NHS Dentistry

Jim Shannon Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I must make some progress.

Turning to other parts of the country, Keir Cozens, Labour’s candidate in Great Yarmouth, has been running a campaign on the state of dentistry in Great Yarmouth. He has heard heartbreaking stories of broken teeth left for months with people in pain, of children unable to be seen, of at least one person a day going to accident and emergency with dental issues, and of people performing DIY dentistry at home after buying kits from Amazon. No one should be doing that, but people are desperate. DIY dentistry does not work, and before you know it, people are back in A&E waiting for expensive emergency dental treatment. I have heard similar stories from Kevin Bonavia, Labour’s candidate in Stevenage. He tells me that people turning to DIY is shockingly common.

No one voted for this. None of the five Conservative Prime Ministers, the seven Conservative Chancellors or the eight Conservative Health Secretaries told the public that this was what the future held, but this is what they have done to dentistry. It is the way all our public services are going, and it is why the Conservative party cannot be allowed five more years to finish the job.

[Jim Shannon (Strangford) (DUP)]

I thank the shadow Secretary of State for bringing this debate forward. The stats from the British Dental Association cannot be ignored. In its survey, 41% of practice owners and 38% of associate dentists said that they would like to leave NHS dentistry as soon as possible. This debate will resonate with many people out there. Does he agree with the chair of the Northern Ireland Dental Practice Committee that now is the time for the funding allocation to pay for a better contract and for training more dedicated dentists who will commit to the NHS, rather than private practice?

[Wes Streeting]

I agree with the hon. Gentleman about the urgency of the situation. There is a different path available to us. We can revive our public services and give our country back what we used to take for granted. Labour’s plan would take immediate steps to rescue NHS dentistry, with 700,000 more urgent appointments and the recruitment of new dentists in the areas most in need. We would also take the necessary steps to rebuild NHS dentistry over the long term, including reforming the dental contract and introducing supervised toothbrushing for three to five-year-olds in primary schools, so that poor oral health is prevented and demands on the service reduced.

In fact, some of my Labour colleagues are not even waiting for the general election to start making a difference. Labour’s candidate in Stroud, Simon Opher—himself a GP—has spearheaded a campaign working with local dentists and the integrated care board. From opposition, he has more than trebled the number of emergency appointments available each day across Gloucestershire, pioneered a new dental stabilisation scheme for people not known to a local practice, opening up more than 130 appointments a week, and introduced supervised toothbrushing in 14 local primary schools. If that is the difference Simon is making in opposition, imagine what he will be able to do as a Labour MP working with a Labour Government. That Government cannot come soon enough.

Sexual Harassment of Surgeons and Other Medical Professionals

Jim Shannon Excerpts

Wednesday 13th December 2023 Westminster Hall

[Rosie Duffield (Canterbury) (Lab)]

I beg to move,

That this House has considered the matter of sexual harassment of surgeons and other medical professionals.

It is a pleasure to serve under your chairship, Mr Mundell. I am grateful for the opportunity to raise the issue of sexual assault against surgeons, nurses, doctors and other healthcare professionals and patients in clinical settings. In April, I used my Prime Minister’s question to mention the report commissioned by the Women’s Rights Network and written by my friend, the sociologist and criminologist Professor Jo Phoenix, entitled “When we are at our most vulnerable”. The report revealed some truly shocking statistics about violent sexual assault, and everyday inappropriate and unwanted acts intruding into the work lives of professionals and disrupting the recovery of the most vulnerable and ill. How dare we call ourselves a civilised society if we turn a blind eye to this and do not do everything possible to support those women, and some men, who are brave enough to come forward, as well as those who do not feel that they can and suffer in silence?

Professor Phoenix found that more than 6,500 rapes and sexual assaults had been committed in hospitals in England and Wales over a period of nearly four years. Some were against children under 13, yet in a mere 265 cases—a minute 4.1%—was anyone known to have been charged. In total, 2,088 rapes and 4,451 sexual assaults—6,539 cases—were recorded by police forces from January 2019, and one in seven of those, or 266 a year, took place on hospital wards. As the researchers at the Women’s Rights Network sent freedom of information requests to 43 police forces across the UK and 35 responded, the figures are, in truth, even higher and even more shocking.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate and on what she does. Those of us who are here have a particular interest. A recent survey of 2,500 doctors by the British Medical Association found that 33% of female and 25% of male respondents had experienced unwanted physical contact in the workplace. Worse still, these are only the figures for those medical staff who felt confident enough to come forward, so unfortunately the figure is probably much larger. Does she agree that provision must be put in place in the NHS and other, private healthcare facilities to ensure that staff members feel not only safe and protected, but encouraged to come forward and discuss instances of sexual abuse and rape within the workplace? In other words, there must be somewhere to go, someone to talk to and someone to sort it out.

[Rosie Duffield]

Absolutely, and I thank the hon. Member so much for raising that important point, which is supported by all the work that the BMA has done, including the report that he mentioned.

The rape of a female child under 13 was included in those shocking statistics, alongside the rape of a female over 16 by multiple offenders in west midlands hospitals, three rapes of a female under 16 in Cambridgeshire, and six rapes of girls under 13 in Lancashire. It is important to note that although the FOI responses do not record the sex of the victims, national data shows that less than 5% of rape victims are men, so it is reasonable to assume that most victims are female. The investigation uncovered 13 rapes of males over the age of 16, however, including one incident involving multiple offenders, and the sexual assault of a male child under the age of 13 in a Cambridgeshire hospital.

We know that hospitals are, of course, monitored by many CCTV cameras, and individual wards usually have safe-door entry systems, which prompts the question of why only a tiny percentage of cases—4.1%—resulted in a charge or a summons. Indeed, five police forces did not issue a single summons or charge a single suspect for any of the 334 reported sexual assaults in their areas. Why not? The WRN report says:

“The damning figures are probably ‘the tip of an iceberg of indifference’ around the safety of NHS patients and staff”,

as some forces gave inadequate information. For example, Police Scotland did not provide any figures, citing cost constraints, and of those forces in England and Wales that did respond, seven forces provided incomplete responses, five did not give information on the number of assaults that occurred on hospital wards, and three did not provide information about the number of people charged or summonsed.

As Heather Binning, founder of the Women’s Rights Network, says:

“These statistics are jaw-dropping. We began this investigation because a number of members raised concerns about the safety of women and children on NHS wards, but we are horrified at what we have uncovered.”

I am grateful to the WRN for highlighting this problem and shining a light on something that has gone almost completely unnoticed in this place before.

The BMA represents doctors and medical students across the UK. It also produced a briefing for today’s debate, as we heard earlier from the hon. Member for Strangford (Jim Shannon). It states:

“The BMA is deeply concerned by the overwhelming number of doctors who have experienced sexual harassment at work.”

Its “Sexism in medicine” report of September 2021 found that 91% of women doctors in the UK have experienced sexism at work, with 42% feeling that they could not report it.

Crohn’s and Colitis Awareness Week

Jim Shannon Excerpts

Tuesday 12th December 2023 Commons Chamber

[Hannah Bardell (Livingston) (SNP)]

I am incredibly grateful for the opportunity to hold this debate and for the flexibility shown by the Speaker’s Office in moving it when I was ill last week.

Last week was Crohn’s and Colitis Awareness Week, an opportunity to break the silence on inflammatory bowel disease and highlight the impact of these terrible conditions on people’s lives. I want to thank in particular: Crohn’s and Colitis UK, which has given us a huge amount of support; the hon. Member—my hon. Friend I would like to call her—for Chesham and Amersham (Sarah Green), who with me jointly recently reconvened the all-party parliamentary group on Crohn’s and colitis; and Alyson in my office, who supported me in writing today’s speech.

Over 500,000 people in the UK—one in every 123 people—live with Crohn’s disease or ulcerative colitis. These are debilitating, lifelong conditions that develop when the immune system attacks the gut. Tragically, there is currently no cure. Symptoms include urgent and frequent diarrhoea, rectal bleeding, pain, profound fatigue, anaemia, and inflammation of the joints, skin, liver and eyes. These conditions are widely misunderstood, with its invisible and stigmatised symptoms often leading to isolation, a lack of support and poor mental health. That is why this Crohn’s and Colitis Awareness Week we wanted to break the silence on inflammatory bowel disease, raising greater awareness of the conditions and helping those many people—many of them our constituents —living with them to speak more openly about the impact on their lives.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady. I was looking forward to her Adjournment debate last week. It is good to see her back in health and strength. Incontinence is a common symptom of Crohn’s and colitis, experienced by as many as three in four people with Crohn’s or colitis. Understandably, incontinence or the fear of experiencing incontinence can cause anxiety about leaving home, which can seriously affect work and social life. Does she agree that more work must be done with the Department for Work and Pensions to train personal independence payment assessors on the impacts of Crohn’s and colitis, to ensure that those suffering have the best possible chance of getting the benefits that they are entitled to?

[Hannah Bardell]

It almost seems as if the hon. Gentleman has read the next bit of my speech, because I was about to come to the point he has just made—and it is an extremely important and salient point. We do need to ensure that PIP assessors, and the whole framework, can take into consideration those with relapsing and remitting conditions such as Crohn’s and colitis.

I now want to share the experiences of some of those people with the House, because one of them is my brother. When he was diagnosed with ulcerative colitis just over nine years ago, he was in his late 20s and a new dad to a premature little girl. While we were cooing, and worrying a little, about this new bundle of joy—who is now a strapping nine-year-old—my brother was struggling, and had been for some time. I think that, in truth, he was terrified about how fatal the diagnosis might be. It was not until much later that it dawned on us all just what he had been through. When his diagnosis finally came, it was truly devastating. His life and that of our family were, for a period, turned upside down. An active and fit football lover, a new dad and an outgoing and often, frankly, a bit too cheeky young man was stopped in his tracks.

As a frontline police officer with big ambitions and talent, my brother had to adjust to a very different life, existence and career path. The pain, the fatigue and the various other symptoms that he, like many others, had experienced suddenly had a name. Apart from the initial period when he was off work to recover and adapt, his condition meant that, for instance, our annual camping holiday in the west highlands was suddenly in jeopardy. A four-hour drive when it could not be predicted whether toilets would be open or available was suddenly something that was potentially out of reach. My brother, however, being the resourceful problem-solver that he is, traded his car for a pick-up truck and popped a portable loo in the back, which meant that while he adjusted to his anxiety about being able to find a toilet when travelling, such things could be managed. I do not think he ever used the portable loo, but it was there just in case.

I believe that my brother would now count himself one of the lucky ones, and that, in fact, is just the point. For those who suffer from any kind of inflammatory bowel disease—and I acknowledge that people with endometriosis or conditions like cancer suffer very similar challenges—finding a loo that is working, stocked and clean is a perennial problem. Perhaps the Minister would like to meet me some time to discuss how we can develop better facilities—perhaps some kind of interactive map, in an app, of “loos that will do”.

My constituent Steven Sharp, to whom I pay tribute, is a brilliant young man from Fauldhouse. He is a Crohn’s sufferer, and he has raised thousands of pounds for charity over the years by, for instance, doing a bungee jump. He has often spoken to me about the joint pain, the fatigue and the unpredictability of the disease and its impact on his life. That unpredictability is one of the major challenges; the symptoms can change and be different every single day. Steven also lives with a stoma. He and I recently met the Prime Minister, and I have to say that the Prime Minister was incredibly supportive and kind to him. I hope that that kindness will be extended to provisions to ensure that those living with Crohn’s and colitis can obtain the support they need.

My friend Rachel Agnew, who I hope is watching the debate and with whom I spent time this summer, also talked to me about her many years of illness with Crohn’s disease and a possible misdiagnosis. Having had many major operations, she now has “Stan the stoma”, who can sometimes be cantankerous but has ultimately saved her life. Rachel recently had to give up a job that she loved, and is now having to navigate the complexities of the benefit system while having a relapsing and remitting disease.

Research commissioned by Crohn’s and Colitis UK has revealed that the scale of Crohn’s and colitis has been vastly underestimated, and that twice as many people as previously thought are living with the condition. In particular, as we know from recent debates and briefings, young children are being diagnosed earlier and earlier in their lives. I think that we need to pause and consider why that is happening. What are the environmental impacts? What are the impacts of over-processed food? I have no doubt that those elements play a part, and we need to fund research to enable us to get to the bottom of that.

--- Later in debate ---

[The Minister for Health and Secondary Care (Andrew Stephenson)]

Let me start by congratulating the hon. Member for Livingston (Hannah Bardell) on securing this debate on this important issue. She is a tireless campaigner for those living with bowel conditions, particularly Crohn’s and colitis, and she has spoken movingly this evening about her own family’s experience of the condition. I also pay tribute to the hon. Members for Chesham and Amersham (Sarah Green), for Strangford (Jim Shannon), for Upper Bann (Carla Lockhart) and for East Renfrewshire (Kirsten Oswald) for their contributions. I will try to address as many of the points that have been made in the time allowed to me.

It is important that we all do everything we can to break the stigma and ensure that sufferers’ voices are heard. The hon. Member for Livingston has already done invaluable work in helping to re-establish the all-party group on Crohn’s and colitis. I also wish to pay tribute to the charities that support half a million people living with IBD across the UK all year round—Crohn’s and Colitis UK, the Crohn’s in Childhood Research Association, and the Crohn’s and Colitis Foundation, to name just a few. On this issue, as with so many others, it is vital that we do everything we can to break down the barriers to those affected from accessing healthcare. As Crohn’s and Colitis UK has said, “it takes guts” to come forward with your story, and I salute its “cut the crap” campaign. I look forward to working with the hon. Lady as we find solutions to improve the lives of people living with this disease. As she has rightly said, living with Crohn’s and colitis can be a daily struggle. Symptoms of the disease can be embarrassing, leading to people feeling isolated and not reaching out for the support they need.

I will focus briefly on three things my Department and NHS England are doing to help sufferers: raising professional awareness, improving diagnosis and research. I begin with the crucial point about raising awareness, as getting people diagnosed as early as possible is key.

There are two kinds of awareness. First, as the hon. Member for Chesham and Amersham mentioned, there is raising awareness among the public. Stigma is the invisible wall preventing people from seeking the help they need and campaigners are central to smashing that stigma, because of their reach into communities across the country. Campaigners, like the hon. Member for Livingston’s constituent Steven Sharp, have done much to raise awareness and break down that invisible wall. They encourage people to get to their GPs and ask the right questions. I am keen for us to be backing people like Steven every step of the way.

By helping GPs to recognise the symptoms of Crohn’s and colitis through NHS England’s “Getting it right the first time” gastroenterology programme, conditions can be diagnosed as quickly as possible. The programme supports primary care services, driving appropriate referrals and managing inflammatory bowel disease in the community, and is estimated to reduce emergency admissions by more than 6,500 a year. It has been commended by the King’s Fund, which is not always in the habit of showering praise on the Government.

It is also right that doctors should be properly trained to treat the symptoms of Crohn’s and colitis as they appear. In the past five years, the National Institute for Health and Care Excellence has produced a range of guidance to ensure that the care doctors provide for Crohn’s is based on the best possible evidence.

Early diagnosis can make a clear difference to people’s quality of life. We are working hard to improve early diagnosis rates through the “Getting it right the first time” programme and through measures that include more six and seven-day services, extended hours, reviewed and expanded endoscopy capacity, and improved patient flow. NHS England is working closely with front-line clinical experts, patient representatives and leading charities to develop evidence-based tools that improve care. The work includes provision of a right care scenario on inflammatory bowel disease. That will set out our expectations of high-quality, joined-up care at every point of the patient journey, from diagnosis to treatment. Officials assure me this is being finalised and will be delivered in the coming year.

NHS England’s national bladder and bowel health project is delivering better care to people with inflammatory bowel disease, with a focus on developing clinical pathways. Making a diagnosis of Crohn’s and colitis can be difficult and frustrating for patients as the condition can be confused with irritable bowel syndrome, so I am pleased that NICE has recently made faecal calprotectin tests available on the NHS as a non-invasive, inexpensive method for assessing patients before invasive procedures are required.

As the Minister responsible for life sciences, I am passionate that we can do everything we can to accomplish better patient outcomes through investing more in research. That is key to gaining a better understanding of the causes of inflammatory bowel disease, leading to better diagnosis, treatment and outcomes.

[Jim Shannon]

I thank the Minister for his comprehensive response, by which I am sure hon. Members are encouraged. However, the hon. Member for Livingston and I asked specifically about PIPs, which we are very concerned about. I know that is not the Minister’s responsibility, but will he undertake to speak to the relevant Minister to ensure there are movements to help and improve that system?

[Andrew Stephenson]

I am happy to give the hon. Member that undertaking. As he rightly acknowledges, I am not a Department for Work and Pensions Minister. I do not want to tread on their toes, but I will be relaying the clear views expressed during the debate to DWP Ministers because it is important that we get the benefit system right to support all people living with conditions such as these.

I will, if I may, return to the research point. We are investing more than £1 billion a year in health research with the National Institute of Health and Care Research. We are funding 60 projects on Crohn’s and colitis research, backed by more than £33 million over the past five years. I appeal to every scientist who may be interested in research in this area to keep applying for grants through the NIHR. I will leave no stone unturned in finding out what more can be done to address the needs of people affected by these conditions. I look forward to working with the hon. Lady to create the kind of care that people deserve. Whatever our political differences, I am sure that we will agree that half a million people living with inflammatory bowel disease are entitled to the highest possible standards of care and support.

I will continue engaging with the hon. Lady and with NHS England to make sure that the “Getting it right first time” programme is delivering results for patients on the ground. I began this speech by talking about the invisible wall preventing people from accessing the healthcare that they need. Let us tear down that wall together.

Question put and agreed to.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 5th December 2023 Commons Chamber

[Maria Caulfield]

First, early indications show that the respiratory illnesses in China are likely to be due to increasing levels of endemic infection. These are normal infections but at a higher level.

Secondly, we are not waiting for the covid inquiry before we implement lessons learned. One of the key changes we have already made is the introduction of the UK Health Security Agency, which carries out surveillance on both national and international threats. A good example of its work is last year’s strep A outbreak, which it managed and contained very well. This year, the identification of a new covid variant—not a variant of concern—meant we brought forward our autumn vaccination roll-out.

[Jim Shannon (Strangford) (DUP)]

For all of us who lost loved ones, covid-19 is still very raw. I have been following the covid inquiry, and two recommendations have so far come forward. The first is that the lockdown should have been earlier, and the second is that those with covid should not have been sent to care homes—covid went through care homes and cast death everywhere. Has the Minister taken those two lessons on board?

[Maria Caulfield]

I know the hon. Gentleman had a personal loss to covid, and he is absolutely right to highlight those lessons learned. We are learning lessons, but each pandemic or increase in infection is different. It may have been appropriate to have lockdowns for covid-19, but lockdowns may not be appropriate for other infections, such as strep A or other respiratory illnesses. We set up the UKHSA to provide expert advice. We are learning lessons from the covid inquiry, and we are already taking action.

Hospice Services: South Devon

Jim Shannon Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

I thank my hon. Friend for his intervention and for the work that he does as the chair of the APPG. I could not have put it better myself; he is absolutely right that there can be postcode lottery. Also, the variations are quite significant; I accept that some areas may have different types of services and some may have a greater ability to fundraise, but we should certainly seek a level of consistency across the country, to ensure that people have access to that service when they need it.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. Hospice care is important for us all, but I want to note Horizon House in Belfast, which is a children’s in-patient unit. It is the only service of its kind in Northern Ireland. There are 10 cots and beds available in Horizon House, but it does not have funding for clinical care. Does the hon. Member recognise, as I do, that it is not just about the clinical funding that comes in, but the voluntary and charitable work that volunteers do to make it happen?

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

World Stroke Day

Jim Shannon Excerpts

Thursday 23rd November 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

You are most kind, Mr Hollobone; thank you for calling me. May I say what a pleasure it is to follow the hon. Member for York Central (Rachael Maskell)? Her contribution was truly magnificent. It was full of the detail, knowledge and experience that the hon. Lady brings to these debates. To be honest, I am a bit in awe of her contribution, because it was exceptional. We thank her for it.

I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for leading the debate. He has spoken on these matters in the main Chamber and in Westminster Hall, and he speaks from personal knowledge and experience. We all have him and his wife in our thoughts. I mean that sincerely and honestly; I cannot begin to understand the difficulties and experiences that he has had. He should be assured that he is in our thoughts.

As my party’s spokesperson for health, it is great to be here to mark World Stroke Day. I am sure that everyone present has been touched by the impact that strokes can have on families and friends. Over the years, I have had a number of friends who have had strokes, and they have been greatly physically disadvantaged. It is not just that; there is also an emotional aspect.

I was recently made aware of the “Neurorehabilitation: State of the Nation” report, published in October by Ipsen UK—which the hon. Member for Bromley and Chislehurst referred to—and Different Strokes. The report outlines the state of UK stroke rehabilitation services, with a focus on post-stroke spasticity, and uses 2022 data to assess the extent of post-pandemic recovery. Post-stroke spasticity is pain and muscle stiffness caused by stroke and nerve damage. Almost half of people who survive a stroke experience it within six months, and it quickly forms part of their physical disability and contributes to the loss of their ability to have a normal life. It interferes with someone’s normal physical function, speech and daily activities, and it is linked to poor health outcomes, including anxiety and depression. People are not able to do what they once did or follow their normal routine—that is the reality of their new physical condition.

The report’s findings demonstrate that many of the needs resulting from the impact of the covid-19 pandemic still have not been actively addressed. Its recommendations include levelling up neurorehabilitation service infrastructure across the United Kingdom of Great Britain and Northern Ireland. It is so important that we all do the same thing everywhere. The report also recommends the adoption of a standardised commissioning framework for those services to balance out regional health inequalities. We do not want to find that there is a postcode where services are good, but that in our postcode they are not so good. Other recommendations include better continuity of care after patients are discharged into the community, to ensure that they have access to rehabilitation and treatments needed to manage their spasticity, and better integration of post-stroke spasticity needs into wider stroke policy, such as the upcoming major conditions strategy.

Every three hours, someone has a stroke in Northern Ireland. There are more than 40,000 stroke survivors in Northern Ireland. Northern Ireland Chest Heart & Stroke is an active charity, and I put on record my thanks to it. The hon. Member for Bromley and Chislehurst referred to charities and volunteers. There are so many groups that do such great work; it is purely voluntary, but it really affects, challenges and helps people.

Stroke is one of the biggest killers in Northern Ireland and a leading cause of adult disability. In addition, we have the second-highest incidence of stroke in the UK and the second-highest mortality rate; in Northern Ireland, whether it is because of our lifestyle or the anxieties and problems of the last 40 years, we have a high mortality rate. For my constituency of Strangford, which is fairly rural, transforming stroke services is crucial in ensuring that patients have immediate access to the care that they need. The hon. Member for York Central outlined the necessity of stroke patients going to the right place and the right home. If they receive at-home care, it should be of a level that can give the necessary assistance.

The recommendations in the major conditions strategy are also applicable to Northern Ireland. While this debate is probably GB-specific, the recommendations and the way forward are clear, and they are things that we would wish to replicate in Northern Ireland. In summer 2022, the Northern Ireland Department of Health published its stroke action plan, detailing future steps in stroke care in Northern Ireland. However, progress implementing the plan is slow, with many stroke patients still not receiving treatment. The hon. Members for Bromley and Chislehurst and for York Central both mentioned that. It is so important, whenever someone’s life is changing physically and emotionally—and family weighs on top of that—that they have all the help they need to ensure that they can deal with their new condition and circumstances.

There is no doubt that there is still work to be done nationwide in our NHS. This debate will raise awareness of that and ensure that we move forward in a positive fashion. We must ensure that stroke patients are able to access the care and aftercare support that they require.

I look forward very much to hearing what the two shadow Ministers, the hon. Members for Denton and Reddish (Andrew Gwynne) and for Motherwell and Wishaw (Marion Fellows), have to say; I do not think there has been any Westminster Hall debate about health that the hon. Member for Denton and Reddish and I have not been in together—in most cases, we say the same thing. As I say, I also look forward to what my friend and colleague the hon. Member for Motherwell and Wishaw, who speaks for the Scots Nats, says. I especially look forward to hearing from the Minister. He is a man of compassion and understanding. I am quite confident that he will endorse what we are requesting.

One thing that we can all take away from this debate is knowledge of the earliest signs of a stroke, not only for ourselves individually but for the people around us—those whom we love and have been good to us, as we have been good to them, and our friends. With the right specialist support, research and campaigning, it is possible—this is the ambition—to rebuild even more lives and support people through their post-stroke treatment. That is my wish. I am sure it is also the wish of the hon. Members for Bromley and Chislehurst and for York Central, who spoke before, and the two who will speak after, the hon. Members for Denton and Reddish and for Motherwell and Wishaw.

I am pleased that we have been able to revisit this topic after Parliament was prorogued. I thank the Stroke Association and Ipsen in particular for their delightful and helpful insights into this debate.

Seaton Community Hospital

Jim Shannon Excerpts

Monday 13th November 2023 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

I would like to welcome the new Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins), to her place.

I rise to raise the pressing situation facing the community hospital at Seaton in the part of east Devon that I represent. I am very grateful for the opportunity to outline why plans to strip away a whole wing of the hospital pose a serious risk to the long-term viability of the hospital, and how small actions by the Government can unlock this space and provide huge benefits for the local communities.

Seaton Hospital is one of 12 community hospitals that provide vital services in my corner of Devon which were given over to NHS Property Services in 2016. Seaton Hospital provides a range of services and clinics that enable people to be cared for closer to home in their own community. I would like to take a moment to give hon. and right hon. Members an idea of the range of services that the hospital currently provides. They include a dedicated Chime audiology service, aneurysm screening, bladder and bowel treatments, and child and adolescent mental health services—we heard a lot about that in today’s health debate—as well as access to a dietician, ear, nose and throat specialists, general medicine, orthoptists, support for those with Parkinson’s, physiotherapy, podiatry, retinal screening, speech and language therapy, and stoma treatments. I could go on.

The hospital also acts as a hub for the growing number of so-called at-home care services. We appreciate that community hospitals have been increasingly moving over to services provided in the community at home. That includes provision for those who are frail and need regular care, or are reaching the end of their life. Indeed, the Seaton & District Hospital League of Friends supports the hospice at home professionals, who provide care to people and their families in those most difficult times of a person’s life or in a family’s life.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. When someone evaluates what a community hospital does, they find that it is about much more than finance and making sure that the books balance. It is about all the things the hon. Gentleman has referred to. The community hospital in my constituency is where my three children were born some 30-plus years ago. It is where I took my youngest son when he broke his arm. It is where I took my other boy when he put his hand through a glass window and had to go to hospital for surgery. That is what a community hospital is about, and that feeling is replicated by every one of my constituents. When the hon. Gentleman speaks about his local community hospital, I am quite sure that he has the same passion, belief and commitment to that hospital, because it is part of the community, and that is how it is measured, not by finance.

[Richard Foord]

I am grateful to the hon. Gentleman for his intervention. His anecdotes about what that hospital has done for his family and community are absolutely the same sort of thing as I hear from constituents every time I speak to them.

Seaton Hospital was built in 1988 to provide better local access to medical care and treatment for people across the Axe valley. It serves people not only in Seaton but in Colyton, Colyford, Beer, Axmouth and other villages dotted around the east Devon countryside. Originally, the plan was that people would not have to travel so far for their treatment. Given that the Royal Devon and Exeter Hospital is perhaps 30 miles away—20 miles at least—people felt that acute provision was on their doorsteps, which is what they wanted.

--- Later in debate ---

[Richard Foord]

I very much thank my hon. Friend for her contribution. She is exactly right. I point to two specific conversations I have had with constituents recently. The first was with someone who lives in Seaton, who was close enough to the hospital that she could walk there. Her husband died in the hospital and she was able to go and see him in his final days. She welled up—more than that, tears rolled down her cheeks—as she told me about her husband, who she was able to see in his final days.

Now we have moved to a situation in which patients are cared for at home. Of course, that means that some of the staff previously based out of the community hospital are driving to people’s driveways and providing that care in their homes. That works for some individuals, but the other day I had a lady in my surgery who was almost shaking with nervousness because her husband, whom she loved dearly, had just been discharged from the acute hospital in Exeter and she was charged with looking after him but did not feel able to look after his needs, as he was overcoming his operation towards the end of his life. We are putting some of our constituents in a really difficult situation that they do not feel equipped for.

The reason for the beds being removed from the hospital in 2017 related to so-called workforce issues. There was a substantial consultation of local people in 2017 when beds were removed from local hospitals, but I fear that following that consultation, which showed the outrage and indignation of local people, the NHS does not want to get involved such a consultation exercise again, hence the desire for the ICB to get shot of the building as soon as possible.

The ICB was talking about getting shot of it by the end of this calendar year, although that has gone to Devon County Council’s health scrutiny committee, so it may be pushed into next year. What we need tonight is an intervention from the Minister in relation to NHS Property Services, which is charging a clinical rate for a space that has not been used for acute medicine—it has not had clinical beds in it—since 2017. Organisations are coming forward with a desire to use it not for clinical use but as a care hub to provide other services.

I want to make hon. Members aware of how those clinical beds got removed in the first place. In 2017, there was deep concern that the removal of the beds was an arbitrary decision made following a last-minute intervention by the then right hon. Member for East Devon, Hugo, now Lord Swire. In fact, it is revealed in a book by his wife, Sasha, that Seaton Hospital was to be kept open, with its beds maintained, but, because of that last-minute intervention by Hugo Swire, the bed closures moved to Seaton and the Sidmouth Hospital beds remained.

As a result of that decision, there was no additional funding to set up extra services at Seaton. Instead, the ICB began charging this exceedingly high rent for an empty space. What we really need to do is reduce that rental fee from its clinical rate to one that acknowledges that there are community alternatives. The palliative care nursing team can operate out of this space, and organisations such as Restore and hospice at home carers can work out of it, too. The friends of Seaton and District Hospital are coming up with a strong business plan, but they do need more time to develop it and a concessionary rate—not the clinical rate—to operate from it. If no solution is found, the ward is most likely to be either sold off or demolished. Again—I cannot stress this enough—we need to do this for the people who feel that they paid for the hospital.

There is a precedent for it, and I am grateful to the hon. Member for St Ives (Derek Thomas) for letting me know that the hospital in Cornwall was saved from the jaws of NHS Property Services. However, there is a big difference between what I am proposing for Seaton and what happened at St Ives. St Ives hospital was paid for by a single philanthropist. As we have heard, Seaton Hospital was paid for with contributions—or subscriptions —from thousands of people.

[Jim Shannon]

The widow’s mite.

[Richard Foord]

Exactly.

Finally, when it comes to healthcare infrastructure in rural areas such as mine, it is so much harder to rebuild something once it has been removed than to maintain it. We saw in coastal and rural communities such as mine the damage that the closure of cottage hospitals caused, and the impact of removing beds from community hospitals. We must put a stop to that, before our rural healthcare centres are left empty skeletal shells of their former selves, where they were once hubs of love and care. I am looking forward to the Minister’s response and hope that she will agree to work constructively with me, as Seaton’s MP, to ensure a fair deal for local people and to protect our hospital for the people who bought and contributed to it.

Building an NHS Fit for the Future

Jim Shannon Excerpts

Monday 13th November 2023 Commons Chamber

[Wes Streeting]

The Minister says, “Is that it?”. It is 700,000 more NHS dentistry appointments than her Government are providing. It is ridiculous. The extent to which Ministers continue to parrot these ridiculous lines is embarrassing. If they want to intervene, make my day. I am perfectly prepared to confront any Member with their own Government’s record. Of course, they do not want to defend the Government’s record; they have a hard enough time doing that on the doorstep.

Turning back to His Majesty’s Gracious Speech, there may not have been any Bills for the health service last week, but we did see the white flag being waved on the Prime Minister’s pledge to cut waiting lists. Hospitals received a letter telling them to cut the number of operations and appointments they are aiming to offer this year. At the same time, an extra funding pot was announced, so we are literally paying more and getting less. No wonder the NHS is in such a state. No wonder waiting lists have trebled since 2010. No wonder hundreds of thousands more patients are waiting for treatment today than when the Prime Minister first made his pledge.

[Jim Shannon (Strangford) (DUP)]

I want to make a plea for those 10,000 young people with cystic fibrosis, who have to take multiple medications and endure daily physiotherapy, blood tests, X-rays, and hospital visits—waiting on many occasions—as part of their normal routine just to stay well. The shadow Secretary of State and the Labour Opposition have given a commitment to endeavour to do better for the NHS. Will he do better for those 10,000 young people who have cystic fibrosis?

[Wes Streeting]

I am very grateful to the hon. Member for his intervention. I am deeply concerned about the situation facing children with cystic fibrosis in particular, given that there is radically life-extending treatment available that offers the hope to those young people not just of longer, happier, healthier lives, but of reduced admissions to hospital. It is right that the National Institute for Health and Care Excellence makes those judgments in a rigorous way, looking at the evidence. I hope that it will be successful in bringing down the price of those drugs by negotiating with the pharmaceutical companies to make sure that we can get affordable drugs to families who desperately need them and are desperately anxious that the announcement they have read about means shorter lives for their children. No family should go through that agony, and I hope that a resolution can be found.

The Government and the previous Health Secretary got into the habit of stealing Labour’s policies—I say that not as a complaint, but as an invitation. It is clear that the Government do not have a plan to cut NHS waiting lists, but we do: £1.1 billion will be paid straight into the pockets of hard-pressed NHS staff to deliver 2 million more appointments a year at evenings and weekends, paid for by abolishing the non-dom tax status, because patients need treatment more than the wealthiest need a tax break—[Interruption.] Conservative Members groan when we mention charging non-doms their fair share, they groan when we talk about closing private equity loopholes and they groan when we talk about taxing private schools fairly. They did not groan when taxes went up on working people. They did not groan when benefits were cut for the poorest people.

We know who the Conservatives are in it for. They are in it for the few; we champion the interests of the many. That is the Labour difference. We believe strongly that people who live or work in Britain should pay their taxes here too. There is still time for the new Secretary of State to lobby the Chancellor ahead of the autumn statement. This genuinely is an oven-ready plan, unlike some of the plans we have heard from the Conservatives, and I encourage the new Secretary of State to nick it.

After 13 years, we have an NHS that gets to people too late. We have a hospital-based system geared towards late-stage diagnosis and treatment, which delivers poorer outcomes at greater cost. We have an analogue system in a digital age. We have a sickness service, not a health service, with too many lives hampered by preventable illness and too many lives lost to the biggest killers. It could not be clearer: the longer we give the Conservatives in power, the longer patients will wait. This was an empty King’s Speech from a Government who have run out of road, run out of steam and run out of ideas; a Conservative party too busy tearing itself apart to govern the country; a Prime Minister who cannot decide whether it is time for a change or to go back to year zero.

The future of the NHS after another five years of the Tories is emerging before our eyes: a two-tier health service, where those who can afford it go private, and those who cannot are left waiting behind—our NHS reduced to a poor service for poor people; our country viewed as the sick man of Europe. It does not have to be that way. The Prime Minister was right when he said,

“It’s time for a change”,

but only Labour can deliver it.

Labour has a different vision for our country in which no one fears ill health or old age; people have power, choice and control over their own health and care; the place people are born, or the wealth they are born into, does not determine how long they will live or how happy their lives will be; patients benefit from the brightest minds developing cutting-edge treatments and technology; and children born in Britain today become the healthiest generation that ever lived.

Only Labour has a plan to get the NHS back on its feet and make that vision a reality: a plan to cut waiting lists, delivering 2 million more appointments a year; a rescue plan for NHS dentistry, delivering 700,000 more appointments, recruiting dentists to the areas most in need, introducing toothbrushing for three to five-year-olds in schools and having an NHS dentist for all who need one; a plan to double the number of scanners so that patients are diagnosed earlier; a plan to recover our nation’s mental health from the damage of lockdowns; a plan to cut red tape that ties up GPs’ time, so that we can bring back the family doctor; a plan for the biggest expansion of NHS staff in history—a plan so good that the Government adopted it and gave us a head start; and a plan to reform the NHS to make it fit for the future. To those who say that that cannot be done and that things cannot be better, I say this: the last Labour Government delivered the shortest waiting times and the highest patient satisfaction in history. We did it before and we will do it again.

It is not a change of faces we need but a change of Government. It is time to call a general election and give the British people the choice: more of the same with the Conservatives or a fresh start with Labour. Call a general election now, so that Labour can give Britain its future back.

--- Later in debate ---

[Amy Callaghan]

The First Minister’s pledge of £300 million to cut NHS wait times is an example of the fantastic work that the SNP Scottish Government are doing. There will be 100,000 fewer patients on our NHS wait lists come 2026, because of that incredible investment.

Despite the year-on-year reduction in Barnett consequentials for health, NHS Scotland staff remain the best paid across these isles. What does that look like in practice? A band 2 porter in Scotland earns £2,980 more a year than their counterpart in England, and a band 5 nurse in Scotland earns £3,080 more a year than their counterpart in England. This is all despite the increased privatisation in NHS England. Under the SNP, the Scottish NHS fares much better than its counterparts across these isles, but under the current funding structures only the UK Government can deliver the funding necessary to get the NHS back on its feet. Down here, the Treasury gives money to private companies to provide a service for NHS England. That means less capital investment into NHS England, which means less money for the Scottish Government to spend on NHS Scotland.

I have always found the monarch’s speech quite baffling, but particularly so over the past few years, with so many broken promises and so many shallow, unfulfilled commitments. I think of promises to ban conversion therapy, commitments to reach net zero and pledges for a mental health Bill. The Government think my party does not respect this place, yet it is them who make a mockery of it by not fulfilling the policy agenda that they set for themselves. Perhaps this threadbare King’s Speech is perfect for them: less to fail on.

[Jim Shannon]

I thank the hon. Lady for her empowered speech. One issue with Barnett consequentials is that although Scotland perhaps is not getting its full complement, Wales does, and I am grateful that it does, but Northern Ireland does not. We have asked for the Barnett consequentials for Northern Ireland to be looked at and reviewed to enable us to be at the same level as Wales; perhaps the hon. Lady would like to see that for Scotland.

[Amy Callaghan]

I absolutely would like to see the same for Scotland. The Barnett consequential system in itself is quite frustrating, because we do not see the full complement we should get because of how the British Government exercise spending decisions. I would absolutely like to see a different funding structure exercised down here. The way it is spoken about is complicated in itself, and a bit of truth around that would be useful.

I have been struggling with the image of the King delivering his speech from his gilded throne while innocent people in Palestine are dying. It feels a ridiculous thing for this Parliament to have been focusing on. We are witnessing the biggest humanitarian crisis that many, if not most of us, have ever seen. It bears witness to how soulless this British Government truly are. Children are dying, refugee camps are being bombed and hospitals are being destroyed. For each second that Members throughout this House fail to call for a ceasefire, more innocent people are dying in Gaza.

Not just a humanitarian pause but a ceasefire is necessary. Riham Jafari of ActionAid Palestine so aptly described the difference between a humanitarian pause and a ceasefire:

“What use is a four-hour pause each day to hand communities bread in the morning before they are bombed in the afternoon?”

Innocent men, women and children in Palestine continue to die. I make a plea to colleagues on both sides of the House: walk through the Lobby with us on Wednesday night to vote for a ceasefire. They need you to show leadership. We need to show leadership and vote for the SNP’s common-sense humanitarian amendment to the humble address.

In preparation for this debate, I found myself reflecting on the words inscribed on the mace of the Scottish Parliament: “Wisdom, Justice, Compassion and Integrity”. The mace is not just about tradition, and it is not a bit of a pantomime like in this Parliament. In Holyrood, the mace is there to signify the relationship between the people, the Parliament and the land.

No institution better represents the link between the people and the state than our precious NHS, but being tied to this financial Union means that our NHS is suffering terribly. We have workforce shortages, medication shortages and equipment shortages—shortages, shortages, shortages. I got into politics because of the rampant health inequalities I saw in my part of the world when I took unwell as a teenager. We all know health outcomes are impacted, whether directly or indirectly, by the quality of our support network. I saw first-hand the effect of poverty on outcomes. That is why I am so proud that our SNP Scottish Government implemented the young patients family fund, which helps to prevent income from being a barrier for families being able to support a young person through ill health. Scotland is leading the way in transforming lives and outcomes with that fund.

It would have been nice to see some flickers of hope and progress woven through the King’s Speech, but given the British Government’s lack of willingness to learn from good practice elsewhere on these isles, it is relatively unsurprising not to see it. The pomp and pageantry of this place, its traditions and its reactionary main parties seem to me to be a distraction from the real work and hard conversations that neither of the two main parties want to have. Instead, we have a celebration of the dance we call debate in this place.

I will now reflect again on the words inscribed on the Mace of the Scottish Parliament. Let us take a look at each and see whether they apply to the British Government. I will start with the wisdom that is being shown—or not shown—in this place where Brexit was forced through, despite the broken promises it was built on. What has come with that wise decision endorsed by both the Government and the Labour party? We have severe medicine shortages, meaning that people are unable to access vital treatments such as attention deficit hyperactivity disorder drugs and hormone replacement therapy, as well as a shortage of staff to supply and distribute them. That oven-ready Brexit deal that the public were promised was lacking one key ingredient: wisdom. My constituents in East Dunbartonshire applied wisdom in advance when they overwhelmingly voted to remain within the European Union, but the structure of the Union meant that their voice was ignored.

Moving on to justice, where is the justice in there being so many material changes of circumstances since the 2014 referendum, while the British Government continue to deny the people of Scotland the right to choose our own future? Some might say that that is an injustice.

Moving on to compassion, there are many ways in which I could question the compassion of this place, but there is nothing more timely or truly horrific than the ongoing attacks on civilians in Gaza. We are witnessing the biggest humanitarian crisis many of us have seen in our lifetimes, and this place has rightfully expressed compassion for those killed and suffering in Israel, yet the compassion is lacking for those children in Gaza. Each day that this place fails to unite behind a ceasefire, children die. Where is the compassion for those children?

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

First, I congratulate the hon. Member for Uxbridge and South Ruislip (Steve Tuckwell) on making his maiden speech. Having mentioned his local boozer, he will no doubt be forever welcomed there with open arms. I welcome him to his place and thank him for his speech.

I note the historic event last week of the King making his first Gracious Address as sovereign. It is just a pity that the speech written for him by the Government was so thin, with little content and little vision. It was a clear demonstration that the Government not only are running out of steam, but have none left at all.

People know that I have campaigned on mental health for many years. It is 11 years since the hon. Member for Broxbourne (Sir Charles Walker) and I spoke, in a mental health debate, about our own mental health. I think attitudes have changed for the better over that period, and it has clearly moved up the political agenda. I was therefore, like a lot of campaigners and professionals, very disappointed that the reform of the Mental Health Act 1983 was dropped from the King’s Speech. The Act is outdated and archaic in parts, and its language is more fitting to the Victorian era. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, in some cases it is leading to people with learning difficulties and autism being locked in the system for many years, without any voice to raise their plight.

The Minister, in her address, seemed to dismiss that as though it was somehow not important, but depriving people of their liberty is a very serious thing. To deprive somebody of their liberty, you have to ensure that they not only have rights, but care. My concerns about the Mental Health Act relate to those with autism and learning disabilities, some of whom have been locked in the system for years without a strong advocate. There are people in the criminal justice system locked into a Kafkaesque system that we have created. The Minister more or less threw that aside. I am sorry, but if you are a black teenager in the criminal justice system or an adult with learning difficulties, the system needs reforming and it needs reforming now.

It is not as though the Government started with a blank sheet of paper. We had Sir Simon Wessely’s excellent review in 2018. The Government made a manifesto commitment in 2019 to bring forward legislation. There was a draft Bill last year and a Joint Committee to scrutinise it. One would have thought it was a clear priority for the Government to move the issue up the political agenda, but what we have had from the Department of Health and Social Care is not just no Bill, but inaction. The Joint Committee spent a great deal of time looking at the Bill and put forward 36 recommendations. Ten months later and they have not yet even been answered by the Government. This is not just the Government abandoning the Bill and a broken Conservative party manifesto promise; it is a dereliction of duties. Politics is about priorities and, for me, this is a priority. Some 50,000 people a year are sectioned under the Mental Health Act. For some, I accept, it is life changing. For others, however, it leads to a system that they get into and cannot get out of. It is right to reform the Act and it is absolutely shocking that that is not in the King’s Speech. It will certainly be a commitment for the next Labour Government. I and many on the Labour Benches will make sure it is a commitment.

The Minister, in her Gatling gun approach to her speech, was more or less saying that it does not matter because everything else is okay in mental health. I am sorry, but it is not. In April 2022 we had, with much fanfare, the 10-year mental health and wellbeing plan. Over 5,200 individuals and mental health charities responded to a consultation, only to find out in January this year that it had been completely scrapped. The Minister talks about mental health being a priority, but the facts do not support that. Unless we have a proper joined-up approach to mental health, we will not get on top of the issue of individuals who need help, or have a system fit for a modern country such as the UK.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on raising this matter. Throughout my time in the House he has spoken up significantly for those with mental health issues, and he understands the subject very well. One group who seem to fall below the radar are veterans. In Northern Ireland, a large number of people who have served in the forces suffer from post-traumatic stress disorder. Does the right hon. Gentleman agree that those veterans who are suffering greatly must be a priority in addressing mental health?

[Mr Jones]

I agree with the hon. Gentleman. As a former veterans Minister, I did a lot about veterans mental health. We now have a disjointed system with a veterans Minister who, in Trumpian style, says that everything is perfect and everything is working, when it is clearly not. We need to ensure that veterans receive the best mental health care in their local areas, and that means adopting a joint approach.

If we are to get on top of the nation’s mental health, that must be done through a public health approach. It must be done at local level, and it must ensure that public health takes a lead. Less than 2% of the mental health budget is spent on preventive work, which needs to be done not just in schools but in communities generally. Fortunately for my constituency, a new initiative has been launched in Chester-le-Street where GPs and local community groups divert people from mental health services by securing them the help they need, and I congratulate those who are involved.

Tobacco affects mental health, with 50% higher smoking rates among those with a mental illness and two-thirds higher death rates, so I support the movement for a smoke-free generation, although I note that the Government will not ask their Back Benchers to support the policy because they know they will not receive it. Action also needs to be taken on illegal sales of counterfeit tobacco, but that cannot be done in the present circumstances, because the number of local trading standards officers has been cut by 52% since 2009. We need to ensure that more money is put into trading standards and policing. The Government keep saying how wonderful it is that we have extra policing, but in fact County Durham has 140 fewer police officers than it had in 2010. It is important for us to have the enforcement side, because without that some people will be driven into the illegal tobacco market, but we cannot see it as a silver bullet that will justify cuts in public health budgets. We need continued, dedicated local smoking cessation programmes, because without them we will not make the strides that we want to make.

I shall say something on two other issues. First, on leasehold reform, let us look at the facts, as opposed to what the Government are saying. The Government have given the impression that this reform will affect every leaseholder, but it will not; it will apply only to new buildings. There is no roll-out of the commonhold for new flats, which constitute the majority of leasehold properties. This outdated feudal system needs to change. There will be a great many disappointed people who, having assumed they would suddenly be given more rights, then find otherwise. Let us be honest: this has been fuelled by the Government’s right to buy scheme, which is being used by Persimmon and other big house builders as a way of making extra cash, mainly at the expense of the taxpayer and those poor individuals.

Secondly, on transport, I have heard the references to the Network North plan. I will not dwell on it too much, because I do not believe anything in it. We know that 85% of it has already been announced, but some of those announcements have been withdrawn very quickly. In the north-east, for example, the Government argued that the Leamside line, which would help my constituency of North Durham, would be reopened, only for that announcement to be withdrawn within 24 hours. I doubt that many of these projects will see fruition.

With my role on the Intelligence and Security Committee, I welcome the investigatory powers reforms, which will be important in ensuring that the right safeguards are in place for the way our security services collect bulk data, and in bringing some of the oversight up to date. It is also important that the Government work closely with the ISC—something they did not do on the National Security Bill that went through in the last Parliament. We are still waiting for a response to some of our arguments around how the ISC is run. This legislation will be important to ensure that we give our security services the necessary powers to protect us all, and to ensure that we get the proper oversight.

This will be the last King’s Speech before the general election. It was half-hearted and full of gimmicks that were designed to be eye-catching, but it has no long-term plan for the future of our country. That is the disappointing thing, and that will only change when we get a change of Government at the next general election.

--- Later in debate ---

[Peter Gibson (Darlington) (Con)]

I congratulate my hon. Friend the Member for Uxbridge and South Ruislip (Steve Tuckwell) on his excellent maiden speech.

Let me begin by paying tribute to His Majesty on his first Gracious Speech. As he reflected in that speech, we were all reminded of the selflessness of his mother, Her late Majesty, which he continues to exemplify. It was fantastic to hear the wonderful speeches of the proposer and the seconder of the motion on the Loyal Address, my right hon. Friend the Member for Scarborough and Whitby (Sir Robert Goodwill) and my hon. Friend the Member for Stroud (Siobhan Baillie). They are both fellow Yorkshire folk and both great friends. My right hon. Friend the Member for Scarborough and Whitby has regaled friends and colleagues alike for many years with his jokes. It was wonderful to hear his entire repertoire in just one sitting. He told us that his first parliamentary contest was, just like mine, in Redcar, where I lived as a child and went to school. It was also where my mum served as an NHS community midwife, so I saw at first hand the incredible work of the NHS from a very early age. Fast forward to the present day, I have the privilege of representing the town, and the hospital where my mum undertook her nursing training. That was some years before I was even born, but still I regularly meet constituents who worked alongside mum in the 1960s.

I welcome the Government’s focus on building an NHS fit for the future. As I visit dentists, doctors and Darlington Memorial Hospital and I speak to constituents at my surgeries, it is clear that despite this Government’s strong record of investment, with record funding, record doctors and record nurses, much more needs to be done. Tees, Esk and Wear Valleys is our local mental health trust. It has some immense challenges to deliver the mental health care that my constituents need. My surgery regularly features people with heartbreaking stories, where the support they need has not been there. That is why I welcome more funding to deliver mental health support.

I regularly see families in my surgery affected by the tragedy of suicide. Those terrible stories of pain and suffering are incredibly difficult to hear. That is why the Government have my full backing in their suicide prevention strategy. However, I think they should bring forward long discussed mental health legislation, just as I believe that we need progress on banning conversion practices. I join my hon. Friend the Member for Thurrock (Jackie Doyle-Price) in her comments on the terminology used. Abuse is abuse, not therapy.

I also welcome the £8 billion commitment for NHS and adult social care. As a solicitor before being elected to this place, I found that the biggest single concern of those planning for later life was how their care would be covered. Our elderly should have confidence in the care and support they need in later life. I welcome the steps being taken to deliver that.

On hospices, I am privileged to follow in the steps of Jack Dromey as co-chair of the all-party parliamentary group for hospice and end of life care. I refer the House to my entry in the Register of Members’ Financial Interests, as a hospice trustee. The Government rightly supported our hospices incredibly well during covid. However, with patchwork commissioning from our ICBs, and despite clear direction in the Health and Social Care Act 2012 to commission palliative care, many hospices are vulnerable to closure or reduction in services, putting increased pressure on our NHS. It need not be like that, with ringfenced funding in ICB budgets for palliative care.

Darlington is still not getting sufficient dentistry. Ministers say that is down to the ICBs; the ICBs say it is down to the dentists; and the dentists cannot make the contracts work. Even when additional funding is found, as it has been recently following the closure of one practice, we still cannot get the dentists we need. Is it time to insist that every dentist trained here spends a number of years providing NHS services before they move to exclusively private work? I welcome the expansion in dental skills and urge Ministers to go further to accelerate growth in numbers.

Tackling the challenges of tobacco, illegal tobacco sales, disposable vape sales, the child grooming that flows with that and the organised crime that lies behind that, is of deep concern to parents in my constituency. I welcome the measures to clamp down on tobacco use and disposable vapes, and I would welcome the licensing of sales of legal tobacco as a further way of cracking down on that.

[Jim Shannon]

Respiratory health is very important. Across the United Kingdom, one of many issues is chronic obstructive pulmonary disease. The hon. Gentleman is well aware of that, for he has spoken before about it. We have the worst figures in all of Europe except for Denmark. Some 33% of COPD patients are readmitted within 28 days of discharge, even though readmission has been found to be strongly related to post-discharge mentality. Does the hon. Gentleman agree that for that 33%, the NICE system in place for COPD needs to be reviewed, and a better service needs to be delivered?

[Peter Gibson]

I concur with the hon. Gentleman’s calls for further work on that. It is deeply concerning to see children using disposable vapes and suffering severe traumas that result in hospitalisation. More must be done to clamp down on the illegal sale of those products.

I am pleased that the Government are focused on building an NHS fit for the future. Finally, can we please see more dentists in Darlington?

Osteoporosis

Jim Shannon Excerpts

Thursday 26th October 2023 Commons Chamber

[Judith Cummins]

I thank the hon. Gentleman for that important intervention. The condition predominantly affects women, but it does affect men as well. Small changes to lifestyle, as well as detection and prevention, are very, very important.

Osteoporosis often develops during menopause, when a decrease in oestrogen can lead to a 20% reduction in bone density. A loss of bone density affects people of all sexes as they age, but women lose more bone density more rapidly than men.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for securing the debate. I referred to this point earlier in the debate on menopause, but my staff and I deal every day of the week with benefit issues relating to osteoporosis. It is clear that the understanding and capacity that maybe should be there in the health sector is not there. Mindful that the Minister is not responsible for the Department for Work and Pensions, does she think that within the Department there should be a better understanding when assessing those with osteoporosis to ensure they can gain the benefits in the system that the Government have set aside and have a better quality of life?

[Judith Cummins]

I thank the hon. Gentleman for that important intervention. Osteoporosis suffers from some mystery, and any light that we shine on the condition is welcome. It is entirely possible for someone with osteoporosis to work and have a very full life, given detection and treatment.

Fracture liaison services are integral to that. They are essential because throughout our lives our bones continuously renew themselves in a process called bone turnover. With osteoporosis, bone turnover becomes out of balance. Bones lose strength and become more fragile, bringing an increased risk of fractured bones time and time again. The FLS can identify osteoporosis at the first fracture through methods including DEXA scanning, and offer treatment that can reduce the risk of further fractures. The FLS also systematically monitors patients after an osteoporosis diagnosis to ensure they get the best out of their treatment plan. With the FLS, patients who would otherwise face a fracture or multiple fractures can continue to lead healthy and fulfilling lives.

With osteoporosis designated as the fourth most consequential health condition when measured in terms of disability and premature death, we have to question the Government’s current record on assessment, treatment and prevention. There is a postcode lottery for access to these vital life enhancing and lifesaving services, with only 57% of the eligible population in England currently having access to the FLS. What we desperately need is a central mandate requiring integrated care boards to invest in established FLS for everyone.

Let me stress not only the moral imperative of acting on this issue, but the clear financial argument for establishing 100% FLS coverage in England. One million acute hospital bed days in England alone are taken up by hip fracture patients. Research shows that FLSs reduce the refracture risk by up to 40%. Applying that to the national picture, we find that a staggering 750,000 bed days would be freed up over five years, saving the NHS £665 million. This would have a significant and positive impact on the social care system. For every pound invested in FLS, the return is more than threefold. With the NHS in crisis, the Government must be bold and recognise the value of services such as FLS.

The future of the NHS lies in prevention, but this argument extends beyond the NHS. Every year, 670,000 people of working age suffer from fractures due to osteoporosis, and a third of those will leave the workplace permanently owing to the impact of chronic pain. We also know that every year 2.1 million sick days are taken in England as a result of disabilities caused by fractures. Any Government would surely understand how consequential this is for our economy. A new analysis provided for the Treasury shows that universal access to FLS can prevent up to 750,000 sick days every year, and that is why trade unions, the TUC, the Federation of Small Businesses and other business groups have joined the campaign to extend FLS access to everyone aged over 50.

It is clear that the Chancellor cannot succeed in addressing labour shortages without taking decisive action on FLS. To provide this vital support—to provide 100% FLS coverage in the UK—would cost an estimated £27 million per annum, which is less than 2% of the UK’s current expenditure on hip fractures. Preventive osteoporosis treatment not only presents a sound financial case for the NHS, but presents a strong business case by ensuring that so many women can continue to work. Improved osteoporosis treatment does not just mean that people can work for longer; it means—perhaps much more important—that those living with osteoporosis can enjoy a higher quality of life beyond their work.

It is time to do away with the stigma because, with people in the UK living to an older age than ever before, 50 has become the new 40. Osteoporosis is no longer an old person’s condition. We have allowed it to become accepted as a natural part of ageing, but it does not have to be. In this country, we have a choice: to diagnose and treat it, or to simply continue to ignore it. This is an opportunity to address old prejudices. Osteoporosis is one of many conditions, mostly experienced by women, that have historically been swept under the carpet. In the 19th century, during the period of its earliest identification, studies crudely described the condition in terms of women tripping over “their long skirts”. Even today, people refer to osteoporosis in crude and demeaning terms such as “a dowager’s hump”. Raising awareness of this long-overlooked condition is essential, and I am grateful for the opportunity provided by today’s debate to further demystify osteoporosis as a health issue which affects so many people across this country.

After centuries of inattention in the world of medicine, we now have revolutionary new technologies and systems such as DEXA scanning and FLS. These services have the potential to transform the lives of so many women throughout the country—women who have so much to offer, who should not be left undiagnosed, but whose quality of life is left literally to crumble along with their bones; women who are left to suffer in pain when treatment can and should be made available. The decision to provide full FLS coverage is not only fiscally responsible and right, but it would be an historical leap forward in terms of women’s healthcare. Today, two thirds of those who need anti-osteoporosis medication are left untreated. That is roughly 90,000 people, every year, missing out on necessary treatment due to Government inaction. This is life-changing medicine. As many people die from osteoporosis-related issues as die from lung cancer or diabetes, so FLS and fracture prevention need to be part of the mandated NHS core contract. We must establish new guidelines to support the establishment of FLS across England.

In August, the Minister publicly stated that the Government would make an announcement on establishing more fracture liaison services by the end of this year. In September, the Minister in the other place said that the autumn statement would include

“a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality.”—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

I understand that, since then, there has been a walking back of this commitment. On behalf of the 90,000 people missing out on life-saving, life-changing medication, I yet again ask the Government to hold their nerve and act quickly.

Now is the time for this Government to turn their back on outdated attitudes towards osteoporosis, now is the time to protect women whose quality of life would otherwise be left to crumble along with their bones, and now is the time to commit to 100% FLS coverage across England. By ensuring that every person in the UK has access to fracture liaison services, we have the power to make this vision of life-saving early intervention and prevention a reality.

World Arthritis Day

Jim Shannon Excerpts

Wednesday 25th October 2023 Westminster Hall

[Tom Randall (Gedling) (Con)]

I beg to move,

That this House has considered World Arthritis Day.

It is a pleasure to serve under your chairmanship, Ms McDonagh. This House was in recess on 12 October, but that date has been celebrated—if that is the right word—as World Arthritis Day since it was established by Arthritis and Rheumatism International in 1996. Its aim is to raise awareness across the world of the existence and impact of rheumatic and musculoskeletal diseases, and to educate people about symptoms, preventive measures and treatment options. I thought it might be helpful to bring this debate to the Chamber today—the closest date to World Arthritis Day that we could arrange—to raise awareness, to highlight the extent and impact of arthritis and musculoskeletal conditions in Britain today and to continue the debate on what we can do to mitigate the impact of arthritis.

What is arthritis? Arthritis refers to painful, stiff or restricted joints, which are common symptoms in conditions that cause joint damage or inflammation. They include osteoarthritis, which happens when the body can no longer maintain and repair one or more joints; autoimmune inflammatory arthritis conditions, including axial spondyloarthitis; crystal arthritis such as gout; or symptoms of inflammatory connective tissue diseases, such as lupus. Arthritis is used as an umbrella term for a range of conditions, and that is how I will use it in this debate, although there are certain issues specific to particular conditions that I will mention later.

The subject is worthy of debate for three reasons: first, to recognise the inherent issues in living with arthritis, and how widespread it is; secondly, to highlight the wait for diagnosis and treatment; and thirdly, to understand the economic costs of not dealing with musculoskeletal conditions effectively. We might think that arthritis only affects old ladies, but it is more widespread than that. More than 10 million people in the UK—one in six of our constituents—have arthritis. One in six of our constituents is in pain and experiences fatigue and often restricted mobility.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing forward this debate. In Northern Ireland, where we have a population of 1.95 million, there are 525,000 people living with arthritis or another musculoskeletal condition. That gives some perspective— it is more than one in four. The scale of the issue is massive.

Does the hon. Gentleman agree that for those in the early stages, help in dealing with pain and strengthening the muscles can prevent further untimely deterioration? We should ensure that people stop classifying arthritis as an old person’s disease, so we can allow younger people to determine what they have and how to manage the progression that the hon. Gentleman wishes to achieve.

[Tom Randall]

The hon. Gentleman is absolutely right. When we have debated this subject in the past, he has raised the issue of arthritis in Northern Ireland; I am so pleased to see him raising it again. He is right in the perspective that he takes on the breadth of the issue, which affects a wide variety of people. I will come on to that point shortly.

One of my Gedling constituents puts it this way:

“Living with arthritis changes you and turns your world upside down. Things you took for granted become obstacles and daily challenges to be overcome. On a good day, you might not look like you’re living with a chronic condition but it never goes away. It’s hard to plan ahead because you don’t know if you’ll be up to going out or meeting up. Arthritis doesn’t only affect the person with the condition but their family too. I have watched Rheumatoid arthritis rob my mum of a life and now I have it too. It makes me frightened for my daughter’s future.”

Early diagnosis and prompt treatment can improve the futures of people living with arthritis and musculo- skeletal conditions, but not always. In the case of axial spondyloarthritis, in which I declare an interest as chair of the all-party parliamentary group on axial spondyloarthritis, a key challenge remains timely diagnosis. In this country, the condition currently takes an average of eight and a half years to diagnose, which puts us behind most comparable nations in Europe.

The latest report of the national early inflammatory arthritis audit, which is run by the British Society for Rheumatology, found that patients are experiencing diagnostic and treatment delays, with 44% of patients still not referred within the target of three working days and 48% of patients experiencing symptoms for longer than six months prior to referral. Although the average time to treatment has improved in England, having been reduced by three days, delays are an average of 12 days higher than the quality standard of 42 days.

The impact of arthritis is ultimately a human story, but the economic cost is also worth mentioning. According to the Office for National Statistics, 23.3 million working days were lost in 2021 due to musculoskeletal conditions. I have thought about how to put that figure in a way that politicians and politicos can understand. Think back to the winter of discontent in 1979, when 29 million working days were lost due to strike action. That was a politically pivotal year, which was notorious for how many working days were lost, and we are facing the equivalent of 80% of that figure—not just in one year but every year because of musculoskeletal conditions.

People with arthritis are 20% less likely to be in work than people without arthritis. Twelve per cent of sickness absence in the NHS between September 2021 and August 2022 was due to back problems and other MSK conditions. The National Axial Spondyloarthritis Society estimates that

“A patient aged 26 who waits 8.5 years for a diagnosis is likely to lose around £187,000”,

the majority of which derives from a loss of productivity due to reduced employment. The average patient also incurs costs of around £61,000 in out-of-pocket expenses while waiting for a diagnosis. That includes the cost of medication, travelling to appointments and private healthcare appointments, including visits to chiropractors.

I first praise the Government for making musculoskeletal conditions part of the major conditions strategy. Making MSK one of the six major conditions signals the importance of this issue, and I believe that it demonstrates that the Government are serious about tackling it. I hope that it will be understood that there are a range of measures that can be taken to improve matters. The Government have made reducing waiting lists one of their top priorities to improve the lives of those with arthritis and musculoskeletal conditions, including those waiting for joint replacement surgery, but I would welcome clarification that it will remain a key Government priority and clarity on how that will remain the case in the face of likely future winter pressures.

According to the British Society for Rheumatology, growing the rheumatology workforce would reduce the health and societal costs of newly diagnosed rheumatoid arthritis by £50 million, so I welcome clarification from the Minister on plans to grow the rheumatology workforce.

Everyone recognises the valuable role that primary care can play. Raised public awareness can help to encourage early presentation in primary care, but there is also work to be done to help GPs and other healthcare professionals to recognise conditions. I spoke earlier of the delay to the diagnosis of axial spondyloarthritis. Fifty-six per cent. of that delay time occurs in primary care, with GPs often failing to identify the symptoms of axial spondyloarthritis and thinking that the patient may have mechanical back pain or back pain associated with injury. That can lead to repeated primary care visits and causes patients to be bounced around in the system, placing further burdens on the already stretched system. I welcome any opportunity to follow up with the Minister separately on that point, particularly on what can be done to improve public and primary care awareness of these conditions.

World arthritis day only comes once a year, but for those living with arthritis and musculoskeletal conditions it is a constant issue. While they might dream of a world free of pain and discomfort, that is not yet a reality. I am grateful for the opportunity to raise this issue on the Floor of the House today and I look forward to hearing further contributions on how we might make that the case.