Abortion Services Commissioning: Northern Ireland

Jim Shannon Excerpts

Tuesday 14th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate on an issue that is very close to my heart. I will replicate the opinions of my colleagues and of the hon. Member for Congleton (Fiona Bruce). I am my party’s health spokesperson. As a Northern Ireland MP—I was born and bred there and I still live there—I have listened to the views of those around me: of women and men; of young and old; of those who are affected by the meddling of this House in one area and cry out for help in other areas, only to be told that the issues are devolved. There is no justification for interference in the devolved settlement in Northern Ireland in this matter.

The Abortion (Northern Ireland) Regulations 2021 conferred egregiously wide powers on the Secretary of State to

“direct a Northern Ireland Minister, a Northern Ireland department, the Health and Social Care Board and the Public Health Agency to take any action capable of being taken that is required for the purpose of implementing the recommendations in paragraphs 85 and 86”

of the CEDAW report. The regulations note that the Secretary of State will have powers to direct any “relevant person” to take any action that they are capable of for the purpose implementing the recommendations in paragraphs 85 and 86 of the CEDAW report. It is not clear that Parliament intended to allow such wide-ranging powers to be created, given the obligations voted on in section 9 of the Northern Ireland (Executive Formation etc) Act 2019, which outlines such powers as applying to Ministers and Northern Ireland Departments only, while the 2021 regulations extend these powers to direct public health organisations.

That sets a dangerous precedent for commissioning on a devolved issue. There is no clear limit to the sweeping powers granted to the Secretary of State; they are potentially indefinite. The Northern Ireland Office states that

“the statutory duty imposed on the Secretary of State by section 9 of the NIEF Act is such that until all of the recommendations in the CEDAW Report are implemented in Northern Ireland, he will not have complied with his statutory duties in full.”

That is very concerning and very worrying. These are wide-ranging powers across a spectrum of issues that extends well beyond abortion. The list under paragraph 86 of the CEDAW report, for example, also includes sex education. The powers taken by the Secretary of State in the 2021 regulations allow the UK Government to override Stormont on devolved issues on an ongoing basis, even though the Assembly is functioning. We may not like all the things happening at the Assembly, but it is a functioning Assembly and it has a cross-section of political support in Northern Ireland.

Notably, consent for constitutional change is one of the fundamental principles of the 2005 St Andrews agreement, which restored the political institutions of Northern Ireland in July 2006. The radical abortion amendment to the 2019 Act has not received the consent of the Northern Ireland Assembly. Repeatedly laying these statutory instruments glosses over the deeper issues related to devolution and that abortion is devolved to Northern Ireland, but seemingly now in name only.

Abortion is an immensely sensitive issue in Northern Ireland, a place where both lives matter—both the life of the pregnant woman and the life of the unborn child, the baby yet to be born. It is an issue that crosses the bounds of political persuasion, class or creed. At the walk for life at Stormont, which I was happy to attend with my hon. Friend the Member for Upper Bann (Carla Lockhart), I stood shoulder to shoulder with nationalists, Alliance voters and Unionists alike. We rose above the politics because life matters, including the life of the unborn baby. I was thankful for the thousands and thousands who came out to respectfully plead that we did not implement the most liberal abortion laws in Europe, to no avail.

I respect the hon. Member for Pontypridd (Alex Davies-Jones)—she knows that, I spoke to her beforehand—and I want to be respectful to everyone because it is my nature to be so. With that in mind, I say this. The hon. Lady referred to consensus. First, back on 2 June 2020, 75 of the 90 Members of the Legislative Assembly demonstrated cross-community opposition to the imposition of abortion legislation that discriminated against those with non-fatal disabilities, including Down’s syndrome, and an absolute majority voted specifically against the imposition of abortion regulations that allow disability discrimination, as the 2021 regulations have done. Secondly, I am aware of a poll earlier this year that indicated that 60% of the people of Northern Ireland were against abortion on demand for any purpose. Those are two reasons why the consensus that the hon. Lady referred to does not hold up.

Thirdly, a poll by the University of Liverpool and Britain’s Economic and Social Research Council showed that only 5% of the public in Northern Ireland support introducing abortion up to 24 weeks, which is what the UK Government implemented through their regulations. Fourthly—my hon. Friend the Member for Upper Bann made this point, but it is important that I put on the record that I feel the same; it has never been contradicted, and indeed has been enhanced—it has been reported that an estimated 100,000 people would likely not be alive today had Northern Ireland been subject to the same drastic expansion of abortion legislation as the rest of the UK has experienced since the Abortion Act 1967. With abortion on demand, those people would not have jobs and would not be contributing to society. I thought that was a very salient tale of just how important that is.

In effect, it seems that abortion in Northern Ireland has become a reserved matter, predicated on the consent of Westminster, and by extension, the CEDAW recommendations, rather than a devolved matter of full legislative control as before 2019. In the last two days, from my constituents in Strangford, I have been contacted with some 400 emails on this issue—I say that honestly. How many emails have I had in favour of abortion in the last six months? Three. Three in favour of abortion, and 400 in the last few days. Indeed, in those six months, thousands spoke against it.

I want to reflect the opinion of those in Strangford and across Northern Ireland. I am very proud to represent everyone on this issue, and people do take the time to come and tell me their views. I have had nationalists come to my office who pleaded with me to stand firm against this most liberal abortion regime in the world. The case is clear. The majority are against abortion.

One of my constituents tells me that she emailed one Member of the House who has spoken out passionately, telling this House that she spoke for the women of Northern Ireland. I will not shame anybody, because that is not what I do, but my constituent, who wrote to that Member and asked her to represent her, is still waiting for a reply. There is a pick-and-choose when it comes to Northern Ireland that goes from Government right down to individual Members. I am not picking and choosing. I can speak with authority and say with certainty that the overwhelming majority of those who have contacted me are appalled at this legislation. They are appalled that the wishes of a cross-section of the Assembly have been ignored by the Government. They are appalled that the legislation means that a reason for taking a life at 27 weeks can be a cleft lip. Does anyone really think that that reason could be condoned legislatively or in any other way?

My hon. Friend the Member for Upper Bann speaks with passion, compassion and sense, and I commend her for that. My voice should not carry any less weight because I am a man. I speak for my constituents—male and female, young and old. I represent them very well, I believe, and I am fervently urging Members to consider what they are asking to be implemented expressly against the democratic will of the people of the Province.

There is coming a day shortly when the day-to-day business of Northern Ireland could well be the responsibility of this House, and all decisions could be made here, but not now and not at this time. Today is not that day. It is the place of the Northern Ireland Assembly to make a decision on abortion. It should be up to Assembly Members to respect them. They should be respecting the thousands upon thousands of my constituents who say that they do not want abortion on demand, that they want to speak up for the unborn and, above all, to respect life. The life of the unborn baby is so important to all of us.

Sickle Cell Treatment

Jim Shannon Excerpts

Wednesday 8th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mrs Miller, for giving me the opportunity to speak on this issue. I am my party’s health spokesperson and it is always a pleasure to speak on any health issue.

I was talking to a colleague about Stephen Pound, the former Member for Ealing North, who told me about this disease. He and I had a good, friendly relationship. I went to an all-party group event on sickle cell, and through Stephen’s introduction I perhaps gained some small knowledge of the disease. I want to speak today on behalf of those people who have sickle cell. We do not have it in Northern Ireland; thank the Lord we do not have it in Northern Ireland—[Interruption.]

[Mrs Maria Miller (in the Chair)]

Order.

[Jim Shannon]

I was just getting started.

[Mrs Maria Miller (in the Chair)]

There is a Division in the House. I am going to suspend the sitting for 15 minutes, and for 10 minutes for each subsequent vote, but may I encourage Members to return to this Chamber as soon as possible so that we can resume the debate and ensure that as many Members as possible can participate? Thank you.

--- Later in debate ---

[Mrs Maria Miller (in the Chair)]

Order. If the next break is 15 minutes long, and we have just one break, we should complete this debate at around 5 o’clock. Can Members bear that in mind?

[Jim Shannon]

I will not repeat what I have already said; I will not take more than four or five minutes, and then I will give other Members a chance to speak. I was referring to Stephen Pound, the former Member for Ealing North, who introduced me to sickle cell and understanding that process. This happened around the time that the daughter of one of my staff members had taken ill—she lives over here. I am not smarter than anyone else when it comes to health issues, but I just happened to say to my staff member, “I hope she hasn’t got that sickle cell.” From what I understand, she could not have had it. However, she did have primary biliary cholangitis; this is a lifetime health issue—a forever illness. It was just because at that time, I had been made aware of sickle cell, and I wondered if there was any connection.

Sickle cell can affect anyone, although it is more common in people from African and Caribbean backgrounds. The National Institute for Health and Care Excellence estimates that there are currently 12,500 to 15,000 people with sickle cell disease in England, while data from NHS Digital shows that there were almost 25,000 hospital admissions in England in 2020-21 where the primary diagnosis was sickle cell disorders. It is very clear that there is a significant issue when it comes to sickle cell. I commend the right hon. Member for Wolverhampton South East (Mr McFadden) for introducing the debate and raising awareness of the condition—I should have done so at the beginning; apologies for not doing so—and I support all the other speakers who are here today.

A stem cell or bone marrow transplant is currently the only cure for sickle cell disease. Neither are commonly undertaken in sickle cell patients. The US National Heart, Lung and Blood Institute notes that a

“well- matched donor is needed for a patient to have the best chance for a successful transplant”.

In the introduction to sickle cell given to me by Stephen Pound, that was one of the things that we looked at in relation to transplant issues. However, most patients who have sickle cell disease are either too old for transplants, since the risks associated with transplants become greater as a person gets older—and the older someone gets, the less they may want to receive one—or they do not have a relative who is a good enough genetic match to be a donor.

There are many issues that need to be resolved. After reading the APPG on sickle cell and thalassaemia report into the quality of care received by sickle cell patients, “No One’s Listening”, my heart went out to those people who quite simply feel abandoned—many people do. How do we improve that? The Minister and I are good friends, and I know that, when asked for help with this issue, she will come back with a response that the right hon. Member for Wolverhampton South East, and others, will be happy with.

The key findings of the report are a true indictment of the current state of play for sickle cell sufferers. Evidence of substandard care for sickle cell patients, either in a general ward or attending an accident and emergency department, including a widespread lack of adherence to national care standards, is unacceptable, as is the fact that there is clearly a low awareness of sickle cell among health care professionals. There are examples of inadequate training and insufficient investment in sickle cell care. In the Minister’s response, can she give some indication of how that can be improved, so that awareness can be raised and sickness levels addressed?

Many sickle cell sufferers feel that they are not getting answers. That is not a criticism of Government, but if we indicate that there is a problem, as we are doing through this debate, and there is a way of curing that problem, let us do that. There is a clear breakdown that must addressed, not simply clinically, with treatments being made widely available, but further with the training of medical staff and teams to understand this disease and its other medical contraindications.

Those are the issues that we are looking to the Minister to address. I support the right hon. Member for Wolverhampton South East and his attempt to highlight this plight, as he and other speakers have done so well—that will continue in the following contributions. They have not simply highlighted the problem, but pushed the Government and the Minister for action to begin the steps to rectify our current approach.

--- Later in debate ---

[Bell Ribeiro-Addy (Streatham) (Lab)]

It is a pleasure to serve under your chairship, Mrs Miller. I congratulate my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) on securing this debate and on his sterling work as the chair of the sickle cell and thalassaemia all-party parliamentary group. I also commend my neighbour, my hon. Friend the Member for Vauxhall (Florence Eshalomi). She always speaks with such affection about her mother, and I hope that she knows that her mum would be so incredibly proud of her if she were alive today.

The APPG’s landmark report, which was triggered by the tragic and avoidable death of Evan Nathan Smith in North Middlesex hospital, reveals the terrible truth of sickle cell treatment: the substandard care, the stigmatisation and the lack of prioritisation of this condition. As an officer of the group, I was pleased not only that the report came out, but to be able to give evidence as somebody who cared for someone with sickle cell—as someone who lost a loved one, my friend Adjuah, to negligent care. I sat with her through many hospital admissions, and I witnessed mistakes and mistreatment. She said to me on more than one occasion, “One day this hospital is going to kill me,” and one day it actually did. I hope that the Minister has read the report, has taken into account its many recommendations and will outline what steps the Government will take to improve the treatment of sickle cell and the overall experience of sickle cell patients in our national health service.

I also hope that the Minister will touch on what steps the Government will take specifically to improve the treatment of black sickle cell patients. Unfortunately, for those of African and Caribbean heritage, the experience of sickle cell is made far worse by the prevalence of institutional racism. In several past debates and in various inquiries, reports and personal accounts, we have heard how racist attitudes have a negative impact on a patient’s healthcare and experience: lack of research, which is certainly a major issue with sickle cell; biased perceptions of pain tolerance, drug habits and medical knowledge; and experiences of overt racism. All of that makes the experience of living with any condition difficult, but it makes living with sickle cell even harder.

When we talk about institutional racism in the NHS, we are sometimes met with Conservative Members saying, “Why are you calling our NHS staff racist?”. We are not calling NHS staff racist; we value our NHS staff. We are recognising that the institution of the NHS, which is governed by the Government, has issues when it comes to race, and that the policies and practices create biases that cause us problems. We want to know what the Government are doing about that.

Sickle cell is often referred to as an invisible illness, because of how the pain is experienced—often it is invisible to others. However, there is also a distinct lack of education and public awareness of the condition and the symptoms. I point specifically to the issue of education. I studied biomedical sciences and specialised in cellular pathology as an undergraduate. Because of the amount I knew about sickle cell before I went to university, I was struck by just how much it was used as an example but just how little those teaching me knew about its practical aspects. If we do not improve the education of those who treat people, we are never going to improve the outcomes. That definitely needs to be looked at.

The recent removal of discriminatory blood donation restrictions on black donors was a massive step in the right direction, which I really welcome. The largest beneficiaries of the change will be those patients who are often treated through blood transfusions and need rare blood subgroups, such as Ro, that are more common in black people. I have that blood group, so I give blood. Blood donations have gone down rapidly during the pandemic, but they are needed no less at the moment. I encourage all people from the black community, and from all communities, to give blood. I would love to see a blood donation stand in Parliament one day; there are so many of us here, and we should all be able to roll up our sleeves and give a pint or two.

[Jim Shannon]

I think that the Government have been keen to have blood donations, and the hon. Lady has very kindly volunteered and has been donating. She could perhaps be a poster lady for the campaign. Maybe the Minister will take that on board.

[Bell Ribeiro-Addy]

I thank the hon. Gentleman for his contribution, and look forward to seeing him roll up his sleeve as well.

Maintaining those discriminatory blood donation rules for so long was really poor. They were based on outdated HIV science and denied thousands of black sickle cell patients the treatment that they needed, but not only that; the legacy of those rules resulted in a reluctance among the black community to come forward to donate blood. The restrictions have resulted in a shortage of black blood donors and have had a severe effect on the willingness of the black community to donate overall. We have to undo that damage.

I call on the Minister to promise all of us here, and those who are keenly watching the debate, that the Government will act to improve the quality of care and treatment of sickle cell patients. Words are good, but action is better. My hon. Friends have touched on prescriptions and the barriers to receiving proper care. We want action on that. Those watching the debate at home do so in eager anticipation of something that will give them hope of better treatment. I sincerely hope that the Minister will not let them down.

Covid-19 Update

Jim Shannon Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

I am sure that my hon. Friend will agree that the best support we could provide for the transport sector right now is to remove these recent restrictions. I am confident that, as we learn more about this variant and if, as is expected, over time it becomes the dominant variant, we can start removing those restrictions very quickly.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement, and I believe his response reflects the seriousness of the current covid disease levels. Has there been any opportunity to speak directly to the Health Minister in the Northern Ireland Assembly to ensure that the regulations put in place here in Westminster may be considered for Northern Ireland, so that all regions of the United Kingdom of Great Britain and Northern Ireland can together combat and defeat the latest omicron variant?

[Sajid Javid]

We do work very closely together across the Union, and I have regular contact with my counterpart in Northern Ireland. I have not been able to discuss these particular measures with him today, but I know that we will do so shortly.

Asthma Outcomes

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Steve McCabe (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate. This is in line with current Government and House of Commons Commission guidance. Members are also asked by the House 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 in the House 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 asthma outcomes.

Thank you very much for calling me to speak, Mr McCabe. This is an issue that is close to my heart and close to the hearts of others here. There are few families in the whole of the United Kingdom for whom asthma has not been a key issue; it has been an issue for my own, and I want to speak about that as well. I am grateful to the Backbench Business Committee for agreeing to have the debate. I am chair of the all-party parliamentary group for respiratory health, which recently completed an inquiry into this issue, so I am delighted to be able to raise the issue of improving asthma outcomes in the UK. I very much look forward to the response from the Minister. I am also very pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place, and I wish her well in her new role.

What does asthma mean to me? My second son, Ian, had asthma. He was born with very severe psoriasis, which meant that we had to apply cream to him three times a day when he was a wee boy. The doctor told us that the psoriasis would eventually go away, but that it would be replaced by asthma. I am not sure of the medical connection—I am not medically qualified to understand it—and I know only what the doctor told me and my wife. Ian has had asthma all his life now—he is 30 years old—and has used salbutamol, the wee blue inhaler, which is always there. It is very clear, from our family’s experience, that those salbutamol inhalers are really important. They are important for Ian. Asthma did not stop him participating in sports, but it meant that he always had to have that inhaler close by, should he at any time feel shortness of breath or need a wee helper.

In Ian’s class at school, there were many others who had asthma issues. As an elected representative, whenever I help constituents with benefit forms, whether for attendance allowance, personal independence payments or whatever, I always ask them about their medical circumstances. More often than not, asthma features among the ailments that they confirm they have—even for those of a different generation. They have often had it for many years. Asthma is an incredibly important issue.

I am pleased to see the Minister in his place. I always like dealing with him, because I always find his answers helpful. He has a passion for the health issues that we bring to his attention, and he always tries to give, and indeed succeeds in giving, the answers that one wishes to receive. Today, we are going to ask a number of questions, and we very much look forward to his responses. I am pleased to see hon. Members in their places. I had hoped that more Members would be able to attend, but I understand that last night was a late night for Members and that there are other pressing matters today.

I have always had a particular interest in respiratory health. This debate has arisen as a consequence of the APPG’s report, which we published last year: “Improving asthma outcomes in the UK”. We looked at the UK mainland, but we also had contributions from Scotland, Wales and Northern Ireland. Obviously, I bring the Northern Ireland perspective to any debate, wherever it may be about, and bring in Strangford too. I am my party’s health spokesperson in this place, and I work closely with my colleagues back home in the Northern Ireland Assembly, particularly with Pam Cameron, my party colleague. She and I work on many things together, including this topic.

Last year, the APPG produced a report investigating the reasons behind the UK’s poor asthma outcomes. We were pleased, honoured and humbled that recognised experts in fields relating to asthma responded to our invitation to take part. The experts ranged from clinical experts from primary, secondary and tertiary care to patient advocacy groups, national asthma champions and patients.

The inquiry was incredibly helpful and detailed. I thank Hugh McKinney of the APPG secretariat and his team for bringing together all the people who wanted to contribute. As a result of the inquiry and the report, many countries in the world now look towards us to learn about how we deal with asthma. They want to learn something from us here in the United Kingdom, and perhaps do things that wee bit better.

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

I congratulate the hon. Member on securing today’s debate. As with most conditions, research and development is key to improving outcomes. Does he agree that funding into asthma research must be provided from a clearly defined central source and that there must be increased capacity for trials in hospitals?

[Jim Shannon]

I absolutely agree with the hon. Lady. No matter what the sphere of health, early diagnosis and attention is key. Indeed, my son is an example of that, as a child born with the ailment. There was early participation in his treatment by the doctors, including our own GP and those in the hospital. It is clear to me that that helped him on the pathway to better health. The hon. Lady is absolutely right and I thank her.

We received a large number of written submissions, including evidence from across the numerous asthma disciplines. We were encouraged that there was such a high level of interest. The APPG tries to do a catch-up once a month with stakeholders and those with medical expertise. Each month, we aim to hear from between 16 and 20 people who have an interest in the subject. They bring all their information to us, which we are pleased to have. We were incredibly encouraged that there was such a high level of interest, and I thank every one of them for their help and expert advice.

Let us consider the impact of asthma on people in the UK. The number of people affected by asthma in the UK is among the highest in the world, with some 5.4 million people sufferers. I had never done an interview with GB News until yesterday morning, but they were interested in this debate and a former colleague in this House was the interviewer. It was nice to catch up with Gloria de Piero again in her new job, and it was a platform and an opportunity to raise awareness and the questions were clear. That figure of 5.4 million people suffering from asthma came up early on in that interview.

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

I congratulate my hon. Friend on securing the debate. On raising awareness, will he join me in congratulating and commending so many of the voluntary groups, particularly those working with issues around chronic obstructive pulmonary disease? I can think of one such group in my constituency, in the Causeway area, that highlights these matters and draws attention to them in the wider community, in order that there is greater awareness across society to try and help people cope with that debilitating condition.

[Jim Shannon]

I thank my hon. Friend and colleague for that point. He is right that there many charities and volunteers, as well as many people who have the disease. A great number of people have expertise, interest and keenness to help and assist them. COPD is one of the most debilitating diseases that I have ever seen. I never realised just how many people in my constituency suffer from COPD, but there seem to be a large number, some of whom are in the advanced stages of a deterioration in health. I have a very good friend who is an artist; we have been friends for many years. He is interested in rural and country sports, as I am, which is where our friendship came from. Today, he is completely dependent on oxygen 24/7 and rarely leaves the house. For a man who was active and fit, COPD has changed his life dramatically.

Some 65% of people with asthma do not receive a yearly review—I am keen for the Minister to respond to that—despite recommendations by the National Institute for Health and Care Excellence that they should. I respectfully ask the Minister, if they are not getting a review, why not? Asthma has an impact on every patient’s quality of life. A recent pilot study for Asthma UK showed that the impact can be considerable: 68% said asthma attacks hold them back from work in school; 71% said severe asthma affects their social life; 54% said it holds them back from going on holiday; and 66% said severe asthma has made them or their child anxious. When the child is anxious, the parent is anxious—we all worry about what happens. The study also found 55% said having severe asthma has made them or their child depressed. The issue of depression and mental health has come up during the difficulties we have had with covid over the past year and a half.

Asthma deaths in the UK have increased by one third over the last decade. Three people in the UK die from asthma every day, which is among the highest in Europe, yet studies show that more than two out of three asthma deaths could be prevented. Three people die every day and if we had the right things in place, we could save two of those three lives every day in the UK. I put that challenge to the Minister, who I hope will give us the confident and positive reply that we would like to see.

[Margaret Ferrier]

Air pollution can trigger asthma attacks, and it is believed that it is linked to the rise in childhood asthma. Does the hon. Member agree that tackling air pollution could also bring public health benefits?

[Jim Shannon]

I absolutely agree. The hon. Member is making points that we all agree with. I am glad she has brought that to my attention. I come to London to work and am aware of the air pollution and the steps that the Mayor of London and others that are taking to try to address that, by restricting the number and type of cars coming in. As the hon. Lady rightly said, people have died in London from air pollution and we must address that. In large metropolises and population clusters, where vehicles and the economy are concentrated, air pollution is important.

I am fortunate to have lived in the countryside all my life. It means that when I go out of my back door there are green fields and the neighbours are about half a mile away, so there is a distance between us as well. However, some 14,000 vehicles a day pass by us on the road—the A20 from Ards to Portaferry—which, by its very nature, shows where the problem is.

Asthma exacerbations lead to over 77,000 hospital admissions each year. It is estimated that asthma leads to a direct cost to the NHS of £1 billion and an indirect cost to society of £1.2 billion due to time off work and loss of productivity. This goes back to the intervention by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) when she referred to early diagnosis which can stop people losing work days and reduce the cost to the NHS. These factors cannot ignored be when it comes to addressing the health issues and helping to balance the books.

This year, the APPG’s intention was to produce a one-year-on report to highlight and emphasise the tremendous work that has been carried out by all those working in asthma. We intended to highlight the progress that has taken place in the past year, the actions of the Government, and any further areas that needed to be reconsidered. Our job will be to continue to note the progress—it may not be the progress we would like to see—and speak to the Minister to see how we can change that. However, covid changed everything. It changed our thinking dramatically. It has had a devastating effect on many lives and has impacted on asthma care. It affected the scope of our latest report, as well as concentrating on asthma outcomes one year on. We have also looked carefully at the impact of covid on respiratory health and asthma in particular.

I have the greatest admiration and respect for all those working in the NHS during these difficult times, especially those in respiratory health, which has been the hardest hit. They are all heroes—that word is used often, but it is true here—and a credit to the profession and the NHS. We are grateful and thankful to them all.

In the past year, covid has had an impact on those with asthma, COPD and the complex health needs that can sometimes be exacerbated by covid, leading to further difficulties. The past year has been difficult for every one of us. We have probably all lost loved ones to covid. In October last year, we lost my mother-in-law, who had complex needs. Covid took her, and we still miss her.

Today, I want to concentrate on the three critical issues identified by the clinical advisers who addressed our inquiry and shared their expertise and evidence. The first issue is the overuse of salbutamol reliever inhalers. We are not saying that people should not have them. That is not what the inquiry said or what the APPG is saying. We are looking at the potential overuse of those inhalers. The second issue is the new unified asthma guidelines. Thirdly, we need better use of biologics.

Prior to the covid pandemic, responders to our inquiry last year identified the overuse of salbutamol inhalers—the blue, not brown, inhalers—and oral corticosteroids as the biggest area of concern and the most important cause of exacerbation and unnecessary asthma deaths. In our report, the APPG also cited numerous studies that have shown that over-reliance on salbutamol may lead to the reduced use of preventer inhalers and to a greater risk of preventable attacks. Regular overuse has also been shown to increase the risk of asthma attacks, hospitalisations and deaths. The Department of Health and Social Care needs to look at the overuse of medications and whether that may do more harm. The evidence in this case seems to show that this is one of those situations.

A recent study by the SABA use in asthma global programme—the SABINA programme—found that high use of such inhalers was frequent among UK patients and

“was associated with a significant increase in exacerbations”

and in reliance on asthma-related healthcare. It stated the need to align SABA inhaler prescription practices with current treatment recommendations.

Some 22.5 million of these inhalers are dispensed to asthma patients each year, an average of five per diagnosed patient. Way back in 2019, before covid, and during one of the few times in my life I have had health issues, there was a week when I could not even come to Westminster, because the doctor told me it would not be safe to travel. My chest and breathing were at a level where he advised me not to travel. At that time, I was on the blue inhalers. I think I had three over that 11 or 12-week period. I may have had a wee bit too much, although I did not realise that at the time. That is one of the issues highlighted by the inquiry.

Patients using excessive numbers of inhalers should be flagged, identified and immediately seen by an asthma-trained clinician. I bring it to the Minister’s attention that we think it is time to rethink asthma treatment and get this right for patients and constituents across the United Kingdom of Great Britain and Northern Ireland. There are innovative approaches that demonstrate SABA-reduction.

A 2018 study in The Lancet suggested a maintenance and reliever treatment, with a combination steroid and long-acting beta-agonist, which would allow SABA-free treatment. That could be an effective way to reduce SABA overuse among patients, where clinically appropriate. As ever, it must always be done in consultation with and under the guidance of your doctor and those with health expertise.

The Sentinel project undertaken in Hull and East Yorkshire improved outcomes for adult asthma patients by identifying SABA over-reliance and appropriate implementation of a MART strategy. There is a pilot scheme, which could be the marker, the guide, the standard, the level for the rest of the United Kingdom. Data from that pilot Sentinel study demonstrated that MART can substantially reduce the SABA prescribing.

To ensure that that happens, it is important to restore the asthma reviews, which were hit badly by covid. It is time, ever mindful that covid is our priority, to look at the other issues in the United Kingdom, and asthma is one of them. Asthma UK’s latest annual survey showed that 66% of people with asthma are not receiving basic care for their condition, and that that level has fallen, for the first time in eight years. Minister, what has been done to address that fall? How can we do it better?

An annual asthma review is an important component of addressing that. I should be grateful if the Minister would update us on the progress that has been made on restoring the annual reviews. When we are responding to health issues in the United Kingdom we often need data, so it is important to have that in place.

We also suggested in our APPG report that primary care incentives might be necessary to drive the reduction of SABA use. We stated that the QOF—quality and outcomes framework—or the investment and impact fund have the potential to help with that. The patient pathway is also an important method to reduce SABA use, which brings me to my second point—the new unified guidelines.

Last year, in our inquiry, we analysed the challenges faced by clinicians in treating severe asthma. We found that almost all the experts identified the existence of multiple asthma guidelines as confusing, unnecessary and a cause for concern. If they are confusing to experts, and therefore for our constituents and patients too, we need to have a singular approach. Again, I look to the Minister for a response.

The Royal College of Physicians told us in its submission that

“national audit data collected from England, Scotland and Wales indicates that the standard of care against national guidelines (NICE and BTS) and recommendations from NRAD are variable and on the whole substandard.”

There is a need to get things right and singular. As a consequence, the APPG strongly welcomed the commitment to and the ongoing work to produce unified guidelines as a necessary step forward to improve asthma outcomes. We felt that it was especially important for our time-stretched clinicians that all guidelines on asthma should be in one place.

The unified guidelines were delayed due to covid, but are due in 2023. Our main concern, however, is that we understand that the draft scope for the new unified guidelines does not include severe asthma. I bring that to the Minister’s attention, because we feel it should. Perhaps the Minister will give us some indication of what will be done to address that, because that appears to me to be a serious omission, and others will agree.

It is unclear how any guidelines could be described as “unified” when the most serious type of asthma is not included. I have a concern, a question mark in mind, about that. It is especially puzzling when we consider that the existing NICE, British Thoracic Society/Scottish Intercollegiate Guidelines Network, Global Initiative for Asthma and NRAD—national review of asthma deaths—guidelines all give similar criteria for referring a patient for severe asthma.

If severe asthma is excluded from the scope of the unified guidelines, the concern is that newer treatment options will not be addressed properly, which takes us back to the intervention by the hon. Member for Rutherglen and Hamilton West. This is about early diagnosis and treatment at an early stage. If we do not get that right, we will have complications and problems later.

Those newer treatment options include the use of biologic treatments and the latest best practice in phenotyping, which were strongly recommended by both clinicians and severe asthma patients in our inquiry. The long-term plan states:

“We will do more to support those with respiratory disease to receive and use the right medication”,

but without severe asthma included in the unified guidelines, that is unlikely to happen. How can we make that happen, rather than being unlikely? Will the Minister therefore give me, the House and those in and outside this Chamber the thinking behind that omission? What is the possibility of adding severe asthma back into the discussion? If we can retrieve that and bring it back in, I will be pleased. I also wonder what can be done while we wait for the new guidelines. Four sets of guidelines are confusing for clinicians. Surely it would be preferable not to wait until 2023 for clarity. We need to act today—for the three people who die every day due to asthma. That is the imperative. Is there any way that the Minister can reflect on that and give consideration to updated living guidelines to reflect current best practice and treatment?

Unified or updated guidelines can materially affect my third point on biologic therapies. They are life-saving treatments for people with certain types of severe asthma and asthma that is difficult to control. They can reduce asthma attacks in severe asthma, reduce the need for steroids and improve symptoms. At present, they are only offered to patients through the specialist asthma clinics. There was strong support in our report last year for the appropriate use of biologic treatments and we supported the extension of prescribing to secondary care clinicians for severe asthma patients. Many clinicians viewed the use of biologics as a better alternative to traditional oral corticosteroid treatment for severe asthma and we received evidence that a large majority of patients who are eligible still do not have access to them.

Asthma UK suggests that

“82% of difficult and severe asthma patients are often not being referred at the right time, or sometimes, not at all.”

That is hard to believe. Asthma UK and BLF also told us that the current NHS asthma care pathway does not take full account of the availability of the new treatments. So most people with severe asthma are still reliant on OCS. According to Asthma UK, three in four people eligible for biologic treatment are still not accessing it and thousands of patients are having to endure treatments that are considered inadequate and suffer unnecessary side effects.

That is linked to the Government’s five highest health gains programme, which introduced a commitment by the UK to match or surpass comparative nations in the access to new and innovative medicines in five clinical areas, one of which is severe asthma biologics. The scheme committed to the objective of

“reaching the upper quartile of uptake for 5 highest health gain categories”

during the course of the first half of the scheme, by mid-2021. We applaud the Government’s initiative and action on that to date, but the deadline has clearly been missed. New data commissioned by NHS England has shown that the UK is far from the upper quartile and confirms that we are currently ninth out of 10 with regard to comparator countries. We must improve that. We must get better and do that for our patients. We also recommended extending the Accelerated Access Collaborative’s severe asthma programme, and increasing resources to increase capacity for prescribing biologics will be important for achieving that. Will the Minister give a renewed commitment to achieving upper quartile access and set a new, clearly defined target for when and how that will be achieved?

In October 2021 the Government announced 40 new community diagnostic centres, which are set to open across England in a range of settings, from local shopping centres to football stadiums, to offer new and earlier diagnostic tests closer to patients’ homes. I want to put on record my thanks to the Government and the Minister for that commitment. It is clearly there and we thank him for that. However, we cannot make it a postcode lottery. If it can happen here in London, it should happen in Cardiff, Newcastle, Liverpool and everywhere else. Nowhere should be any different, so I would like to see that happening.

The Government have stated that the new centres will be backed by a substantial amount of money—a £350 million investment—and will provide around 2.8 million scans in the first full year of operation. They are designed to assist with earlier diagnosis through faster and easier access to diagnostic tests for symptoms in areas including breathlessness, cancer and ophthalmology. In the Budget, the Chancellor announced an additional £5.9 billion to tackle the backlog of general diagnostic tests to deliver more checks, more scans and more treatment. The intention is to increase the number of diagnostic centres to at least 100 and I understand that each one will include a multidisciplinary team of staff, including nurses and radiographers, and will be open seven days a week. The Government and the Minister are to be commended for that, and I warmly welcome it and the funding that will be allocated. I hope they can help address the covid-imposed inequalities that we have seen across the country in asthma care and treatment. Will the centres be fully staffed, will they have trained staff and will they be in place?

I also welcome the breathlessness diagnostics, which will be included in the centres. It is essential that they should be equipped to diagnose any cause of breathlessness, whether cardiovascular, lung cancer, asthma or chronic obstructive pulmonary disease, which my hon. Friend the Member for East Londonderry (Mr Campbell) mentioned. It is also important to establish an appropriate referral system from the centres, should further investigation be warranted. Will the Minister confirm that the FeNO and spirometry tests will be included in all centres, to allow for fuller asthma assessments?

I look forward to the contributions from other Members, and I thank those who intervened on my speech. I very much look forward to the Front-Bench contributions, particularly from the Minister.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

[Jim Shannon]

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

[Edward Argar]

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their immense contributions and incredibly helpful comments. I think we all spoke with a united voice, from all parties and all parts of the Chamber. I believe we got an excellent response from the Minister and a commitment—even though asthma is not in his direct portfolio.

My hon. Friend the Member for East Londonderry (Mr Campbell) referred to volunteers and charity groups. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to air pollution, as others did. The hon. Member for Loughborough (Jane Hunt)—also a Leicester City supporter, though we lost on Saturday, but that is by the way—referred to prescription charges. The firm that she mentioned contacted me as well, and I am pleased that the Minister was able to respond to her questions. The hon. Member for Blaydon (Liz Twist) brings a vast amount of knowledge of and interest in this subject. She referred to quality of life, mental health issues and how biologic therapy is needed.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), a friend and the SNP spokesperson, spoke about her personal experience of asthma. It is also pleasing to have so many Members present to support the shadow Minister taking her place for the Labour party, the hon. Member for Enfield North (Feryal Clark). Certainly; she has had an exceptional debut as the shadow Minister in Westminster Hall. I was pleased with her contribution, which encompassed all our thoughts and ideas, notably the effect of air pollution and how treatment for severe asthmatics is not in place.

I thank the Minister so much for his response. He gave us the details and told us about the 2023 target, but we will try to do better. He referred, too, to consideration of the annual review and to the unified or joint guidelines to be agreed. There is much to be encouraged by in his response. With that in mind, I thank all hon. Members for their contributions. Here is a battle to be fought; we are about to fight it.

Question put and agreed to.

Resolved,

That this House has considered asthma outcomes.

Antimicrobial Resistance

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

You are most kind, Sir Gary; thank you very much. I am not sure about the pure gold, but I will certainly do my best to make my contribution to the debate. I congratulate and thank the hon. Member for Thirsk and Malton (Kevin Hollinrake). He is not only an hon. Member but my friend, and has been for all the time we have been together in the House. We have spoken on many issues together, so I am pleased that he has brought this subject forward.

I have an interest in this issue, probably because of my constituency. I will start with a comment from back home. This is not only a UK-wide issue but a global issue. As Northern Ireland’s chief medical officer, Dr Michael McBride, said:

“As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.”

If that does not shock hon. Members or sound horrific, it should. If hon. Members thought the covid-19 pandemic was their worst nightmare, with all its repercussions and problems and horribleness, I suggest that this debate has the potential to be their even worse nightmare. Will I be here in 2050? It is highly unlikely, but many others will be, so we should ensure that what we do today will be sufficient to protect those of tomorrow—my children, my grandchildren and, whenever they come, my great-grandchildren.

The rise in antibiotic-resistant infections is of real concern: England saw 90,000 hospital admissions because of such infections in 2019-20 alone. There is a real problem, and we need to act now, as right hon. and hon. Members have said. There is a rising tide of antibiotic-resistant infections. We have to do something.

I declare an interest as a member of the Ulster Farmers’ Union. I have acknowledged on the record the need for investment in agriculture in the effort to tackle antimicrobial resistance from every angle. The Ulster Famers’ Union said:

“As a farming industry, we are committed to playing our part in reducing antibiotic usage and resistance. Significant progress has already been made in the pig and poultry sectors, which have seen their usage fall by over 50% and 80% respectively. Historically, those working with cattle are smaller users of antibiotics but there are improvements that can be made.”

I welcome that commitment from not only the Ulster Farmers’ Union but the National Farmers Union here on the mainland; it is a joint operation. We should support the clear commitment by the farmers unions to do these things and take this action.

[Kevin Hollinrake]

The hon. Gentleman is making a very good speech, and he makes a good point about the pig sector. I am sure he will be aware that the reduction in antibiotic use in the pig sector has not affected yields at all, which demonstrates that things can be done more sustainably, and can be better for the environment, without affecting the economics of farming.

[Jim Shannon]

The hon. Gentleman is absolutely right. The farmers unions welcome these things because, first, they are the right things to do, and secondly, because they do not affect the profitability of the sector or the industry. We need to try to reinforce that.

My constituency has only two or three pig units—one is fairly big, by the way—but a big poultry sector, which has made significant moves towards those things. I live right in the middle of a farm. All my neighbours are dairymen or have beef cattle or some sheep, and they told me that they are careful about what antibiotics they give their animals because that is the right thing to do. Who led the way on net zero targets from the farming sector? The National Farmers Union. It did not have to be coaxed to do that; it was happy to do it. Those are some good things.

It is clear that the farming community is stepping up to the mark and that we in this House need to do more. We need to get the message out that antibiotics are a last line of defence. We must allow our bodies to do their work against viral infections, which antibiotics cannot hope to address. I do not take antibiotics often, but I had to in 2019 because I got a bad infection, and those worked well to clear up my chest infection. Researchers at the University of Limerick found that GPs often felt pressurised into prescribing antibiotics, particularly for fee-paying patients in both in and out-of-hours situations, despite being aware that antibiotics were inappropriate for treating non-bacterial infections. Can the Minister provide an idea of what GPs and consultants do in relation to that and why it is important to get that right and not to be pressurised into giving those out?

GPs need our support and a clear message needs to be sent. We need to ensure that the message is simple: that it is a matter of life and death. Antibiotics are the last of our steps to take and only if we hold them as sacred will we ensure they can still work effectively and save lives. At the end of the day, that is all we want.

Adult Social Care

Jim Shannon Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Of course I am trying not to be too disappointed by the reactions of Opposition Members; I did not really expect an awful lot more.

Areas such as Sutton Coldfield and Surrey are expensive to live in, and we need to recognise that. Most of us, when asked about our future care arrangements, would say that we would like to stay in our own homes, and we want to make that possible. There is a great deal of technology that will help, but it is also important to adapt more supported housing and to work with local groups to deliver the right approach for the right areas, and that will include local hospitals as well.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her statement, and for the progress that she is clearly trying to achieve.

Workforce availability for care homes is vital. Today a representative of a care home bordering my constituency rang to say that a quarter of its staff are off work owing to close covid contacts, although they are now treble-jabbed, and it has no more staff and a lack of agency staff to employ. What can be done through this strategy, Minister, to ensure that the recruitment and retention of care workers are improved?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I cannot believe that the hon. Gentleman said “Minister” again. I thought that he was beginning to get it, and that he would not make me unhappy any more!

[Jim Shannon]

I should have said “the hon. Lady”.

[Madam Deputy Speaker]

I thank the hon. Gentleman very much for that. I can say “Minister”; it is the hon. Gentleman who cannot. Minister!

Public Health

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

I reiterate that I cannot speak for other people. I am setting out the measures today that we implemented this morning in a timely fashion, and it is those measures that we are considering. From the Government’s point of view, that is the legislation that we are implementing.

[Jim Shannon (Strangford) (DUP)]

I support what the Minister is putting forward. What happens here will happen in Northern Ireland, as the Minister in Northern Ireland has said that he will follow the instructions and guidelines from Westminster. We are aware of the variant and we are aware at this stage that our vaccinations may be enough to combat it. If we hand wash, distance and wear a mark, surely we cannot do anything other than support the measure. Does she agree that other hon. Members should adopt the same attitude?

[Maggie Throup]

I speak for myself in saying that I have changed my habits with regard to hand washing since the pandemic began, much to the detriment of my skin. We can take simple measures that have been put in place that have no impact on other people but help to protect us and others indirectly.

NICE-Approved Products: Patient Access

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I rise to address the challenging issue of access for patients to medicines and medical devices. We all believe absolutely passionately that we should have access to doctors and nurses, good hospitals and operating theatres, but I think the pandemic has shown beyond question that access to medicines and medical devices goes hand in hand, and without that we do not have the NHS that I think we all believe everyone deserves.

What is the problem? The problem, I shall explain, is as follows. When a medicine is approved, it goes through two processes: first, with the Medicines and Healthcare products Regulatory Agency, which checks whether or not a drug is actually safe and does effectively what it says on the tin; and then it goes to a separate process run by the National Institute for Health and Care Excellence, which looks at cost-effectiveness and value for money. The theory goes that, once those two hurdles have been passed, the medicine is then accessible to anyone. It is very clear in the NHS constitution, which explains that there is a legal right for people to have NHS NICE-approved drugs if it is right for their particular circumstances. Indeed, the NICE guidelines say that there should be automatic adoption, if clinically appropriate and relevant, within 90 days of approval. So where is the problem?

The problem is partly in the system and partly in the words. The words in the constitution are effectively caveated: people can have a medicine if it is right for their particular circumstances. Likewise, according to the NICE guidelines, it will be automatically adopted if clinically appropriate and relevant. The challenge is that, in the current system, NICE will approve medicines for the condition for which they are most cost-effective, so in this country we do not have the ability to approve a medicine for multiple conditions—multiple indications, in the jargon. It is what is most cost-effective that gets approved, and others do not, and there is not a system, either than paying privately, to ensure that the medicine that has been approved for the condition for which it is most cost-effective is available to those with other conditions, but that medicine may in fact still be the only possible solution.

Assuming we get over that hurdle, there is a second hurdle, because not only must NICE have approved the drug, but it has to go on the approved list of drugs locally in the local health authorities—now integrated care systems. The problem is that to get on those formularies, somebody has to put it on those formularies. Currently, while in theory under the NHS NICE guidelines there is a system, it does not actually happen. There is currently a drug for multiple sclerosis, and research shows that people are still waiting after 150 days for it to go on the formularies in something like 25% of the local health systems across the country. So the system, fundamentally, does not work.

What does this result in? It results in a postcode lottery. If someone has type 1 diabetes, it is absolutely crucial that they monitor their condition. There is a device, a flash monitor, that is state of the art, and research shows that the uptake across the country varies between 16% and 65%. What is most worrying is that those parts of the country with the greatest levels of deprivation have the lowest levels of uptake. We all think we have access to medicines for cancer given that we now have the highly innovative and very welcome cancer drugs fund. However, that drugs fund is only relevant when the particular drug is approved for a particular type of cancer. So there will be some drugs—Avastin, for example—which those with the appropriate cancer can get through the CDF, but those with a different type of cancer or who do not fit the profile again have to pay for it privately, costing £252 to £1,088 per cycle, which is every three months.

Sadly, NICE does not approve much for those with skin conditions. For those with mastocytosis—blotches on the skin and boils causing vomiting and diarrhoea—the only solution is usually NICE-approved food allergy drugs, but they are approved for NICE allergies not skin conditions so they have to be paid for privately. For cystinosis, the accumulation of amino acids, which gives rise to kidney problems and kidney damage, the drug Procysbi has been approved by NICE but, bizarrely, there seems to be no uptake of that to date at all. That is important because that drug is, unlike the existing drug, a slow-release drug and therefore mums and dads do not have to keep waking up their kids in the middle of the night to give them the next dose, which, as we can imagine, takes a real toll on family life.

For those with an obesity problem there is a good solution in Saxenda, but that is approved for diabetes. So those whose obesity does not give rise to diabetes will not get access except by case-by-case approval. I am pleased to say that Imperial has finally accepted and approved.

How are we going to resolve some of these issues to make sure there is no longer a postcode lottery? First, let us look at the simple case of those drugs that are deemed to give the most health benefit and are therefore in theory approved and people can get hold of them. What can we do to make sure they do actually finally appear on those formularies and how can we then make sure the system for take-up is actually in place? One of the problems is that there is nobody sitting in these health bodies who monitors NICE drugs coming up, and therefore no one who looks to see whether in their health community they may be of benefit.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing a debate on this topic. As she says, this is about NICE-approved products as well as drugs. One of those products is cognitive rehabilitation therapy, an important intervention for those with dementia, enabling them to live independently for longer. However, despite being listed in the NICE recommendations there is a barrier to delivery. Occupational therapists and other staff in memory clinics do not have the capacity to deliver programmes that are National Institute for Health Research and Alzheimer’s Society-funded. Does the hon. Lady agree that the NICE recommendations must address not just drugs but also products?

[Anne Marie Morris]

I could not agree more. It is crucial to realise we are talking not just about medicines and drugs but also devices and, as the hon. Gentleman says, the processes, which are often the connection between the medicine, the device and the patient.

Within these health bodies, there is no training and nobody specifically focused on monitoring innovation, and there is no obligation to prescribe. Even more peculiarly, for these drugs there is an agreement between the industry and the NHS, the voluntary payment scheme or VPAS, under which manufacturers that are members of the scheme effectively agree with Government when the medicine or device is approved that it will be supplied at a well-discounted price. In addition, there is an agreement that sets a cap so that if, as it happens, more prescriptions are written for that particular drug, it is agreed that the extra cost that the NHS has incurred will be reimbursed by the manufacturer.

So if there is excessive prescribing—we assume that is why there is an attempt to limit how much goes on to formularies—why is that a problem when we have the VPAS scheme? It is a problem because the scheme does not the pass the benefit, other than the reduced price, down to the local health authority. The money is put into a separate pot, and that pot is then used generally to support the NHS writ broadly; it is not ringfenced, either for medicines or to be used, as it could be, to support local health authorities—integrated care systems—when their budgets are put under pressure, which is why they do not want too many things on their formularies. This would help them pay the price.

It seems to me, Minister, that there are some solutions here. You will be aware that I raised three of them in proceedings on the Health and Care Bill. To deal with the imperfections of the current arrangements, if those drugs that were approved by NICE—we are talking about the most cost-effective drugs—were mandated to be on formularies within 28 days automatically, so no one had to decide whether they went on or not, that would be a good system. It would also ensure that the decision was in the hands of the clinician and not of the bureaucracy of the health authority.

It seems to me, Minister, that the second suggestion I made—

Covid-19 Update

Jim Shannon Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

First, I noted what my hon. Friend said about walk-in access in Hampshire, so I will take that away and get back to him. Secondly, he is right to talk about the impact of these measures. Although I believe that they are right, proportionate and balanced, we must never forget the impact that they have on individuals and their daily lives. That is why they must be removed the moment it is safe to remove them. In terms of when we will have more data, we have set a three-week review point because that is the time when we believe that we will have more information—not just the information that we will have come up with, but information through our international counterparts.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State and his team for all they do to combat covid-19 in the UK. This has an effect on Northern Ireland; the Northern Ireland Health Minister said yesterday that Northern Ireland will follow the guidance that comes from Westminster. With that in mind, having heard a leading Northern Ireland scientist say this week that he believes that the current vaccination and booster roll-out will have an effect on the new variant, will the Secretary of State assure us that any and all curtailments, such as those faced by the travel industry, will be proportionate and scientific, taking into account transmission and the seriousness of the new covid variant?

[Sajid Javid]

Yes, I can give the hon. Gentleman that assurance.

Access to Salbutamol Inhalers

Jim Shannon Excerpts

Monday 29th November 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Hosie, for giving me the opportunity to speak in the debate. I am very pleased to see the Minister in her place, and I am convinced that I will get a decent response from her on the issues I raise. I think we are all convinced of that, and I look forward to her contribution. I thank the hon. Member for Don Valley (Nick Fletcher) for setting the scene so well, as he always does, on a matter that is of some interest to me.

I am the Democratic Unionist party’s health spokes- person at Westminster, so I want to be involved in these issues. I am also the chair of the all-party parliamentary group on respiratory health, so this is a topic in which I have a particular interest. As the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) said earlier, we will have a debate on asthma next week, and it could well be that the Minister will respond to that debate as well—I suspect that she will.

Why am I interested in this issue? As I said, I am my party’s health spokesperson, but also my second son Ian—he is a young man of 30 now, so this is a long time ago—was born with a combination of asthma and psoriasis. The doctor informed us at an early stage that the psoriasis and skin problems that he had would diminish as the years went by, but that his asthma could increase. In a way, that is probably what has happened. He takes an inhaler with him every day and manages to control his asthma. It is a very personal matter for our family, as it is for many others. When I am in my office, which is very busy—everybody’s office is busy—I get lots of referrals on this issue.

As hon. Members will be aware, I have been intimately involved in the drive to have asthma inhalers available in school so that a qualified person can administer salbutamol and other relief inhalers for a child who has a medically documented need. It is essential that if a child forgets their inhaler, the school nurse or equivalent has the ability to provide an inhaler and supervise its use. I am pleased that this endeavour was successful back home in Northern Ireland.

Prescriptions are prepared for a specific person only. If someone other than the person named on the prescription were to buy or use the drugs, that would be illegal. The provision within schools for emergency inhaler use has various safeguards, and it is important to have them in place. A clinically trained and responsible person—usually the school nurse or someone equivalent—acts as a guarantor of the appropriate use. The inhalers are held for specifically named children, people cannot use someone else’s inhaler and the school nurse is legally permitted to prescribe the inhaler. With covid-19, those safeguards are even more important and the restrictions are more stringent now than perhaps they were a year ago or further back.

Therefore, in theory, I understand and agree with the impetus behind this petition. However, I believe it is right and proper that we highlight the difficulties that there clearly are. Safeguards need to be in place and there needs to be care in the widening of allowing prescription-based relief inhalers to be available to anyone, on any occasion.

With asthma, undoubtedly prevention is better than cure. That is always the case with health issues, alongside early diagnosis. In June 2020, The Pharmaceutical Journal reported a substantial increase of 60% in inhaler prescriptions in 2020 from the year prior to covid. I think we are all convinced that those increases are down to the pandemic, the problems people have had and the dangers that they perceive there to be.

NHS data showed a similar large increase in inhaler prescribing across the United Kingdom of Great Britain and Northern Ireland. In March 2020, 2.77 million prescriptions were made for salbutamol inhalers, a rise of 63% from the previous February. I know that this led to supply issues. Can the Minister reassure us that supply issues for inhalers have been addressed? We all have constituents who use their inhalers monthly, and in Northern Ireland there were some who were worried that they could not get their inhaler. I hate to bring it up, Mr Hosie, but the Northern Ireland protocol is to blame for many things, including access to salbutamol inhalers. Can the Minister give us some indication that that will not be a problem in the future?

People whose asthma had been well controlled for years and who did not use their inhalers were getting one, as they said, “just in case”. We all know that prescriptions are not handed out just in case, but given only when the case is fully justified. I am concerned if prescription medication is to be given out not as needed by a dedicated healthcare professional but at random and different buildings; such an extension, as proposed in this petition, would have to be carefully considered. It is about making it safe, getting it right, and doing it the right way. We want to make sure that that happens.

We would need more information to ensure that there was appropriate regulation, as there is with the current prescription service through which the GP prescribes, and then the pharmacist checks the dosage and informs people about how and when to take the medication. I believe this is imperative for medicinal safety. It is a safeguard for the young children who get the medication, and gives their parents peace of mind.

To conclude, while the drive behind this petition is laudable, there is much work to be done to make it safe. In her response, can the Minister reference the concerns I have raised, as we seek to get the delicate balance of the availability of salbutamol inhalers exactly right? That will save lives in the process and make sure that everyone is safe.