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.

Alcohol Harm

Jim Shannon Excerpts

Thursday 25th November 2021 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House notes the grave harm to society caused by excessive alcohol consumption and alcohol addiction; further notes that alcohol-specific deaths in 2020 were the highest ever recorded by the Office for National Statistics across many parts of the UK; and calls on the Government to commission an independent review of alcohol harm.

I thank the Speaker and the Backbench Business Committee for allowing this debate to go ahead. I am grateful to have secured this debate because the issue of harm caused by alcohol misuse has concerned me for many years—since long before I got into this place. I have seen far too many examples of when alcohol misuse has wrecked lives, trashed families, caused great disruption to communities, exhausted police and NHS staff and led to a miserable, hopeless lived experience for those who find they have an alcohol addiction.

I was due to co-sponsor this debate with the hon. Member for Liverpool, Walton (Dan Carden), who is unable to be here for family reasons. Colleagues will be aware of what he has had to say on this subject in respect of his own lived experience and through his sterling work as vice-chair of the all-party parliamentary group on alcohol harm.

I declare an interest as a commissioner on the commission on alcohol harm, which is ably led by Baroness Finlay. She said:

“Alcohol harm impacts us all—in families, our communities, and throughout society. For too long, the onus has been on individuals, with drinkers urged to ‘drink responsibly’…We need to finally acknowledge the true scale of the harm caused by alcohol, which goes far beyond individuals who drink, and put the responsibility squarely with the harmful product itself. By doing so we will help to do away with the stigma and shame that surrounds those who are harmed by alcohol and often stops them from accessing the help that they need.”

Those words were in the introduction to the commission’s “It’s everywhere” report.

The alcohol harm commission was set up to examine the full extent of harm across the UK—the physical, mental and social harm caused to people around the drinker, to wider society and to the drinker themselves. We considered the effectiveness of current alcohol policy and made recommendations for the reduction of harm.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this debate forward. Is he aware that in Northern Ireland there were 336 alcohol deaths in 2019—the highest number of alcohol deaths on record, and up 18% on 2018—and similarly record-high figures in England and Wales for 2020? Does he agree that the Government’s current strategy is not working and that something has to change?

[Derek Thomas]

I absolutely agree. The figures are similarly worrying for Cornwall and across the Isles of Scilly, which I represent. The point of this debate is to try to start a new conversation about how we can support those who are caught up in such a difficult and tragic situation.

Those whose lives are affected by alcohol every day best understand its impact, yet their voices are often missing from policy discussions. We set out, as a commission, to give these individuals a platform. In addition to experts by experience, we heard from hospitals; local councils; UK and devolved Governments; academics and universities; alcohol treatment providers; the alcohol industry; medical royal colleges; children’s charities; homelessness organisations; public health experts; and older people’s representatives.

The commission received evidence on the wide-ranging impact of alcohol on wider society through the burden it places on public services and the economy. In England, hospital admissions related to alcohol reached a record level of 1.26 million in 2018-19, and the total cost of alcohol to the NHS is estimated to be £3.5 billion. The costs of alcohol are not limited to health: my right hon. Friend the Minister for Crime and Policing has noted that

“alcohol-related crime in England and Wales is estimated to cost society around £11.4 billion per year.”

The body of evidence received by the commission indicates that alcohol is a harmful and addictive substance that must be carefully regulated—as is done with tobacco. Far from being an issue for individual responsibility, as it is often framed by the industry, there is a compelling case for Government intervention to end the cultural celebration and normalisation of alcohol in public, while vulnerable individuals suffer harm and stigma behind closed doors.

The long list of vulnerable people in need of protection from alcohol harm includes alcohol-dependent people, children, drink-drive collision victims, domestic abuse survivors and those who experience crime and antisocial behaviour, including emergency service personnel. Another such example is an unborn baby at risk of foetal alcohol syndrome disorder, a condition caused by prenatal exposure to alcohol in the womb and which is around three to five times more common than autism, but much less widely acknowledged and discussed. FASD is a lifelong neuro-developmental mental disability that affects the brain and body. Maternal alcohol misuse is one common factor in children being taken into care, increasing the likelihood that those children have been exposed to alcohol before birth. The prevalence of FASD is therefore much higher in those who are care experienced, with one study suggesting that two thirds of adopted children are potentially at risk of FASD. It is unacceptable to leave their fate up to individual responsibility. Instead, we need systematic change to protect vulnerable individuals and communities.

For starters, I call on the Government to ensure that those with FASD, or at risk of FASD, are given proper support. One possible route to provide that support would be as part of the excellent work of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). Her vision for the 1,001 critical days now being brought into reality as part of a newly funded Best Start in Life initiative would be the obvious approach. The family hubs, which I know my hon. Friend the Member for Congleton (Fiona Bruce) has been a great advocate for, is a key part of this initiative and may well be the place where support for children with FASD and their families can be delivered.

The covid-19 pandemic has accelerated alcohol harm in the UK. Deaths from alcohol increased by 20% in England and Wales and by 17% in Scotland in 2020. They are now at the highest level since records began. In England, the number of adults drinking at high-risk nearly doubled between February and June of last year. The data also show a rapid acceleration in deaths from alcoholic liver disease since the start of the pandemic, beyond that of the pre-existing upward trend. Those numbers are alarming. We know that drinking harms more than just our liver, with alcohol being a causal factor in more than 200 diseases and injuries. In my own constituency, between 2016 and 2018, 760 people received an alcohol-related cancer diagnosis. Alcohol is of course also linked to mental health issues: in many countries, including the UK, those with depressive or anxiety symptoms were among the groups with the largest increase in consumption during the pandemic.

Latest data provided to me by the Alcohol Health Alliance showed that, in my constituency, 73% of dependent drinkers in 2019-20 were not in treatment. Shockingly, that is better than the national average. The Royal College of Psychiatrists warned last year that addiction services in the UK are not equipped to treat the soaring numbers of high-risk drinkers.

Even if I had not taken a serious interest in alcohol harm previously, having seen further statistics that relate to my constituents, I have no excuse but to draw attention to this terrible situation. For example, those drinking above the chief medical officer's recommended levels—at-risk drinking—account for 24% of my constituents. There were 220 alcohol-related deaths recorded in 2019, 11,422 alcohol-related hospital admissions in 2019-20, and 192 road traffic accidents attributed to alcohol between 2014 and 2016.

Never before has action on alcohol been so urgently needed as it is now. We must do more; we must do better. The Government must commit to increasing treatment funding and maintaining that funding so that everyone who seeks support is able to receive it. The Dame Carol Black independent review of drugs called for additional funding of £1.78 billion for drug and alcohol treatment services over the next five years. The Government must act on this now. Additionally, there must also be a commitment to increasing the numbers of the addiction treatment workforce.

Outside of treatment service provision, significant work is needed to tackle the stigma surrounding alcohol. While serving on the commission on alcohol harm, I had the privilege of reading and hearing deeply personal and moving testimonials, with experts of experience commonly agreeing that the focus on individual responsibility for drinking leads to a culture of secrecy, shame, and stigma. Tim Norval, an expert by experience, told the commission that the stigma people carry tells them,

“I’m worthless. I’m not worthy of the treatment. I’m not worthy of the support”.

But the blood that runs through their veins is just the same red as mine. There is absolutely no reason whatever that they deserve any less treatment than I would if I had any sort of health condition. We all have a part to play in changing the narrative around alcohol addiction: please, encourage and participate in conversations about drinking and its effects, and challenge the stigmas around alcohol use.

Beyond health consequences for the drinkers themselves, there is of course a significant impact on those around them. A national survey found that approximately one in three victims of domestic violence in England and Wales reported that the perpetrator was under the influence of alcohol. Alcohol or drugs was thought to be a factor in 61% of care applications in England.

Across the UK, the people from the most deprived areas are more likely to die or be admitted to hospital than those in the least deprived areas. The Institute of Alcohol Studies found that lower socioeconomic groups experience up to 14 times the incidence of alcohol-related violence than higher socioeconomic groups. Researchers have linked alcohol consumption with inequalities in life expectancy, social and emotional wellbeing, and child development. Public Health England has also stated that tackling alcohol-related harm is an important route to reducing health inequalities. In the light of this and the announced levelling-up White Paper, it is important to reiterate that for any levelling-up agenda to be truly successful, it must address alcohol harm as a top priority. Beyond that, there are several additional steps that could move the UK in the right direction.

I have long pressed for minimum unit pricing to be introduced in England to bring us in line with other UK nations. The evidence from Scotland has been highly encouraging. I especially highlight the fact that the impact on prices has almost exclusively been in the off-trade sector, while on-trades prices have largely been unaffected. This is important because colleagues have told me that a reason for not supporting MUP is the perception that it will harm our village pubs. This debate is not related to the “Saving Your Local Pub” campaign, but it is important to note that introducing MUP would have little, if any, impact on pubs and off-licences. What MUP can do is address the “in your face”, cheap alcohol promotion that faces us all when we venture into a supermarket—something that appeared to be more apparent during the lockdowns.

To conclude—I am sure that you will be glad to hear me say that, Madam Deputy Speaker—there are some clear recommendations that I would like the Government to consider and act on, with no unnecessary delay. First, we need to deliver a new comprehensive strategy. The UK Government must introduce a new alcohol strategy as part of the covid-19 national recovery plans. The strategy must take into account the best available evidence and include population-level measures to reduce harm from alcohol. Its development must be free from the influence of the alcohol industry. Although the Government must support economic recovery and our hospitality industry, this must be balanced with minimising harm from alcohol. A new strategy should include the interventions recommended by the World Health Organisation.

The last alcohol strategy will be celebrating its 10th anniversary next year. The Government have so far failed to fulfil their promises for an update, and have now caused fears that alcohol will fall by the wayside while they focus on drugs and gambling. Developing such a strategy, specifically on alcohol, would allow the Government to understand all the influences and drivers of alcohol harm—including its availability, price and marketing—and to identify the most effective ways to tackle this in the UK. The final report of the commission on alcohol harm concluded that we need a new alcohol strategy that is evidence-based, comprehensive, and focused on population-level measures. Organisations such as Alcohol Health Alliance UK, Alcohol Change UK, the OECD and the World Health Organisation have echoed those calls. I support the recommendation wholeheartedly and call on the Government to launch such a strategy urgently.

The second of three recommendations is for the Government to introduce MUP without delay to reduce the consumption of cheap, high-strength products. The Chancellor’s move in this direction in the Budget was welcome. However, alcohol duty collects between £10 billion and £12 billion each year, but is estimated to cost £27 billion in social costs, including the cost to the NHS that I have mentioned.

Finally, I call on the Government to introduce alcohol advertising restrictions to reduce alcohol harm, and protect children and vulnerable people, including those in recovery.

If we have any hope of turning the tide on alcohol harm, there is no more time to wait. We must do more, do it better and do it now.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Mr Speaker]

Unfortunately, that question is not relevant to Question 1. We will come back to it as a substantive question later.

[Jim Shannon (Strangford) (DUP)]

When it comes to the integration of health and care services, it is very important that we have early diagnosis. The covid-19 pandemic has shown that there are some 200,000 potential type 2 and type 1 diabetics. What can be done to address the issue of diabetes, speaking as one who is a diabetic?

[Sajid Javid]

The hon. Gentleman is absolutely right to raise that as one of the unintended impacts of the pandemic. The reassurance that I can offer him is that there is close co-operation across the devolved Administrations when it comes to working on those impacts. NHS England is working with the health service in Northern Ireland to see what more can be done.

Health and Care Bill

Jim Shannon Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt]

I rise to speak in support of amendment 10 but, before I do, I also want to express strong support for amendments 40 to 43, tabled by the hon. Member for Central Ayrshire (Dr Whitford), which will make a big difference in making the new health services safety investigation body a success. I strongly encourage the Minister to listen to what she says later not just with the deference due to an experienced surgeon, but with the enthusiasm to follow a doctor’s advice, because what she says is extremely important.

I also thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous comments about me. Having sat opposite him at the Dispatch Box on many an occasion, I realise how difficult they must have been for him to say. He must have wrestled with those thoughts for a long time, and I am delighted that he has been able to unburden himself today.

The hon. Gentleman was absolutely right to focus on burnout in the NHS workforce. All of us would agree that NHS and care staff have done a magnificent job looking after us and our families in the pandemic, but right now they are exhausted and daunted. They can see that A&E departments and GP surgeries are seeing record attendances. They can see nearly 6 million on waiting lists, which is more than one in 10 of the population. They also have the vaccine programme and covid patients.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman for amendment 10. With 2,700 vacant nursing posts in Northern Ireland, and 40,000 in the NHS as a whole, will the amendment offer more nursing bursaries, train nurses up to relieve the pressure, and provide a decent working environment?

[Jeremy Hunt]

I believe it will. I am grateful to the hon. Gentleman for raising that issue, because medical training is relevant to the whole United Kingdom, not just one part of it. I hope the amendment will be beneficial to Northern Ireland as well.

If we put ourselves in the shoes of any frontline doctor, nurse or care worker, we would see that they are all completely realistic that this is not a problem that can be solved by next Monday. It takes a long time to train a doctor or nurse. All they have is one simple request: that they can be confident that we are training enough of them for the future, so that even if no immediate solution is in place, there is a long-term solution. That is the purpose of amendment 10. It simply requires the Government to publish every two years independently verified estimates of the number of people we should be training across health and care.

The Government have recognised the pressures on the NHS by giving generous amounts of extra funding. I commend the Government for doing that, but extra money without extra workforce will not solve the problems that we want to solve. At the moment, the NHS just cannot find the staff.

--- Later in debate ---

[Carla Lockhart (Upper Bann) (DUP)]

I wish to speak to new clauses 51 and 52, both of which stand in my name. New clause 51 relates to the practice of abortion based on sex selection, and it seeks to clarify that abortion on the grounds of the sex of the foetus alone is illegal. Hon. Members from across the House would doubtless agree that aborting a baby on the basis of their sex is immoral, yet the status of this in law remains unclear.

Unfortunately, there is growing evidence that this horrible practice is taking place in Great Britain today. A 2018 BBC investigation found that non-invasive prenatal tests were being used on a widespread basis to determine babies’ sex early in pregnancy. We know that women are being coerced into having abortions based on sex selection. This was confirmed by a 2015 report from the Department of Health that detailed the awful testimonies of women who had been forced into a sex-selective abortion. The problem has been made much worse by the use of abortions pills to be taken at home. Abusive partners who do not want a particular sex of child—usually a girl—can more easily force their partner into having an abortion via telemedicine. The new clause seeks clarification that this practice is illegal, so provides an opportunity for the Government to do more to help women who are pressured into having an abortion on the basis of sex.

I wish briefly to touch on new clause 52—also tabled in my name—which would introduce an upper gestational limit on abortion on the grounds of disability that is equal to the upper limit on most other abortions. It would correct the current deeply discriminatory situation that permits abortion up to birth if

“there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.”

That has been interpreted as permitting abortions up to birth following the diagnosis of either a cleft lip, a cleft palate or a club foot. This is inconsistent with disability discrimination legislation, because it allows for abortion on the grounds of disability more widely than most abortions are allowed.

[Jim Shannon]

Does my hon. Friend share my concerns that a large number of people throughout the whole United Kingdom object to this? We have had hundreds and hundreds of emails from my constituents about this issue. I commend my hon. Friend and the hon. Member for Congleton (Fiona Bruce) and totally oppose new clause 50—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. That intervention is quite long enough.

--- Later in debate ---

[Sajid Javid]

I listened carefully to the hon. Lady and I will look into the specifics of what she said, but it is clear—I hope she agrees—that if people are clinically ready to be discharged, it is better that they are discharged rather than staying in hospital a moment longer.

I take this opportunity to thank everyone who has helped us to shape this important legislation, including hon. Members across the House and colleagues in Wales, Scotland and Northern Ireland, whose engagement will help us ensure that the Bill delivers for the four nations of the United Kingdom. I also thank members of the Public Bill Committee for their constructive scrutiny. The Bill is a lot better for it.

Let me draw the House’s attention to some of the changes that we have considered since Second Reading.

[Jim Shannon]

The Secretary of State referred to how the Bill delivers for the four regions of the United Kingdom. I just put it on the record that 60% of people in Northern Ireland are opposed to abortion on demand, so when it comes to representing the views of those in Northern Ireland—elected representatives and the local people—I am afraid that Westminster and the House do not relate to the people of Northern Ireland on abortion.

[Sajid Javid]

I heard what the hon. Gentleman said. He will know that there are strong feelings on the issue of abortion across the House, on all sides of that issue. If legislation does ever come to the House, it is important that it is always a matter of conscience, and that is how MPs are expected to receive such legislation.

--- Later in debate ---

[Jim Shannon]

It is a pleasure to be able to make some comments on Third Reading. The Secretary of State and the Minister will know my position on these matters. I should like to commend the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Upper Bann (Carla Lockhart) for their dedication to these issues. Their passion in this House is matched by many in my constituency who, despite the fact that their view is constantly disregarded, still urge me in their hundreds—I received hundreds of emails yesterday and hundreds today—to do what I can to speak for life. That is what I do here today. I care about the life of the woman and I care about the life of the unborn child. I am starting from the position that both lives matter, and it is one on which I stand firm.

In this House, there is a large number of MPs who are opposed to abortion on demand and who have an opinion on that. They include those who represent Northern Ireland and other parts of the UK in this House. I want to reiterate my position on the last vote that took place in Northern Ireland. An opinion poll found that 60% of constituents were opposed to abortion on demand. I am sure that I am far from being alone in recognising the double standards that our medical guidelines currently endorse, fighting for a life at 22 weeks in one case and ending it at 22 weeks in another case.

There are those who advocate that choice comes above viability, but that view is not replicated even by the many who support abortion in principle. It is a pity that clause 31 and clauses 51 and 52 were not brought to the House today. We expressed our concern some time ago that this House making the decision for Northern Ireland over and above the views of its elected representatives, its constituents and a majority of people across Northern Ireland would have an impact on the abortion rules in this House. We would have had an example of that today if new clause 50 had been approved, which it was not. It would have removed vital safeguards for women and girls seeking abortions up to 28 weeks of pregnancy, such as the requirement for two doctors, or even any medical professional, to be involved. The law change that was agreed in this House for Northern Ireland could have the shocking impact of placing at risk women and girls in abusive situations. It could legalise abortions that women and girls would carry out on themselves up to 28 weeks of pregnancy, for any reason.

[Mrs Miller]

Will the hon. Gentleman give way?

[Jim Shannon]

I have almost finished my speech.

The Health and Care Bill is an opportunity to improve health and wellbeing, and it should not be usurped to remove essential safeguards such as contact with a medical professional, counselling and referral to appropriate care pathways. This House must be mindful, whatever decisions it takes here, that those decisions will have an impact on Northern Ireland. We in Northern Ireland are very concerned, and there is great disappointment at where we are.

Question put, That the Bill be now read the Third time.

Health and Care Bill

Jim Shannon Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Mary Kelly Foy]

I entirely agree. Tobacco is the only legal product that kills one in two of those who use it, and most people start smoking at a young age. These new clauses are therefore extremely important, because they would tackle that problem.

[Jim Shannon (Strangford) (DUP)]

The figures back up what the hon. Lady says. Two thirds of smokers in the UK start smoking under the age of 18, and over a third—39%—start under the age of 16. What she proposes will address that issue in a substantial way. We need legislation in place, and there needs to be punishment as well; that is the only way forward.

[Mary Kelly Foy]

I thank the hon. Gentleman, and I will address that issue.

New clause 5 would close another loophole in the law, which allows the free distribution of e-cigarettes and other consumer nicotine products to children under 18. The Government rejected the proposal, saying that there was no evidence of a serious problem, but the Minister sympathised with the argument for preventive action. Prevention is precisely our intention. Fixing this loophole is an appropriate application of the precautionary principle.

New clause 6 would remove the limitations on the ban on flavourings in tobacco products. That ban currently applies only to characterising flavours. The new clause would extend the flavour ban to all tobacco products, as well as to smoking accessories, including filter papers, filters and other products designed to favour tobacco products. In Committee, the Minister claimed it was unclear how a ban could be enforced in practice, as it would include a ban on flavours that did not give a noticeable flavour to the product. I suggest that he seek advice from Canada on this point, where a complete ban on flavours is already in place and has been highly effective.

The new clauses on the tobacco levy would give powers to the Secretary of State to implement a “polluter pays” levy on tobacco manufacturers. The Minister dismissed this in Committee as a matter of taxation for the Treasury to consider. However, we are not proposing additional taxation. Our new clauses are modelled on the American user fee and on the pharmaceutical pricing scheme in the UK.

--- Later in debate ---

[Alex Norris]

My hon. Friend will be delighted to hear that I will be coming on to the modesty of the Government’s plans for tackling obesity, but I have to finish my remarks about new clause 16.

New clause 16 compels the Secretary of State to publish an annual statement about the spend and impact of alcohol treatment funding. After a decade of reduced commitment in this vital area, the Secretary of State should seek to embrace this opportunity. At the moment, national Government cannot say they are meeting their responsibility to tackle alcohol harm with the requisite financial commitment and in the right place, which should discomfort them greatly. New clause 17 would replicate in England the minimum unit pricing restrictions that we see in Scotland and Wales, and we are all watching with great interest as evidence gathers as to their impact.

Let me now turn to the amendments and new clauses relating to advertising. The Government have included a couple of elements of their obesity strategy in the Bill. As I have already said to the Minister—in Committee and upstairs in the delegated legislation Committee—I wish that they had put the entire obesity strategy in this legislation, because there are bits that could have been improved by amendment, by debate and by discussion, as we heard in the contribution of the hon. Member for Buckingham (Greg Smith), and as I dare say we will in that of the hon. Member for North East Bedfordshire (Richard Fuller). We should have taken that approach to the entire document, and it is sad that we did not.

On the obesity strategy itself, it is too modest and it fails to attack a major cause of obesity, which is poverty.

[Jim Shannon]

The hon. Gentleman is absolutely right in what he is saying. I am a type 2 diabetic and I am well aware of the issues. As I understand it, figures that have been gathered during the covid-19 pandemic showed that the number of diabetics rose by some 200,000. That tells me that, if we are going to address the issue of diabetes, we need to have a tax process in place, which I think is what the hon. Gentleman is referring to, rather than a regulation, because that is the only way that we can control diabetes.

[Alex Norris]

I think that a solution might be a little from column A and a little from column B, but I am grateful to the hon. Gentleman for making that point.

We have heard about the modesty of the strategy from the hon. Member for Buckingham. The reality is that any benefits from the obesity strategy will be outstripped by losses in the nation’s health caused by the impact of the cut to universal credit. We want the strategy to succeed, but it needs to be seen in that broader category.

Obesity is an important issue, with nearly two thirds of adults carrying excess weight. Childhood obesity is also a significant issue, with one in 10 children starting primary school obese, rising to one in five by the time they leave—extraordinary at such a young age.

--- Later in debate ---

[Richard Fuller]

I am grateful to the hon. Lady for making her point clear.

As the hon. Lady and other hon. Members know, my amendments relate to the ways in which the Government are seeking to restrict advertising for foods that are high in fat, sugar and salt as part of their obesity strategy. Those measures essentially ban such advertising on TV before the 9 pm watershed and ban all paid-for HFSS advertising online at any time of the day or night. My hon. Friend the Member for Buckingham (Greg Smith) has already done a very good job in drawing out some concerns about that.

What are the concerns about what the Government are doing? First, I should mention that I have a number of important food businesses based in my constituency, including Unilever and the cereal company Jordans Dorset Ryvita, and I think everyone would be surprised to hear that products such as porridge, muesli and granola are going to be subject to these bans. All these products have ingredients such as naturally occurring oils and sugars, as well as fibre, vitamins and minerals, and because of those natural ingredients they will be caught by the Government’s definition of “HFSS”.

It is also worth considering—I was not on the Committee and I do not know if it was considered at length—the impact on food services such as takeaways and home-delivered foods. Papa John’s, which is located near me in Milton Keynes, supports hundreds of entrepreneurs and small businesses through its franchise model, and it writes to warn me:

“These would restrict our ability to invest in our businesses and our people, at a time of significant economic uncertainty for the UK economy, and would also place our franchisees, many of whom are single owner small businesses, on an unsustainable financial footing.”

I think the Government have to do a few more hard yards in support of our small businesses, and this is not a very good way of showing any support for them.

[Jim Shannon]

The number of diabetics, both type 1 and type 2, across the United Kingdom and the number of children with obesity is rising. Does the hon. Gentleman feel that new clause 14 cannot address the issue of those rising numbers? If it cannot, what more needs to be done?

[Richard Fuller]

I absolutely do not agree. The reason why the Opposition Front-Bench team are probing on this is that we are not harnessing all the talents to come up with the solution. As the hon. Member for Nottingham North said, he does not have, or want, any objection to the objective—he just feels that there may be better ways to do it. That is what my amendments are trying to create. They would introduce a better way, working with established principles and with the industry—let us face it, it has the experts in this—rather than undermining issues to do with how the Advertising Standards Authority has managed how products are advertised and rather than bulldozing through the industry, which is the current process that the Government, or this Department anyway, are proposing.

Let us just remember that this pressure on our food and drink manufacturers is part of a wider effort of social responsibility that we are putting on them. The proposal does not sit alone, but with other things, in particular around environmental protection. The Food and Drink Federation has calculated that the cost of the UK Government’s proposed environmental health policies is at least £8 billion. That is equivalent to £160 a year on household food bills that we are asking the industry to take on.

It is estimated that the introduction of this policy will cost £833 million, but the Government’s own impact assessment estimates that the benefits are likely to be in the order of only £118 million. That is a real dead loss that we will be putting, let us face it, on food bills, primarily of those in lower income brackets. Members on all sides should take a moment to consider whether this is the right time and the right process for doing that. As the Government’s own assessment shows, the actual effect on diet for those who are targeted is estimated to be 1.7 calories a day, so it is a lot of effort and cost, but not very much impact.

New clause 14 proposes an alternative that would require the regulator to implement an alternative set of increased restrictions for online, but developed through the industry by the Committee of Advertising Practice. The new clause would legislate for a three-step filtering process drawn up by the industry to appropriately manage the targeting of online ad campaigns.

Another of my amendments would introduce brand exemptions. I take a different view from the hon. Member for Central Ayrshire, who said that brands are intrinsically tied to their product. The truth of the matter is that Coca Cola is made by Coke and Coke Zero is made by Coke. Coke Zero is advertised with the word “Coke” on it. This issue is not necessarily covered by the legislation, but Coke is not tied to one thing. Brands are extraordinarily flexible in how they can assist progress in achieving some social means. The Minister should consider looking again at this area.

Finally, on the nutritional profile, the issue is consultation. I can see that the Secretary of State has tabled some amendments on that, and perhaps the Minister can talk about that. They do not seem to make the changes I would like to see, but I would be interested to hear what he has to say.

It is worrying that the Government have undermined the Advertising Standards Authority with their approach. One of the other things is targeted advertising. I am sure it has struck hon. Members here as it has me that the tech revolution of the dotcom era was 20 years ago, and two decades of technical expertise in understanding how adverts are targeted is being swept away or ignored by the Department of Health and Social Care, which would much rather have “nanny knows what’s best”. The truth of the matter is that, by harnessing technology, the Government could get a better outcome than this official ban. As my hon. Friend the Member for Buckingham said, there are plenty of other ways to do it that would be hard for advertisers to get around.

I say to the Minister that I am trying to be helpful, as always, and, to be serious, as are the Opposition. The Government have made a slight misstep by adopting a top-down, state-driven model. I say to the Minister that the path of good intentions is littered with unintended consequences. The essence of conservatism is not to use the state to bully or, as perhaps the advisers in the various Departments say in modern parlance, to nudge. It amounts to one and the same thing. The Department’s attempt to censor products such as these is profoundly un-Conservative. Our party believes in individual responsibility and that families are the foundation of society where choices and power in society most naturally lie. Nowhere is that more important than in health matters, yet these proposals extend the role of the state and undermine parental responsibilities.

The measures make the Department of Health and Social Care look like a new outpost of cancel culture that denies free speech and has a predisposition that individuals should conform to what the state determines, rather than enabling informed free choice. It is desperately sad to see them being pushed through by a Conservative Administration. I say to my colleagues on the Back Benches: when will we wake up and realise that we need a Government who support free enterprise and individual responsibility, and who understand that the way to create growth in the economy is through enabling people to make free choices, rather than expecting the state to be the answer to every problem? With that question, I will wait to listen to what the Minister has to say.

Automated External Defibrillators: Public Access

Jim Shannon Excerpts

Thursday 18th November 2021 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Before we begin, I am required to read out some advice from Mr Speaker. I remind Members that they are expected to wear face coverings when they are not speaking in the debate. That is in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are 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 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 public access to Automatic External Defibrillators.

I am pleased to see many hon. Members from all political parties in the Chamber. I will also say, because I mean it, that I am especially pleased to see the Minister in her place and I look forward to her response. She understands the importance of the debate. Each hon. Member who speaks will illustrate the strength of the need for the Government and—dare I say it—civil servants to understand the importance of the debate. If they understand it, and if the Government press the issue, the general public will be glad to see it happening.

It is a pleasure to have this debate before the Second Reading of the Automated External Defibrillators (Public Access) Bill on 10 December. I thank the Backbench Business Committee for granting my application. The intention is to deliver public access to AEDs across the whole United Kingdom. All MPs will have at least one person in their constituency who has been saved by an AED.

I am grateful to the hon. Member for Sedgefield (Paul Howell) who co-sponsored the debate and supported me in making it happen. I appreciate his co-operation, partnership and friendship. He made representations to the Committee alongside me and shared his own experience, which he will tell us about shortly. He has referred to the dedicated work of his constituent Councillor David Sutton-Lloyd, who advocates and lobbies with him about the importance of awareness and public availability of these lifesaving devices.

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

In my constituency, Councillor Mo Razzaq has been championing the cause and has fought hard to improve provision, which has led to a community defibrillator installation outside Strachan Craft Butchers in Blantyre. Does the hon. Gentleman agree that locally elected representatives can be instrumental to the cause?

--- Later in debate ---

[Jim Shannon]

I appreciate the hon. Lady’s intervention about the importance of councillors, which I will return to, such as the friend of the hon. Member for Sedgefield. Communities lead on such matters.

There are many defibrillators across great parts of the United Kingdom of Great Britain and Northern Ireland, but the Bill legislates so that everyone must have one in place. There is no cost to the Government; the Bill just puts in place the necessity to do it, rather than saying that it must come from community activities or otherwise.

To give an example from my constituency, in Newtownards some of the shop owners got together and spent £1,000 on a defibrillator, which is available on the high street in the middle of town. Every school in Northern Ireland has a defibrillator. As I will say later, I had a meeting with the former Secretary of State for Education about this issue, and he was committed to it in that role.

I am deeply encouraged by and thankful for the amount of support for the Bill on both sides of the House. I thank hon. Members present for contacting me to offer their support and for suggesting that I hold a debate before Second Reading. The purpose of the debate is to raise awareness and to build the campaign outside the House. We are all able to point to many cases. It is a fundamental aspect of our democracy that Members are able to scrutinise and debate proposed legislation. This debate offers Members the chance to do just that. I have worked with the Minister and look forward to continuing that work to bring this important piece of legislation forward—to bring this ideal into reality. If we can do that, and deliver across the United Kingdom, I will be more than pleased.

Since the Bill’s First Reading, I have been overwhelmed by the amount of support. Support has come from across the House—from all sides, from all parties—which is a reflection that it is welcomed across society. I thank all Members who wrote to the Secretary of State for Health and Social Care urging him to engage on this issue. I was able to meet the Secretary of State to discuss the Bill and he demonstrated his sincere support, which we appreciate. The members of the public and people in industry who have contacted me—I have held meetings with as many as possible over the past few months—are the driving community spirit behind this Bill. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to that community spirit. It drives us as constituency MPs.

I thank the Minister for her invaluable contribution. I thank Tom, Sandra and Daniel from Stryker, Matthew Spencer from Healthcomms Consulting, Greg Quinn from BD, Sarah French from SADS UK, Gabriel Phillips of APCO Worldwide, Iain Lawrence from Aero Healthcare UK, Sudden Cardiac Arrest UK, as well as the Arrhythmia Alliance, the Community Heartbeat Trust and British Heart Foundation Northern Ireland. I suspect most of those bodies have already contacted the Minister, as well as her local community and other community groups.

I have been interviewed by university students about the Bill. This demonstrates the concern and interest of a wide cross-section of society about the need for public access to AEDs. I am very grateful for their interest and for broadening my knowledge. No matter what age I am, I will always learn. Today I learn more, and the next day more again. I have an open and active mind, and I want to respond and to learn things that we can use in this House for the benefit of everyone. They taught me about the consequences of a lack of awareness of and training in cardiopulmonary resuscitation, which added to my knowledge and understanding of sudden cardiac arrest.

There is momentum growing, not only from The Mirror, which has its own campaign. I turned on the Denmark match at the Euros and did not realise what had happened. I was trying to figure out what was happening on screen, as I had missed the first 30 minutes or so of the match. I thought somebody had got hit on the head by a bottle thrown from the crowd or something. The Danish team were all around Christian Eriksen, and I realised that he had had a heart attack. That day, an AED saved his life, because it was there. The Premier League has donated 2,000 AEDs or thereabouts, aiming for them to filter down to some of the junior clubs. There is definitely a growing momentum out there.

I want the debate today to be marked by hope and commitment, but also by respectful demand. We should all support this issue. I am in no doubt as to the wishes of people in the community with regard to the proposed legislation, its importance and the need to have it in place now.

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

This is an incredibly important debate. Does the hon. Gentleman agree that AEDs should be put on public buildings? Those buildings are not open 24/7 and the AEDs should be accessible to the public 24 hours a day, so they should be on the outside of the building. Does he also agree that if every child in school had one hour’s training in CPR every year, we would have far fewer deaths? A combination of those two measures would save many more lives.

[Jim Shannon]

I do agree, and I think there would be a positive consensus in the House on that. I will give an example later of how an AED in a school saved a life in my constituency. I have two examples to illustrate the point.

I have seen over the past year how we have begun to address the importance of CPR training, to which the hon. Lady referred, and AED availability. I agree with her. The AED in Newtownards is in the street, but it could have been in the shop, which closes at six o’clock, so from 6 pm to 9 the next morning it would not have been available. The hon. Lady is right about what should be done.

The right hon. Member for South Staffordshire (Gavin Williamson) backed the campaign, in his former role as Secretary of State for Education, to see all schools equipped with defibrillators. I believe that has been accomplished. I was encouraged by that, as we are trying to do it back home as well. However, it is not just about primary schools; it is about having AEDs available in streets, shopping centres, Government and local government buildings, and leisure centres. The Bill says that they should be available, but it does not put a cost factor on it. To make this happen is a win-win for the Minister and the Government.

I will explain where the campaign came from. The Minister will remember that we met with Mark King, of the Oliver King Foundation, whose 12-year-old son Oliver died of cardiac arrest during a school swimming lesson in 2011. I was incredibly moved, as I know the Minister was, by Mark’s experience. I was motivated too by his commitment to installing AEDs as far and wide across the community as possible. I know that he will be watching the debate today, and it will be a poignant one for him. Throughout this journey, I have stayed in touch with the foundation. I want to remind Members that this Bill was inspired by a young fella called Oliver King—a 12-year-old—and that we bring this debate to the Chamber in the hope of ensuring that Oliver’s legacy continues.

I am encouraged that in Northern Ireland, the Education (Curriculum) (CPR and AED) Bill has reached its second stage. This is not about politics; it is about the issue. That is the way I see things. I am a political person, of course, but what drives me is asking what is the right way to do things—that is important. One of my colleagues who is not of my party, Colin McGrath MLA, has brought the Bill to the Northern Ireland Assembly. We have worked together; he was keen to know what I was doing and I was keen to assist him back home in the Assembly. He has expressed his best wishes for the Bill, because it is just as important for children to acquire the CPR and AED skills that the hon. Member for Mid Derbyshire referred to, as it is for adults. It is good to see a devolved Administration talking, taking this on and encouraging others to follow suit.

I believe in acts and not just words. Very shortly, the hon. Member for High Peak (Robert Largan) and I will be doing an AED instruction session in the House, when we are able to. I am not sure when that will be, but we are hoping to do it this side of Christmas—the idea is to have a date that coincides with the Bill’s Second Reading on 10 December. It will be with David Higginbottom of Driver First Assist. My staff and I back home will also be taking part in a CPR and AED training session in the office in Newtownards led by Mrs Pauline Waring, superintendent of the St John Ambulance Dufferin Cadet Unit in Bangor. She, along with many other volunteer leaders, does incredible work with St John cadets by training them in first aid and lifesaving skills. It is always good to remember that the St John Ambulance is voluntarily staffed and funded by its own efforts; I encourage Members to engage with their local St John Ambulance if they can.

The hon. Member for Sedgefield, in his representation to the Committee for this debate, raised the very important point that many people are afraid of AEDs. They should not be, and that is why the training is important. Right away, people ask, “Will I know what to do?”. They will know what to do, because it is quite simple. I am not being smart by saying that; the instructions are really easy—they are easy for children to use as well, if that is necessary. People will learn that AEDs and CPR cannot do any harm; they can only do good. That is the motivation. I refer again to my message of hope for this debate, because anything that equips and inspires our young—anyone, in fact—to do good for the community carries the spirit of hope.

I want to raise some important facts about AEDs and CPR because they are two of the links in the “chain of survival” referred to in the UK Resuscitation Council’s updated guidelines. The third link is targeted temperature management. I want to touch on TTM here because I have been made aware of how this impacts on the recovery process. While the focus of this debate is on promoting the prevalence and availability of AEDs in public spaces and buildings, it remains essential that we consider the whole “chain of survival” once a person has experienced a cardiac arrest and been resuscitated.

In my constituency of Strangford one Saturday afternoon at a football match, one of the supporters collapsed at the side of the pitch. I spoke about this at the debate on the ten-minute rule Bill in February. What saved that man was the fact that the club had a defibrillator at all its matches. That is characteristic of all football matches in my region. People were able to resuscitate that man and he is alive today because the Portavogie football team and one of its staff members were able to get him back. He is alive today and can still attend football matches.

I want to give another example, but I am conscious of the time and other Members want to speak. A father was outside a school after leaving his children there. Unfortunately, he then had a heart attack. The children were inside and did not know what was happening to their daddy. The school had a defibrillator and, again, access to an AED saved that man’s life—he is alive today. Not only is he alive; he is able to continue taking his children to school.

I have given two examples, and I know that other Members will have lots of their own. It is hard not to get enthused about this issue, because of the clear benefits. I have referred to Christian Eriksen who collapsed at the football match. I acknowledge and praise the hard work and unfailing efforts of the Minister, who brought forward legislation in 2016 and 2019. Her support is needed if we are to get this done.

In May 2021, the Italian Government passed legislation requiring all offices open to the public with more than 15 employees, transport hubs, railway stations, airports, sports centres and educational establishments—schools, universities and all those places—to have public access to AEDs. In France, a Bill was passed in 2018 requiring almost all buildings where people gather to have access to an AED, including restaurants and shopping centres. It went a stage further by including holiday centres, places of worship, covered car parks and even mountain refuges. In Singapore, AEDs are carried in taxis.

In this House, we are at an important stage. We have more AEDs per head than across the whole of the country—that is not a criticism, Mr Hollobone. I am not saying we should not have them, but I would like to see that replicated everywhere else.

[Margaret Ferrier]

Following cardiac arrest, for each minute that passes the chances of survival fall by a massive 20%. Outside urban areas, and certainly in very rural locations, ambulance call-out times are often much longer than a matter than minutes. Does the hon. Member agree that provision needs to be prioritised in rural areas?

[Jim Shannon]

I certainly do. Living in a rural area as I do, I know the hon. Lady is absolutely right. I would hope and expect that to be the case. I want to give others the opportunity to speak and will make my closing comments now.

Let us remember why we are here today. We are here because there are currently over 30,000 out-of-hospital cardiac arrests in the United Kingdom each year. Of those people, only one out of 10 will survive. I put it to the Minister, the Government and civil servants that I want—indeed, I think we all want—the other nine to survive as well. How can they survive? They can survive if we have access to AEDs in the places where people are, including in rural places. That is why we must push this forward.

What value do we put on a life? A typical defibrillator for the community can cost £800. The Library notes refer to the cost being between £600 and £2,500. However, across Northern Ireland, with the efforts of all the charities and groups I have mentioned, the defibrillators are already in place. I have also mentioned the efforts of organisations such as the Premier League and the Education Ministers here in Westminster and back home in Northern Ireland, and I suspect the same is true in Scotland and Wales as well. That is why, when the legislation is introduced, it will be to encourage those who have not yet gone to that extra stage to make sure that there are defibrillators. That is why this debate is incredibly important. If the cost is £600 or, as it is in Northern Ireland, £800, that is a small price for the Government and the private sector to pay potentially to save lives.

Is it not right that every leisure centre should have a defibrillator? Is it not right that there should be one in the centre of every town? Is it not right that defibrillators should be available and accessible in restaurants, and outside buildings for times when people are out and about, including to visit pubs and restaurants at night time?

There is a campaign called The Circuit, which registers all community AEDs. The sale of AEDs rose significantly after the Euros incident, and when AEDs are registered on a central database, emergency call handlers can direct callers to the nearest AED. The objective of this Bill is to have an AED within three minutes of everyone. That is what the hon. Member for Rutherglen and Hamilton West wants to have; indeed, I think it is what we all want to have.

The Bill does not cost the Government anything. I have said it three times now; forgive me for saying it three times, but I want to emphasise it and say why it is important. Here is a Bill that delivers across the whole of the United Kingdom of Great Britain and Northern Ireland. This Bill will save lives, which is why it is important.

I say to my hon. Friends—all the Members here are my hon. Friends; to be truthful, on this issue all Members are probably hon. Friends whether they are in the Chamber or outside it—that this proposed legislation is neither to the left nor the right of politics. It is about what is right and what is wrong. It is about our whole society and equipping it with the means to save lives. Can there be a more civilised or caring thing to do? If words could make the difference—I will use a quotation, but before I do so I will say one other thing.

Today, this House can support the campaign to deliver AEDs, at no cost to the Government. AEDs save lives. That is the purpose of the Bill—it is to save lives. It is about those nine out of 10 who die every year because the AEDs were not available. It is as simple as that. It is about saving lives. For me, that is the crux of it.

I say that life and death are in the hands of the Minister and her Government, and they would seem to be in the hands of civil servants too. So what action will those hands—the hands of Ministers, the Government and civil servants—take in the coming days when the Bill comes back to the House on 10 December?

I will close with very poignant words. I know that the Minister knows that they refer to wee Oliver King. His dad said, and I have never forgotten it:

“Had the swimming pool had an AED, my son, Oliver, would still be here today.”

That is what we are here for.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 3 o’clock. I am obliged to call the Front Benchers no later than 2.27 pm and the guideline limits are: 10 minutes for the Scottish National party; 10 minutes for Her Majesty’s Opposition; 10 minutes for the Minister; and then Jim Shannon will have three minutes at the end to sum up the debate. So, until 2.27 pm, we are in Back-Bench time. Four distinguished Back Benchers are seeking to catch my eye and we will start with Rob Roberts.

--- Later in debate ---

[Jim Shannon]

First, I thank all hon. Members who have spoken for their contributions. A consistent theme is coming through about having all the data in place; and The Circuit network is going a long way towards that.

I am very keen to be aware of the Welsh perspective and what is happening in Wales. There might be lessons there for us all to learn about how to do what is needed. I thank the hon. Member for Delyn (Rob Roberts) for giving us that perspective.

The hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) referred to access to AEDs and training. Again, that is a central theme that consistently comes up, with each and every person. He gave the example of Denmark. He also referred to the fact that in some cases AEDs can be delivered to rural areas by drone. I am not quite sure about the science of how that is done, but the point is that it is happening somewhere, and if it is happening somewhere and is successful, it might be the way to address this issue in some rural areas.

I was so sorry to hear about the lady whose case was raised by the hon. Member for Newcastle-under-Lyme (Aaron Bell). The necessary timescale very clearly was not there. As a result, there will now be an AED in place. It was not there when the lady needed it, and all of us, including the Minister, have said that we wish to convey our sincere sympathies to the family.

[Aaron Bell]

May I thank the hon. Member and all other hon. Members who have expressed their sympathy? When I see Mr Benson, I will ensure that they are passed on to him, and when I speak to the headteacher tomorrow, I will ensure that they are passed on to the school as well.

[Jim Shannon]

There is a united consensus of sympathy in relation to that case.

I thank the hon. Member for Sedgefield (Paul Howell) for his support for this cause. He gave us a salient reminder of the 300 children who die each year from cardiac arrest. Sometimes, when we hear the figure of 30,000 for out-of-hospital cardiac arrests, we do not focus on all the people that includes.

I think we are all really interested in what the hon. Member for Beverley and Holderness (Graham Stuart) has done in his constituency. We would be very keen to find out more about how that has happened, because there is obviously something that we could learn from there.

I am very impressed by the fact that the hon. Member for Gordon (Richard Thomson) is so learned in this sector. I know him as a friend, so I am not surprised at his knowledge on this subject matter. I know that he is also a very athletic person. He gave the example of the sixth-form student who is alive today and pursuing a career because of an AED that was in the right place, at the right time. The hon. Gentleman and I feature in many debates together; indeed, I cannot think of any debate on a health issue that we have missed. I thank him. I am certainly keen to look at that, and will discuss how to bring it forward in a positive way with the Minister and the hon. Member for Sedgefield, if that is possible.

I want to sincerely thank the Minister. She referred to the fact that some 12 young people die from cardiac arrest every week. It is shocking that we can lose so much young life—people who could have done so much and had their futures ahead of them. The hon. Lady will know of young Oliver King. He comes to my mind on many occasions. I never knew the young boy, but I knew his daddy—that is very real.

The Minister referred to discussions with stakeholders, the NHS and first responders, who do excellent work in my constituency. She also referred to teaching and training in schools. That is all part of the joint approach that we need, alongside St John Ambulance and CPR training. The Minister also referred to Bills that will require an AED to be in place in all those buildings and that AEDs will be mandated in any new build. I am very grateful for that positive response from the Minister.

However, my private Member’s Bill aims to do one thing, if I can achieve it: it would mandate that all buildings, not just new buildings, must have AEDs. I know that the Minister agrees with that. We need a consensus across all Departments that have responsibility in this area. AEDs are available in lots of buildings already—in schools, Government buildings, many leisure centres, football clubs and so on. However, the Bill aims to achieve one thing: that AEDs are mandated in all buildings, and that those who are responsible for them will know that. The signage, training and all of the other things to which the Minister and others have referred are great points and are very important, but they illustrate that the Bill is so important. I hope that on Second Reading, on 10 December, the Government will see that the Bill is a win-win; there is no cost, but everyone gains. Those nine out of 10 victims of sudden cardiac arrest who are lost every year can be saved. The Bill is a lifesaver. I encourage the Government and all those involved to support it.

Question put and agreed to.

Resolved,

That this House has considered public access to Automatic External Defibrillators.

Chronic Obstructive Pulmonary Disease

Jim Shannon Excerpts

Wednesday 17th November 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak on these issues, Ms Nokes. I commend the hon. Member for Weaver Vale (Mike Amesbury) for bringing the debate to the House.

I am my party’s health spokesperson, but it is not just a duty for me to be here—I also have a particular interest in this issue. As has been said, we all know people who have COPD, and I can think of a number in my constituency. One gentleman, Kenny Legge, has been a friend of mine for umpteen years. He has COPD and is on a 24/7 oxygen tank, which he takes everywhere with him. That means that if he goes to the shops or to the doctors he takes it with him. It is possible to carry it because it is a small tank, but he lives with it 24/7—his whole life.

My other introduction to COPD—I suspect the same is true of others in the Chamber—was filling in benefit forms. When filling in forms, we always ask the constituent what the issues are, and they explain them to us. Although we might need to know more about the COPD, the issue becomes clear when we are talking face to face with our constituent and he or she is gasping for breath. We are able to be agile and athletic. People tell me they go for runs, and others tell me they go for walks, but I am one of those who goes for a dander, which is the third category. But people suffering from COPD cannot even do that. That is the issue.

Throughout the pandemic we often forget about other health conditions that must be awarded awareness. Covid has taken over our lives; everywhere we look there is something related to covid. That is not a criticism; it is a fact—an observation. There must be sustainable support for those who, sadly, suffer from other respiratory diseases, such as bronchitis and emphysema.

The British Lung Foundation is the leading charity in the UK highlighting the impacts of chronic obstructive pulmonary disease. Statistics show that an estimated 1.2 million people in the UK—wow, that’s a big figure—live with diagnosed COPD, with thousands more not yet diagnosed. I wonder sometimes whether we are just scraping at the figure, which may or may not be there. That figure equates to 4.5% of all adults over 40.

Intense research by the British Lung Foundation shows that prevalence is growing. I hope the Minister will give us the answers we seek, and I know she will endeavour to produce them. One thing I always ask about is prevention, and it is important that we address it, because it prevents costs further down the line. Perhaps she can tell us what has been done on that. The research also shows that COPD diagnosis has increased by 27% in the last decade, so additional resources and funding are needed to improve research into it.

I always make the comment—although that does not make this any less of an issue—that research and development is so important in, hopefully, addressing some of the issues for those with COPD. Last Friday I had a lady in my office with severe COPD who has an issue with housing She is in a flat, and when she moved there I suppose the issue was not apparent, but she is now a prisoner in her flat and cannot get out unless someone takes her. She is overwhelmed by exhaustion whenever she goes anywhere, and I am trying my best to help get her relocated to a property at ground level that is nearer the centre of the town, where perhaps her quality of life can improve.

The Regulation and Quality Improvement Authority for Northern Ireland has stated that 37,000 people have been diagnosed as having COPD. Half as many as the number already on the COPD registers are thought to be living with COPD without the disease being diagnosed —a point I made earlier—bringing the total to approximately 55,500. Those figures are just for Northern Ireland, where 37,000 people have it, but 55,500 might have it—one third more. If that is replicated in the rest of the United Kingdom, the figures will be almost 2 million. I am not the greatest mathematician in the world, but I think those figures are fairly approximate.

The Northern Ireland Chest, Heart and Stroke charity, which does incredible work, has nicknamed COPD the “creeping killer”, as it is the fifth biggest killer in the UK, but very often people are completely unaware of its severity. When we see constituents in the advanced stages of COPD or living on 24/7 oxygen, we very quickly understand the severity of it.

The all-party parliamentary group for respiratory health, which I chair, has recently gained mass support from respondents for a lung cancer action plan to draw together all the different strands of respiratory policy and make them into one strategy. The British Lung Foundation has strongly supported that plan. The Primary Care Respiratory Society also supported the need for a national NHS action plan, claiming it would help to improve rates of earlier diagnosis and reduce the rates of death from lung cancer. If we adopt, pursue and fund those twin goals, we can try to address the issue, reduce the numbers and give people a better quality of life. It was also felt that any action plan should consider a pathway for people who are found to have non-cancer respiratory symptoms that need investigating.

We often find that constituents do not have just one issue; they have a complex number of issues, and central to that for those with COPD is the COPD. People with COPD who have been active for most of their days suddenly have issues with mobility, anxiety and depression and cannot be active any more. Some of the most prominent ways to help slow the progression of the condition are often the simplest.

The summarised treatment options from the NHS include encouraging people to stop smoking. We had a debate in this Chamber yesterday morning on the tobacco control plan and it was clear—certainly to me as a Northern Ireland MP—that the figures for those stopping smoking have not reached the targets we hoped they would. The consensus among parties on both sides of the Chamber yesterday was clear.

Treatment options also include taking up the use of inhalers and tablets, lung rehabilitation and transplants. The NHS long-term plan addresses the need for early diagnosis and more suitable treatment. Given the figures stated earlier, the long-term plan must be implemented as soon as possible. I ask the Minister—I usually try to ask a couple of questions in my contribution—when will the long-term plan be implemented? We need to see a timescale for that so that we know whether the right strategy has been adopted. I am not criticising anybody—I want to make that quite clear—but if we are committed to the long-term plan, can we have the timescale, please?

Much of our time and funding has been dedicated to covid, and there is no doubt that it falls under the umbrella term of respiratory disease. Our lungs are one of our most vital organs—needed to keep us alive—and there must be better awareness of the symptoms of COPD. The main ones include increasing breathlessness and a persistent phlegmy cough—we get that with colds or flu, but those with COPD have it every day of their lives, and every hour of every day. Those are not normal symptoms to have for a prolonged period.

I want to conclude by thanking the charities that do significant work in providing support for those who suffer from COPD, such as the British Lung Foundation, the National Association for the Relief of Apnoea—the breathing charity—and the COPD Foundation. I call on the Minister and the Government to study the figures and strongly consider allocating additional funding. We must help those constituents and patients with COPD. That, if we can do that, is the most essential way of preventing serious illness or even death. Our lung health is something that we should all make a priority.

--- Later in debate ---

[Gillian Keegan]

Of course, access to GPs’ services is a concern that all Members will have heard a number of their constituents raise. That is why we put in place £250 million to increase access to face-to-face GP appointments as part of the recovery plans, which are quite extensive for the NHS.

The guidelines I was talking about aim to highlight ways to support people with COPD, such as signposting charities and support groups for better health and wellbeing. They recommend using technology to reduce some in-person appointments, while making sure not to provide a service that would increase health inequalities through a lack of digital access—it is additional, not instead of—as well as offering advice on how to modify care during the pandemic.

A number of questions were raised about the recovery plan, and how to restore services for patients and restore the diagnostics to pre-pandemic levels, or above them. The 2021-22 priorities and operational planning guidance set the priorities for NHS England and NHS Improvement, and includes tackling the backlog for non-urgent treatment such as services for lung disease patients. That plan aims to stabilise total waiting lists, and eliminate waiting times of two years or more and the increase in waiting times of more than one year. We have made £1.5 billion available to assist local teams to increase their capacity and invest in other measures to achieve those priorities, and the 2021 spending review announced £2.3 billion to increase the volume of diagnostic activity and open community diagnostic centres to provide more clinical tests, including for patients with lung disease.

Targeted lung health checks are running in the parts of the country with the highest rates of mortality from lung cancer. However, those projects will not just identify more cancers, but pick up a range of other health conditions, including COPD. People aged between 55 and 74 who have ever smoked are now offered a free lung health check closer to where they live. They may then have a lung cancer screen scan if that check shows that they need one. A review undertaken by Professor Sir Mike Richards highlighted that patients with respiratory symptoms would benefit from community diagnostic centres, due to the number of diagnostic tests that will be made available. As well as supporting patients with COPD, the Government are committed to strategies that will help to prevent that condition, as a number of Members have mentioned.

[Jim Shannon]

Just for clarification, following on from the question that the hon. Member for Halton (Derek Twigg) has asked, does the Department of Health proactively—perhaps even aggressively—contact smokers to follow through, rather than those smokers contacting the health service? I am not sure whether that would always happen. What is the Government’s policy on that?

[Gillian Keegan]

Obviously, there would be a relationship between the GP and the smoker, but that can go either way. Anybody who is in those age groups needs to be made aware that they are entitled to this free lung health check, and it is the responsibility of us all to make sure those checks are available. I am sure we will all ensure that that is understood.

In 2019, 85% of deaths due to COPD were attributable to smoking, and in 2019-20, 84% of hospital admissions with COPD were attributable to smoking. The proportion and the number have remained quite similar over the past five years, and as has been mentioned by a number of hon. Members, smoking is a key factor in many cases of COPD. This Government are committed to reducing the harms caused by tobacco, and have made good long-term progress in reducing smoking rates, which are currently 13.9%, the lowest on record. However, with 6.1 million smokers in England, tobacco is still the single largest cause of preventable mortality, and a radical new approach is needed to address the stark health disparities associated with tobacco use. As such, we have set out the bold ambition for England to be smoke free by 2030. To support that ambition, we have announced the publication of a new tobacco control plan, which will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda.

The NHS long-term plan commits to delivering NHS-funded tobacco treatment services to all inpatients, pregnant women and people accessing long-term mental health and learning disability services by 2024. COPD is responsible for around 33% of annual deaths from respiratory diseases and is the single largest cause of occupational lung disease. There are an estimated 17,000 annual new cases of self-reported, work-related breathing or lung problems, which is why our colleagues in the Department for Work and Pensions are also helping to tackle the causes of COPD in the workplace.

Autism and Neurodiversity Research Funding

Jim Shannon Excerpts

Tuesday 16th November 2021 Commons Chamber

[Robert Buckland (South Swindon) (Con)]

It is with great pleasure that I rise in my first end-of-day Adjournment debate in the better part of eight years, but it is a topic that I am very happy to return to from this position. It is one that I championed in Government and one that I worked very hard on when I was a Back Bencher prior to my ministerial office. I am hugely grateful to Mr Speaker for granting me today’s debate.

Many hon. and right hon. Members will know that this issue has been close to my heart for many years: autism and the range of brain conditions that can be summarised by the word neurodiversity. From my own direct family experiences, which I spoken about in this Chamber when we held the first Chamber debate on autism back in 2013, and from the plethora of constituency casework that I have worked on over the years helping families of children and young people with autism and associated conditions, I have developed a certain knowledge and experience of these issues. As a Minister and a Secretary of State, I was glad to be able to push the agenda even further.

One of the privileges of being a Back Bencher is that I can put on record my thanks to local organisations in my constituency which do so much to support and work with people with autism, whether it is officers of the local authorities, volunteers in local carers’ groups such as the Swindon Carers Centre, or organisations such as the Uplands Enterprise Trust, which is pioneering and developing more post-19 support for young people with autism and other disabilities in my area, working with the excellent special schools network and the Brunel multi-academy trust in Swindon. It is really innovative work.

My debate today is the beginning of a process that was made clear in my exchange of letters with my right hon. Friend the Prime Minister on my departure from Cabinet two months ago: to bring about a sea change in how autism and other brain conditions are not only diagnosed, but supported and treated throughout the lives of those people. Our country is one of the most advanced in the world when it comes to these issues, but there is still a huge amount to do.

My successor as chair of the all-party parliamentary group on autism, the late, great Dame Cheryl Gillan, will always be remembered as the author of the groundbreaking Autism Act 2009, which was a new departure for health, in that a specific condition was delineated in legislation, much against the initial resistance of the then Government, but the strength of feeling in this place and outside was such that Dame Cheryl thankfully got her way. The autism strategy, which was revised in its latest iteration only in July this year, is the direct result of that important legislation. Twelve years on, I think we can safely say that awareness and diagnosis levels have risen dramatically, but the situation remains stark.

About 1 million people in the United Kingdom are autistic, but they still have some of the worst outcomes in our society. First, the death rates mean that they die on average decades before the rest of us. Secondly, with two in 10 in employment, they have the lowest employment rates of all disability groups. Importantly, and deeply worryingly, disproportionate numbers of autistic people and people with brain conditions end up in mental health detention or, even worse, in our criminal and youth justice systems. They are being locked up by a system that represents barbaric practices from a generation ago. I have certainly found, from my professional and ministerial experience, far too many in our prison system, our young offenders’ institutions and our criminal justice system generally with those conditions.

[Jim Shannon (Strangford) (DUP)]

I know the right hon. and learned Gentleman has had a particular interest in the issue for a number of years, for both personal and other reasons, so I congratulate him on securing this debate. I give an example from Northern Ireland, which to be fair is not the Minister’s responsibility, but shows what is happening: an increase of 148% in the number of children waiting for an assessment for autism and a 687% increase in the number waiting more than a year for an assessment. This is a system where the capacity is nowhere near meeting demand, as I think the right hon. and learned Gentleman has also said. Does he agree that a corresponding increase in funding to get to the root of autism and how best to treat and live with it must be a priority for the Government?

[Robert Buckland]

I am grateful to the hon. Gentleman, who rightly outlines some of the pressures on the system—the increase in diagnosis, which in many ways is a good thing, and the personnel and capacity issues that cause many of the delays in diagnosis, which are all too familiar a pattern for many families, including those in England, Wales and Scotland.

It is interesting to note that research by, I think, the Northern Ireland Assembly calculated the estimated cost to the country of the failure to deal with autism at a staggering £32 billion. Let us just think about that. What a cost to our country: resources wasted, lives wasted and lives lost as a result of these omissions. It does not have to be like this.

Tobacco Control Plan

Jim Shannon Excerpts

Tuesday 16th November 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this important debate. He and I share many interests in common in this House, and this is one of them. I welcome the new Public Health Minister to her role. It is vital that smoking should be at the top of the Government’s list of priorities. Although Northern Ireland and the devolved nations are responsible for our own public health policies, the Government in Westminster retain responsibility for important UK-wide policies. Ensuring that the Minister understands the importance of urgent action on smoking is therefore vital for ensuring that we make the progress we need to make in Northern Ireland.

Last year, a review of Northern Ireland’s progress in the 10-year tobacco control survey, published in 2012, was released. Although we met our target in ensuring a minimum of 5% of the smoking population accesses smoking cessation services annually, that was the only target from the 2012 strategy that had been achieved, which is disappointing. Quite clearly, we are not hitting our targets at a population level. Results from Northern Ireland’s health survey show there has been no significant change in smoking rates from 2018-19, with 17% of the adult population still smoking—the highest rates in the UK. This is extremely disappointing and, as my party’s health spokesperson, I am concerned about what is happening.

Of most concern, however, is that we are failing the most disadvantaged smokers. The target was to reduce smoking rates among manual workers from 31% to 20% by 2020. We are far from this, with rates among manual workers still at a very stubborn 27%. Similarly, rates of smoking in pregnancy have barely declined over the years, despite that having been a priority in the strategy, as the hon. Member for Harrow East mentioned. We had hoped to reduce levels from 15% in 2010 to 9% by 2020. However, the proportion of pregnant women who smoke at the time of delivery is still a very disappointing 14%. We all know that that puts women and their babies at risk of serious and avoidable harm. We are, however, doing better with children and young people—another priority area. Smoking rates among 11 to 16-year-olds have been halved to 4% since 2010. We had set a target of 3%, which was missed. We are not there yet, but that is one area of improvement.

Although smoking rates have declined among children and young people, analysis by Cancer Research UK estimates that 10 children under 16 take up smoking every day across Northern Ireland. If that does not worry you, Mr Bone, it should. Children who live with smokers are almost three times more likely to take up smoking than children from non-smoking households, which creates a generational cycle of inequality, with smoking locked into disadvantaged communities. It is clear to me, in the statistics that are put forward, that disadvantaged communities are one of the areas that the Government and the strategy need to address.

A third of smokers in Northern Ireland still report smoking inside their home, which demonstrates that there is much further to go in creating smoke-free communities and protecting children and others in the household, but progress is being made. I trust that hon. Members saw the recent announcement that, not before time, Northern Ireland will join the other UK nations in banning smoking in cars carrying children. That overdue but welcome measure will help to protect our young people and prevent the creation of a new generation of smokers.

Smoking is a significant challenge in Northern Ireland, particularly in our most disadvantaged communities, which have faced so much adversity in the last 18 months. Those problems are not specific to Northern Ireland, however, as smoking and the inequality that it causes are challenges for the whole UK. Our job is not over yet. Northern Ireland and the whole UK have much further to go on smoking, and there is no time to lose.

I trust that the Minister agrees with all hon. Members and will be even more steadfast in her conviction by the end of the debate. The recent Budget and spending review was an opportunity to go much further in achieving the smoke-free society that we need. Regrettably, that was not realised. Tax increases are one of the most effective interventions that we have to reduce smoking rates and uptake, although that may not be all hon. Members’ opinion. Vitally, they are also the only intervention proven to reduce inequality.

I am convinced, like the hon. Member for Harrow East, that increasing the cost of tobacco products through taxes drives down smoking rates, increases tax revenues and reduces the cost to public finances and society. I hope that the Minister will give us some reassurance. It is an intervention that we should make the most of. The Chancellor’s announcement that the duty escalator rate on all tobacco products would increase by 2% above inflation, and by 6% above inflation on hand-rolling tobacco was welcome, but we could and should have gone further.

There is still a major gap in excise tax rates between factory made cigarettes and hand-rolling tobacco, which makes the latter more affordable and encourages smokers to trade down to it rather than quitting. That disparity has made hand-rolling tobacco increasingly popular over the years, which should have been addressed by the Chancellor. It is not the Minister’s responsibility, but I am keen to hear her thoughts on it and what discussions she may have had with the Chancellor. In 1998, fewer than one in five smokers mainly rolled their own cigarettes, but that number is about one in three in Northern Ireland today. I would welcome that issue being addressed through tax revenue. Tobacco taxes are a reserved issue, so I hope that the new tobacco control plan will commit to maintaining high duty rates on tobacco products, as the last one did. I also hope that the Chancellor will seize future opportunities to increase duty rates for tobacco products.

I have repeatedly raised the issue of licensing for tobacco retailers in this House and I will do so again. In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the tobacco register of Northern Ireland; the final deadline for doing so was 1 July 2016. That built on a similar scheme already in place in Scotland, and a scheme is due for implementation in Wales. Since 2018, we have implemented a track-and-trace scheme that requires every retailer to have an economic operator identifier code registered to their business and a facility identifier code for each store or premises that stores tobacco.

Since leaving the EU, the UK has established and launched its own system, with Northern Ireland operating in the UK and EU systems. That makes it easy for all nations in the UK, including England, to not just implement a retail register scheme, but go further and implement a comprehensive retail licensing scheme. Retail licensing is the obvious back-up to the tracking and tracing of cigarettes and would help to tackle the illicit trade that gives smokers access to cheap tobacco.

In Northern Ireland, there has been a serious issue with paramilitaries using illegal tobacco as one of their revenue streams. Those who sell it have no compunction about selling it to children too. The illegal trade makes it not just less likely that smokers will quit, but more likely that children will start. That double whammy greatly concerns me. The Police Service of Northern Ireland is aware of that and is taking steps to address the issue.

I urged the Minister’s predecessors to ensure that their officials were in contact with the devolved nations on retail licensing and I do so again. Will the Minister ensure that her colleagues at Her Majesty’s Revenue and Customs talk to their equivalents in Northern Ireland, Scotland and Wales about their experiences with tobacco retail licensing and the lessons that they have learned regionally from the experiences of the devolved nations?

I am conscious that other hon. Members want to speak. England remains an outlier on this important measure that could help to tackle illicit trade and protect children from tobacco. My absolute priority is stopping children’s access to tobacco. We can and should address those issues collectively, bringing knowledge from the nations that we represent—the four regions of the great United Kingdom of Great Britain and Northern Ireland. If we do so, I am confident that we can and will deliver policy that helps not only us but the constituents that we serve. That is our duty.

Covid-19 Update

Jim Shannon Excerpts

Monday 15th November 2021 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

And finally, I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his clear commitment to protecting all citizens in the United Kingdom where the control is. I am a type 2 diabetic. This Saturday, between 2 pm and 3 pm, through my local surgery, I will receive my covid booster, as will other priority cases as well. Can the Secretary of State outline what discussions have taken place to ensure that, before over-40s are able to access their booster jabs, the vulnerable groups of all ages, including diabetics, can access theirs in a timely manner throughout the UK? Decisions taken in this House set the marker for other regions to follow, including Northern Ireland.

[Sajid Javid]

As the hon. Gentleman will know, one reason why our vaccination programme has been such a huge success is that it is a truly UK-wide programme. We are able to do that because of the strength of our Union. I work closely with my colleague in Northern Ireland: we co-ordinate together and share resources. When it comes to supply, that supply is for the whole United Kingdom. In terms of making sure that particularly vulnerable people have access, each of the devolved Administrations has a slightly different approach, but we do work closely together to make sure that the supply is there.