests they should be a never event. The concept of a surgical fire is terrifying enough that if we asked a lay person whether it should be classified as a never event, they would likely agree that it should never happen—indeed, they would probably be astounded that it even did. Only by classifying surgical fires as a never event can the national safety standards continue to be fit for purpose.

I have been paying keen attention to some of the Government’s responses to my questions about surgical fires over the past year. I realise that the Government have previously stated that they have no plans to classify surgical fires as a never event. Again, I urge the Minister, in the light of the evidential base we now have, to do just that. I note in the latest response to me that the Minister says that it is not possible to make surgical fires a never event because

“there is currently no national guidance or safety recommendations to prevent surgical fires in operating theatres”.

I say respectfully that we need to do that. If we can do that, we can move forward.

I have good news for the Minister—I always try to bring good news, and not just because it is Christmas. The expert working group has already developed national guidelines. Its report made safety recommendations for perioperative staff, and the group is waiting for them to be adopted. What the expert working group has done could be a template for exactly what the NHS needs to do. It has informed me that it is more than willing to pass on its hard work directly to Government. If the Minister is agreeable, I would be happy to have a meeting to exchange those views, and those papers as well, with the Centre for Perioperative Care expediting the process. I believe there is now no reason not to classify surgical fires as a never event.

We should not forget the most important impact of surgical fires: the human impact. As I mentioned earlier, I had the pleasure of chairing the launch of the report last year. During the event, I also had the pleasure and the privilege of listening to a patient who had experienced a surgical fire. He explained to us the impact that the incident had on his life. What happened to this gentleman is quite tragic. I will quote his story, but I will not name him, and I will be careful what I say in relation to him.

He told the group that he had visited the hospital for a routine procedure, but that when he woke up the staff informed him that his body had been set alight during surgery. He told us how he had been burnt on the left side of his chest and upper arm, and of the impact that this trauma had on him. He was not aware of the fire because he was under anaesthetic having an operation. He went on to explain how it had prevented him from continuing his career in social care, which he had been in since the age of 16, because he was disabled as a result of the incident. He explained how it had left him physically and psychologically drained, and how it had left him in pain, unable to carry out simple household tasks such as making a cup of tea—he did not have the stretch or lift in his arm any more. He told us of the impact that the fire had on his family. His partner became his carer and he could no longer spend time with his granddaughter. Having five grandchildren—three girls and two boys—I know how much I enjoy spending time with my grandchildren.

That is a jarring story—one that is all the more shocking and disturbing the more details that are revealed. I am not going to name him because there are legal discussions going on with the trusts involved and because he has nothing but praise for the nurses who have cared for him since the incident. He understands that nobody set out for it to happen, but it happened, and it happened because the precautions were not in place, because there was no safety measures and no training. The so-called never event happened.

He is a very kind man—a gentleman. However, no matter how good the nurses have been to him, it would be remiss of me not to mention how inadequately his situation was addressed. To cause severe harm to a patient is beyond the pale; it is against every medical principle that exists. The NHS and all its staff are tasked with saving life, and that is what they do to the best of their ability. We must not forget the impact on the operating theatre staff, who may also experience a psychological cost from these experiences. It is equally essential that surgeons learn how to give both physical and emotional support to the victims of surgical fires. They are the ones who have suffered most, and surgeons must be empathetic to them and their needs.

What is also concerning is that, despite this serious incident taking place, the hospital appears not to have made the appropriate changes to its systems and protocols. We all learn lessons—every day of my life, I learn lessons; I am not so proud that I do not learn from all those around me and those who I speak to. The patient required follow-up treatment in the same hospital and, on inquiring what had been done to prevent the incident from happening again, was told that nothing had changed; there had been no updates. How disappointing.

As I mentioned, I cannot name the patient, but I pay tribute to his bravery and his determination to prevent this from happening to another person. That is one of the reasons why he told us his story. He wanted to provide us with the evidential basis for what had taken place and to ensure that it did not happen to somebody else. He is truly an admirable person. I thank both him and his partner for sharing their story with me and, ultimately, with everyone in the House and Westminster Hall and with the Minister and her Department.

I am coming to the end of my speech, Ms Rees. I will begin summing up, so that we can also hear from others. I look forward to hearing some thoughtful and insightful contributions from the shadow Ministers and, specifically, the Minister. As I have stated, I hope this debate will bring greater attention to the issue of surgical fires and shine a spotlight on this danger. It is clear to me, from reading the expert working group’s report and patients’ testimonies and from listening to expert guidance, that more needs to be done to prevent surgical fires. That is why I am so pleased to play my part in today’s debate in support the aims of the expert working group.

I hope that in the short time—it feels like a long time perhaps, Ms Rees—that we have been making the case today that it is clear that we are supporting the aims of the expert working group. There needs to be mandatory reporting of both surgical fires and near misses, because until we can effectively quantify the scale of the problem, we cannot effectively address it. Similarly, we need to introduce effective and mandatory education for all surgeons and perioperative practitioners in order to prevent surgical fires from occurring and to ensure that they are effectively managed when they do occur. This can also be done by classifying surgical fires as a never event. NHS operating staff are already aware of the threat of surgical fires, but they have not received the proper support and guidance to ensure that these incidents are prevented.

I therefore hope that our actions today will start the necessary change. Whether we are talking about simple steps such as introducing a checklist to ensure the taking of appropriate preventive measures, such as using the correct antiseptic skin solution, or ensuring the presence of the appropriate tools and equipment for the management of fires, which we should have as a precautionary measure in all operating theatres, these are all necessary steps to ensure the safety of patients and operating theatre staff alike. This is about the patient; it is about the staff; it is about getting it right. If we do not, we will have to confront the reality that many more people will be harmed by our failure to act. Classifying surgical fires as a never event is, I believe, the only way to effectively prevent patients and NHS staff from coming to harm.

I thank hon. Members for attending the debate and ask them to consider the reaction of their constituents if they were asked about surgical fires. If a Member here were asked about this matter, what would he or she want done in relation to it? They would surely all agree that such fires should never be allowed to happen. Making them a never event is the common-sense option, and I hope that others will join me in urging that that rational action be taken on this issue.

The people to whom I have referred, including the gentleman who made his own personal submission, are real human beings. They are people who have gone through operations and been confronted with the reality of this issue. We know about 631 of them in the United Kingdom, and we believe there are more. Addressing this issue would put an end to the need for the £13.9 million of damages and legal charges. We live in an age in which we must also be careful with the money we spend. If we are not, things may happen that cost the NHS money. People have been affected by this issue, and people will continue to be at risk until we act. I therefore invite the Minister and other hon. Members to join me in what I believe is a very worthwhile campaign to make surgical fires a thing of the past—as I said before, a never event.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing this hugely important debate. While he is right that we may be small in number this afternoon, it is the quality not the quantity of the Members that counts.

Health is a devolved matter, so I can really only respond on behalf of the NHS in England to the issues the hon. Gentleman raised, but, as the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), said, surgical fires are a priority area of concern in all the devolved nations. Patient safety is our absolute focus. We want to provide the public with the safest care possible. As the hon. Member for Strangford said, a fire affects not only patients but the NHS staff working in those units. We traditionally think of surgical fires as taking place in hospital-based settings such as theatres, but more and more minor surgery is taking place in community facilities such as primary care facilities. This issue is expanding to other areas of the NHS, so it is important that lessons learned in hospital trusts are learned in the community as well.

Supporting a culture of safety in the NHS is critical, and we have put in place a number of measures aimed at supporting the NHS. The key is learning from incidents. Where there have been surgical fires in the past, it is important to identify their causes and how they could be prevented in the future. It is also important to hear from staff, who will sometimes not be surprised when an incident occurs or who may have flagged issues a number of times before attention is taken.

We are taking a number of initiatives to improve patient safety across the board. The first is establishing the health safety investigation branch, which conducts independent reviews and investigations into any patient safety concerns, including surgical fires. We are also introducing a statutory duty of candour to ensure that NHS organisations are open and honest towards patients. If a surgical fire happens, as in the hon. Gentleman’s tragic example, a patient who may have been asleep at the time should be made aware of that and receive an apology and support afterwards. Sometimes the fires are quite minor and the patient is not affected, but it is important that they know that an incident happened. We are also setting out in legislation the first ever patient safety commissioner, which will be for England only. They will be a champion for patients in relation to medicines and medical devices and will certainly look at the issue of surgical fires.

Regrettably, despite some of the progress and some of the measures we are putting in place, and despite the high quality of care provided by NHS staff, incidents happen that cause harm to patients and put staff at risk. If a surgical fire is extensive enough to take a theatre out of service for a time, that has a knock-on effect for other patients on surgical waiting lists, who may be delayed as a result. Minimising the risk of surgical fires is an area we take very seriously, and although rare, when they do occur in or around the operating table, they can cause extensive damage and put patients and staff at risk.

The issue is how to best minimise the risk of fires in the first place. As has been pointed out, work is going on into this area. NHS England’s national patient safety team has been involved with the expert working group on the prevention of surgical fires, which the hon. Gentleman referred to and which is chaired by the chief executive of the Association for Perioperative Practice. We will continue to support the development of its guidance. I am happy to meet the hon. Gentleman to follow this up, because as highlighted by the shadow Minister the working group published a report in September last year on the prevention and management of fires and made a number of recommendations. It is the view of the national patient safety team that further work on surgical fire prevention following the report is best developed alongside the wider national safety standards for invasive procedures. Those standards were created to support all aspects of patient safety in the surgical environment and are currently being led by the Centre for Perioperative Care, which is responsible for ensuring that national safety standards for invasive procedures continue to be fit for purpose.

[Jim Shannon]

I am very encouraged by the Minister’s response. I referred to four key recommendations, which she referred to. She also referred to the fact that there are ongoing negotiations and discussions with the expert group. Has there been an opportunity to push for those four key recommendations as part of the change that is needed?

[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) for his contribution. He developed the debate in the way we hoped he would, referring to the strong evidential base, the urgent need and the update on progress, as well as patient safety and preventive action.

I am pleased to see the shadow Minister, the hon. Member for Ilford North (Wes Streeting), in his place. I wish him well in his new role—I should have done that at the beginning, and I apologise for not doing it. Being the true MP that he is, he took the opportunity to make a mark for his constituency, as we all would, by the way—none of us misses that opportunity. I thank him for a very constructive contribution, in which he referred to the training that is needed now, the national guidelines and the never event. Incidents can be prevented—I think that is the thrust of the debate. I thank him for that and wish him well for the future in his new role.

I want to say a big thank you to the Minister, who clearly responded on the key issues. The first one, which is important in relation to the example I gave, was that if we get it wrong, we apologise and we change the system. That is a key issue. It is never hard to do, but sometimes difficulties seem to arise. I thank her for her comments on that. She also referred to the four key recommendations and the data to be collated. I thank her for agreeing to a meeting—we will do that.

On staff training, this is not just about patient safety; it is about the staff as well. On the never event, I think that that will be really important when the expert working group meets the Minister and her officials. For patients and staff, work continues to progress, and I very much thank the Minister for her constructive response to all three of us here today.

I take this opportunity to wish a merry Christmas and a happy new year to you, Ms Rees, to my colleagues the hon. Members for Coatbridge, Chryston and Bellshill and for Ilford North, and especially to the Minister and her Department. The Minister and I have worked together on many things, and we will work on many more if God spares us to the new year. Her Department, her Parliamentary Private Secretary—the hon. Member for Grantham and Stamford (Gareth Davies)—and all the officials certainly make our jobs easier. We could not do this job without them.

I am a very simple person when it comes to these things. I wish to make progress and to do that alongside people. I never want to score a point—that is not my form. I think that we have made progress today and that we will make progress on other things in the new year, which I am looking forward to. Once again, I wish a merry Christmas and a happy new year to all of you and your families. I hope that we will see each other here on 5 January 2022.