Ultra-processed Food

Jim Shannon Excerpts

Wednesday 21st June 2023 Westminster Hall

[Suzanne Webb]

I thank the hon. Member for her intervention. Again, we are having the same conversation and I hope to answer her question later in the debate.

Ultra-processed food makes up half of the total purchased dietary energy in the UK. In fact, when it comes to UK children, more than 60% of the calories consumed comes from ultra-processed foods such as frozen pizza or fizzy drinks. All that food is linked to obesity, which causes me great concern. In England, 64% of adults and 40% of 10 to 11-year-olds are either obese or overweight. Those figures are taken from the Dimbleby report. They are staggering.

Figures from 2019-20 show that 1.5 million years of healthy life are lost to diet-related illnesses every year. Tackling obesity costs the NHS about £6.5 billion a year and is the second biggest cause of cancer. To put it starkly, it is a ticking timebomb. Some might say that the ticking has stopped and the bomb has already exploded.

Some 100,000 people have a stroke each year. There are 1.3 million stroke survivors in the UK, thanks to the advances of medicine and medical interventions such as blood pressure tablets, statins and so forth. Children who have high levels of ultra-processed food consumption have been shown to have high levels of cholesterol, increased weight and tooth decay. Obesity has been brought to the fore due to covid. Living with excess weight puts people at greater risk of serious illness or death, with risks growing substantially as body mass index increases.

The cost of all that to the NHS is significant, from prescription drugs and GP and out-patient appointments to the orthopaedic impacts on limbs of weight bearing. Of course, the greatest impact is on NHS hospital admissions. Tackling obesity is one of the greatest long-term health challenges that this country faces. Ultra-processed food is one of the main routes to all obesity issues, because the food is mainly high in fat, salt and sugar. It is marketed aggressively, to the detriment of our health, feeding a growing obesity crisis and feeding our arteries full of fat.

The food supply chain endorses and promotes products that are linked to serious health outcomes, marketing products for which the motivation is profit over health. Certainly at the cheaper end of the market, ultra-processed food does not provide a fully nutritious meal. The marketing and branding of ultra-processed food is relentless. Have we ever seen a high-profile marketing campaign for anything that falls off a tree or comes out of the ground? The answer is no. Instead, we see highly aggressive campaigns selling us the dream of so-called delicious meals. In reality they are highly addictive foods and, without moderating consumption, contribute significantly to poor health outcomes.

I am slightly disappointed that the Government are not proceeding with the plan to ban two-for-one junk food deals. That plan, which has been delayed, would have prevented shops from selling food and drink high in fat, salt and sugar through multi-buy deals. However, at a time when household budgets are under continuing pressure from the global rise in food prices, it would not be right to restrict those options. The principal issue for health outcomes is not so much two-for-one deals anyway; it is the food itself, and we should not lose sight of that. Buying multi-deals does not matter; it is the product itself that matters. That is what we should focus on: trying to eliminate addictive products that are creating poor outcomes for our children.

A good step forward would be an advertising watershed—a 9 pm watershed has been mooted—that would restrict the TV advertising of foods that are high in fat, sugar and salt, not forgetting those online. Current advertising regulations do not go far enough in protecting children from a significant number of unhealthy food adverts. I think that we have all seen the continual adverts for pizzas when we watch family programmes, certainly at the weekend. Those should not be allowed. Half the time, I am moments away from going online to order a couple of those pizzas, but I don’t do that any more.

[Jim Shannon (Strangford) (DUP)]

Don’t order a couple—just order one.

[Suzanne Webb]

Jim, it would be two.

Children and young people are not sufficiently protected from exposure to adverts for unhealthy products. It has been pointed out to me that Government research shows that TV and online advertising restrictions on food that is high in sugar and salt could reduce the number of children with obesity by more than 20,000. I therefore urge the Minister to look at that and bring the timeline forward. I think at the moment it is going to be 2025, but we could and must move faster. There should be a watershed for adverts for both ultra-processed food and products high in fat, sugar and salt, sooner rather than later.

A bigger light must be shone on the manipulative marketing tactics that companies use to lead us into consuming and over-consuming foods that are bad for our health. My office manager and my comms guy are advocates of disgusting microwave burgers, which further strengthens my resolve on the matter. When I first looked at the product that they are addicted to and that they shove in that microwave, I thought, “What is not to love?” It says that it is 100% beef—it tells me three times that it is 100% beef—and with that look, I was hooked. I thought, “I want one of those,” but then I read the side of the packet. It is in fact a composition of beef fat, soya protein, salt, wheat flour, stabiliser E451, dextrose, sugar, egg white powder, yeast extract, something called hydrolysed soya protein, barley malt extract and flavourings. It is 44% beef, so not quite the 100% beef that was advertised. In fact, it is a concoction of emulsifiers, preservatives, colourings and other things, which made it look like the tastiest 100% beef burger in the world. The beef was 100% beef, but it was actually only 44% of the burger itself. That is incredibly misleading. I nearly went out and bought it myself.

The obesity crisis is not helped by the overly aggressive marketing of highly addictive food. Let’s face it: if advertising did not work, companies would not do it. That is what encourages us to go out and buy such products. We saw it in the cigarette market. Changes were needed to advertising, starting way back in 1965, when the poor health outcomes from smoking were being understood. It was many years before one of the biggest health interventions, which was the ban on smoking in public places in 2007. I was one of those smokers many, many years ago. I think I gave up before it was banned in public places, but I can tell hon. Members that smoking is highly addictive, and it was sold to be highly addictive.

When I worked in logistics, the company pushed out the cigarettes into big lorries, which took them to the centres to sell. Even there, packs of 200 cigarettes were handed out to employees as an incentive at the end of the week: “Well done—they have done a great job.” People were allowed to smoke in their offices, although I believe that at the time they were not supposed to. Unhealthy food is now being peddled and pushed in a similar way. We really have to think about that. Something very akin to what happened with cigarettes is happening with ultra-processed food.

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[Jim Shannon (Strangford) (DUP)]

It is indeed a pleasure to speak in this debate. I thank the hon. Member for Stourbridge (Suzanne Webb) for raising the issue. She comprehensively set the scene and, with the interventions, added to the understanding of why the debate is so important. My research for today mimicked some of the research carried out for the debate on fatty livers a number of weeks ago, and the links are clear. I noted during that debate that my good friend the Minister of State, the hon. Member for Colchester (Will Quince), noted that there is no definition of “ultra-processed”. That is an important starting point so that we can begin to address the problems of a highly ultra-processed diet.

The hon. Member for Stourbridge referred to diabetes, and others have as well. I am a diabetic today because for a long period of time—probably a number of years, I suspect—I was the person who bought a Chinese five nights a week with two bottles of coke. That was the way I was; that was the way I lived. It saved me going home to get something to eat, and I ate in the office. Added to that was probably a fair level of stress, and all of a sudden I was almost 17½ stone. I never realised just how the weight had crept up, and I went to see my doctor. My doctor always says “I’ve got good news and bad news for you.” I said, “Well, tell me the good news first.” “The good news,” he said, “is that you’ve got a heart like an ox. But the bad news is that you’re a diabetic.” That is a fact of life.

That was my lifestyle. I was to blame; I will not blame anybody else for that. I am not blaming the Chinese people who sold me the Chinese, nor the shop that gave me two bottles of coke, because it was something I did and I realised what was happening. I am now on medication, so that has helped to administer and control my diabetes. The point that I am making is that we have to be careful what we eat. What we eat is what we are, and, indeed, what we become.

As has been noted, the UK is at the top for ultra-processed foods in Europe. When I say that, I include packaged baked goods, snacks, fizzy drinks, sugary cereals, ready meals containing food additives, dehydrated vegetable soups and reconstituted meat and fish products. They often contain high levels of sugar, fat and/or salt, but lack vitamins and the fibre that I, as a diabetic, need. Those were all noted in the BMJ report on ultra-processed foods in 2019.

Such foods are thought to account for around 25% to 60% of the daily energy intake in many countries. Previous studies have linked ultra-processed foods to higher risks of obesity, high blood pressure, high cholesterol and some cancers, but firm evidence is still scarce. There is some evidential base to be arrived at.

Results in the BMJ report showed that a 10% increase in the proportion of ultra-processed food in a diet was associated with significantly higher levels of overall cardiovascular disease, coronary heart disease and cerebrovascular disease, with increases of 12%, 13% and 11% respectively. I am my party’s health spokesperson, so I am very conscious of health issues. In contrast, the researchers found a significant association between unprocessed—or minimally processed—foods and lower risks of all reported diseases.

Results from another test showed that higher consumption of ultra-processed foods—more than four servings per day—was associated with a 62% increased risk of all causes of mortality, compared with a lower consumption of fewer than two servings per day. In her introduction, the hon. Member for Stourbridge referred to ordering a couple of pizzas. I was not responding to her facetiously, but the point I am making is that, yes, it is easy, and, as the hon. Member for Glasgow North West (Carol Monaghan) said, when people start, they want to keep on eating, and that is a problem.

For each additional daily serving of ultra-processed food, mortality risk increases by 18%. It is clear that more research should be done, and I join colleagues who have spoken—including the hon. Member for Stourbridge—and of all those who will speak afterwards to ask the Minister, who always responds very positively and helpfully, and our Government, to get the information and begin the public awareness campaign that must follow those results.

The health of our nation is the wealth of this nation—this great United Kingdom of Great Britain and Northern Ireland—and we must take the necessary steps to make people aware of the dangers of their diet choice, because it is a choice. Hopefully today is the next step, perhaps maybe the first step, in that journey to better health.

Podiatry Workforce and Patient Care

Jim Shannon Excerpts

Tuesday 20th June 2023 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[Jim Shannon (Strangford) (DUP)]

I declare an interest as a diabetic, so I understand exactly what the right hon. Gentleman is saying. I am aware of the silent but vital work carried out by podiatrists throughout the United Kingdom. In my constituency of Strangford, a nursing home where funded podiatry appointments were cut was still visited by a podiatrist. He was able to attend, but he treated people without taking any money. Does the right hon. Gentleman not agree that access to podiatry for the elderly in care homes should be fully funded and that they should not have to rely on family or kind-hearted podiatrists to get their health needs taken care of?

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

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[The Minister for Health and Secondary Care (Will Quince)]

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

Let me say first how grateful I am to the right hon. Member for Hayes and Harlington (John McDonnell) for raising this important issue. He said that he did not know a huge amount about podiatry. I must say that I did not either, because I am not the Minister with responsibility for primary care, but I do have responsibility for the workforce. One of the powerful aspects of debates of this nature is that they force not only Ministers but the Department to focus on a particular issue and give Members from across the House—including the Minister —a crash course in it. As a result of my research ahead of the debate, I know far more about podiatry than I did yesterday. I thank the right hon. Gentleman for that.

I know having undertaken that research—and, indeed, from my constituency inbox—that podiatrists are a hugely important part of the workforce. They are an invaluable part of our NHS, as the right hon. Gentleman eloquently set out. I join him in saying how hugely grateful I am for their vital work supporting patients day in, day out across our NHS. The Government know that personal care that is responsive to people’s needs is essential and the service that podiatrists provide to local communities is important in helping people maintain their mobility, independence and wellbeing.

As the right hon. Gentleman rightly pointed out, early identification of foot problems helps to prevent or delay the onset or exacerbation of long-term conditions, thereby reducing the risk of wounds, infection and, ultimately, amputation. He also pointed out that foot problems have a significant financial impact on the NHS through out-patient cost, increased bed occupancy and prolonged stays in hospital. Working mainly at the heart of primary care, podiatrists are well placed to ensure patients receive a quality foot screening service, as well as the appropriate onward referrals for foot and lower-limb interventions.

The right hon. Gentleman correctly pointed to our ageing population. That is not exclusive to us; it is a global problem, certainly in the western world. I say “problem” but, actually, it is a great thing that people live longer. However, it is a challenge for health systems, because people are living longer with long-term conditions and complex needs that we need to ensure we can support and manage as a society. As the right hon. Gentleman pointed out, the need will continue to grow.

The right hon. Gentleman raised a number of issues but, with his permission, I will focus mainly on the workforce rather than on podiatry more generally. I recognise that the workforce remain under sustained pressure, having worked tirelessly throughout the pandemic to provide high-quality care for those who need it. I recognise that podiatrists’ role in supporting our NHS is as important as ever. It is vital that we support the workforce both now and in the future.

[Jim Shannon]

The right hon. Member for Hayes and Harlington (John McDonnell) referred to volunteers. I have them in my constituency, and if it were not for the volunteer podiatrists who give their time every day of the week, free of charge, I believe the NHS would be suffering even more. That is why we need to push for the recruitment that he referred to.

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

Smokefree 2030 Target

Jim Shannon Excerpts

Tuesday 20th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for securing this important debate. I am always pleased to come along and make a contribution.

Although Northern Ireland does not yet have a smoke-free target, I strongly support the Smokefree 2030 ambition. I welcomed the Minister’s announcement in April, which set out a number of bold and innovative measures. Putting in place the measures needed to make England smoke free by 2030 will enhance efforts to tackle smoking across the whole United Kingdom. Although Northern Ireland and the other devolved nations hold responsibility for their own health policies, the Government in Westminster maintain responsibility for UK-wide policies, which will impact progress in the devolved nations. I know that the Minister is always keen to respond in a positive way; perhaps he could confirm that discussions have taken place and tell us their outcome.

I particularly welcome the commitment to hold a consultation on pack inserts. All of us have probably called for that—I know I have—and I am pleased to see that it has been adopted by the Government. Cigarette pack inserts providing health information have been required in Canada since 2000, and there is substantial evidence that they are effective. Research carried out in the UK supports their use here too. I hope that the Minister will confirm when the consultation will open—that is my first question.

As the Minister knows, healthcare services are under severe pressure across the United Kingdom. Tackling smoking, which is a leading preventable cause of death and disease, killing 2,300 people in Northern Ireland each year, is vital if we are to ease that pressure. In Northern Ireland, cases of lung cancer among men are projected to increase by 74% by 2035. That is massive, but the figures are even more massive for women, for whom cases are projected to increase by 91%. Smoking is responsible for over seven in 10 cases of lung cancer. Therefore, real, targeted action needs to be taken. I am keen to get the Minister’s thoughts on that.

In 2016-17, the estimated hospital costs for treating smoking-related diseases in Northern Ireland were £172 million. If we do not take urgent action now to reduce smoking rates, our healthcare service will continue to face huge pressure. Analysis by Cancer Research UK shows that current rates of decline in Northern Ireland will not achieve the smoke-free ambition of smoking rates of 5% or less until the late 2040s, which is a decade after England. That means that our deprived populations will not be smoke-free until 2050. We need to step up efforts to achieve a smoke-free future at both the devolved level and the UK level.

I was interested to see the Minister’s announcement on how the Government intend to crack down on illicit tobacco and vaping products. We can give some credit to the Government, and to the Minister in particular, for the action they have put forward. The sale of illicit tobacco undermines efforts to reduce smoking rates. It is concentrated among poorer smokers and disadvantaged communities, contributing to higher rates of smoking. Retailers who sell illicit tobacco are much more likely to be happy to sell to children, so the illicit market also poses a particular risk to children’s health. Addressing the issue requires tackling not just the supply but the demand for illicit tobacco in communities where smoking is endemic.

The UK has made great strides in reducing the trade of illicit tobacco in the last two decades, with a comprehensive anti-smuggling strategy, which has more than halved the market share of illicit cigarettes, from 22% in 2000-01 to 9% in 2021. The Government need to be thanked and congratulated for that. It is a very positive and clear strategy, and it is working, but we need perhaps to sharpen it up a wee bit. There is still more to be done.

The announcement that His Majesty’s Revenue and Customs and Border Force will publish an updated strategy to tackle illicit tobacco is welcome. Northern Ireland, with its land border with the EU, is particularly geographically vulnerable to illicit trade run by criminal gangs, and we have a proliferation of paramilitary groups on both sides using the illicit tobacco sector to create moneys for their criminal uses. Border Force and HMRC have a key role to play in tackling smuggled tobacco, especially in our most disadvantaged communities, where smoking rates are highest. It is not the Minister’s responsibility, but perhaps he could give us some idea about how that co-operation between the Police Service of Northern Ireland, Garda Síochána and the mainland police here is working.

I also welcome the Minister’s commitment to adapting the tobacco track and trace system to strengthen enforcement and target the illicit market. In particular, the Minister’s commitment to explore how to share with local partners information about who is registered on the track and trace system is critical. Will he confirm whether sharing information with local partners from the track and trace system overseen by HMRC will be part of the new strategy? It is important that it is. The Minister is nodding, so I expect that the answer is yes, which would be good news. Will he also tell us whether the new illicit tobacco strategy will be launched before the summer recess? As MPs, we always like timescales—I know I do, so perhaps he could respond positively to that question.

Hospice Services: Support

Jim Shannon Excerpts

Wednesday 14th June 2023 Westminster Hall

[Paul Holmes]

My hon. Friend, who is my past employer, makes a good point—although not as good as when I wrote his speeches. He is absolutely correct that there is uncertainty about that grant, and about how it is handed out by local commissioning groups. It is not getting through to children’s hospices, and I hope the Minister will have something to say about tweaking the way that grant is allocated to local areas.

[Jim Shannon (Strangford) (DUP)]

Sixty-six per cent. of adult hospice income and 80% of children’s hospice income is raised through fundraising—bake sales, charity shops and marathons—and Marie Curie depends on that more than others. Does the hon. Gentleman agree that we should put on the record our thanks to the volunteers who make the effort and get the money in?

[Paul Holmes]

The hon. Gentleman is absolutely correct. I only have to see Mountbatten local networks of fundraising and charity supporters, whether in charity shops or in fundraising roles. I am honoured that I may become part of that community—if I land on the ground safety, alongside Miles—but it will not end there. I will carry on fundraising for a fantastic cause.

When Mountbatten hospice wrote to me in January to outline those extraordinary energy costs, I was happy to write on its behalf to the Secretary of State. Unfortunately, the energy bill relief scheme and the later energy bills discount scheme did not ease the pressures, as the hospice was not eligible. Mountbatten still faces unsustainable pressure, as do hospices across the United Kingdom.

Of course, there are some people who ask whether a charity should not take the majority of its funding from its local community—from donations and contributions, rather than from Government funding. That is a fair question, but unfortunately it does not provide a solution, especially considering that community donations already support 70% of Mountbatten’s funding, which it has calculated to be the limit of what it can ask from people.

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[Jim Shannon (Strangford) (DUP)]

This is one of those occasions when being called last means I gain a minute, so I am pleased to have the opportunity to do just that—thank you, Ms Nokes. I thank the hon. Member for Eastleigh (Paul Holmes) for setting the scene so well, and for giving us the chance to participate in a debate that moves us all. Some Members have told very personal stories.

I put on the record my thanks to all the charities, groups and staff who give hospice care, and give families, and us in this House, so much across this great United Kingdom. Our NHS is under immense strain, and we completely understand that there is a finite budget, but questions have to be asked about the use of funds when we look at those at the end of their lives living in conditions that are not acceptable. Rising costs from energy, food prices and staff costs, which are required to meet expected NHS pay rises, mean that hospices across the United Kingdom of Great Britain and Northern Ireland are collectively budgeting for a massive deficit of £186 million this year. Unless we are going to understaff, under-feed, under-medicate or under-heat our dying patients, more money is needed—that is the bottom line.

It is always a pleasure to see the Minister in her place. She grasps the situation very well. She is a lady well known for her compassion and understanding, and I look forward to her response. I agree with Hospice UK, which says that hospices need financial support to continue to offer their essential services. Government funding of £30 million for UK hospices to offset the increased cost of energy bills in the year ahead needs to go beyond the energy bills discount scheme. Additional funding for hospices from the Department of Health in Northern Ireland is also needed; I do not know whether the Minister has had a chance to consider that. The fact is that funding for hospice care is unsustainable. By the end of the year, 86% of hospices will be impacted by increasing energy prices. They need to keep medical machines running and their in-patient units warm for those in their care. Some 71% of hospice expenditure is on staff, which is a massive issue. As I referred to in an intervention, charities and volunteers run 66% of adult hospices and 80% of children’s hospices.

Over the next few years, I and others, as we often do, will help those hospices. Marie Curie, based in Knock Road in Belfast, is a hospice that I have visited to see people who have now passed away. I understand what such hospices do. The facts are clear: savings can always be made with improvements, but on nowhere near the scale that is needed. I therefore believe, with respect, that the Government and the Minister must man the breach. We regularly prioritise human rights in other nations, and the most basic right to a good death must be prioritised in the United Kingdom. That is what we want. It is a very simple request, and I hope the Minister can answer in a positive fashion.

[Caroline Nokes (in the Chair)]

That brings us to our Front Benchers. I call Patrick Grady.

Cancer Medicines: Appraisals

Jim Shannon Excerpts

Tuesday 13th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the matter of appraisals for cancer medicines.

It is a real pleasure to serve under your chairship, Mrs Harris, and I am always pleased to see you in the Chair, as you know. I am always greatly impressed by your commitment to these issues, and I have been pleased to support you in a small way, although always fully. I thank you for being here.

I thank Members for coming along to participate in this important debate. I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place, and the SNP spokesperson, the hon. Member for Midlothian (Owen Thompson). I do not think there is a debate when the Labour spokesperson and I are not together, and we are, more often than not, saying the same thing. I am also incredibly pleased to see the Minister in his place, and it is no secret that he listens and responds to the questions we ask. I think he will find today that there is a united front pushing for the same things. Hopefully, we are pushing at an open door and he can respond in a positive fashion.

It is great that Members have the time to be here to support this matter. The UK’s health technology appraisal process must evolve if it is to keep pace with innovations in cancer treatment and improve outcomes. That is important because, across this great United Kingdom of Great Britain and Northern Ireland, one in every two people—half the people we meet out on the street—will be struck by cancer. My father had cancer on three occasions. He was a Christian and he survived all three times due to the prayers of God’s people, the skill of the surgeon and, ultimately, the care and love of the nurses and the family who supported him.

There are many global healthcare challenges, and the UK must emerge as a leading force. That is why this debate, which is specifically about appraisals for cancer medicines, is so important. It is essential that the Government, the NHS and the National Institute for Health and Care Excellence evolve their processes to address emerging access challenges—and there are challenges. We must have a process that moves quicker, focuses attention and delivers in the necessary timescale.

In July 2022, cancer waiting lists stood at over 320,000 across the UK, which is breathtaking. In addition, there are wider challenges with patients getting treatment in Northern Ireland. As you and others will know, Mrs Harris, I always try to give a Northern Ireland perspective. I am ever mindful that this is not the Minister’s responsibility, but what is happening in Northern Ireland encapsulates what is happening in the UK, Scotland and Wales. Waiting times for cancer treatment in Northern Ireland are the worst on record. Just a third of urgent suspected cancer referrals from GPs—only 35.6%—began receiving treatment within the 62-day target in the final quarter of last year. We have a big challenge, there is a lot to do and there is clearly a lot more for Northern Ireland to do. It is incredibly concerning that we have deteriorated further since those figures from 2021-22. Back home we have a crisis; a catastrophe is perhaps waiting to happen. It is unacceptable that almost 64% are waiting too long to start cancer treatment.

We in Northern Ireland have a cancer strategy that echoes the asks of many cancer charities across NI, including Cancer Focus Northern Ireland and Cancer Research Northern Ireland. I want to put on record my thanks to those cancer charities, which do fantastic work and are very good at contacting us—I do not think there is an MP here who does not have regular correspondence with them. The information they formulated and sent to myself and others before the debate was really helpful.

The cancer strategy was agreed in March 2022 but, over a year later, given stringent funding cuts from central Government, we simply have not had the finances to fully implement it. It still has the potential to play a crucial role in the transformation agenda of the health and social care service, and I believe that it will prove to be an exemplar of true healthcare for cancer sufferers, but we look to our Ministers back home and here in Westminster to ensure that we have the funds to make that happen.

Throughout the United Kingdom of Great Britain and Northern Ireland, cancer survival rates have risen thanks to improvements in planning, but levels of diagnosis and treatment lag significantly behind those in other countries for some cancer types, especially our five-year net survival rates.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

I congratulate the hon. Member on securing the debate. He mentioned the significance of diagnosis. Medical radioisotopes are highly significant for the diagnosis and treatment of dangerous cancer cells, and it is important to secure a domestic supply of them, in terms of both security of supply and cost. I am told there is a shortage of supply in the offing in the United Kingdom, but there is a chance to secure a generating reactor at Trawsfynydd in north Wales, known as Project ARTHUR. I am sure the hon. Member agrees that it would be a positive step for cancer care in the UK if the UK and the Welsh Government were able to make progress together on delivering that project.

[Jim Shannon]

As so often in Westminster Hall and in the main Chamber, the right hon. Lady makes a positive suggestion, and it is one I know you would also support, Mrs Harris. We think it should be the Government’s intention to make every effort to deliver that project in Wales alongside the Welsh Assembly, because it will help us all in the United Kingdom. I always enjoy these debates because they bring us all together, focused on the issue and not the politics of it. If we can make life better for all of us in the United Kingdom through that project in Wales, let us do it. I do not know whether the Minister has had time to prepare, but hopefully his civil servants will give him some indication on that, and then we can look forward with a positive suggestion out of this debate. I thank the right hon. Lady for her intervention; it was very helpful.

Our poor international standing and lack of supportive frameworks mean that, in some cases, certain innovative cancer medicines are not submitted for UK regulatory approval or to NICE, further impacting access for UK patients. Resolving challenges in the appraisal process for licensed medicines will provide important benefits. First and foremost, there will be benefits to our constituents and patients, including, importantly, access to a wider range of treatment options and the potential for improved outcomes for those needing treatment.

Secondly, there will be benefits to the NHS, which will be able to deliver more efficient care and have permission to access a full range of licensed medicines. Thirdly, there will be benefits to the UK—this great nation—because resolving these challenges will improve its attractiveness as a destination for clinical research by incentivising research and development to focus on new and more challenging patient populations. How the Government respond to what the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) asked for is an indication of how we will move forward and lead the way.

One issue is that NICE guidance is not automatically applicable in Northern Ireland, although the Department of Health there does tend to adopt NICE guidelines and approaches. As such, the patient access challenges outlined will likely have the same impact on Northern Irish cancer patients as they will on cancer patients in England and Wales. To be a successful, leading force in cancer medicines and treatments, we must be united, not divided, in how we tackle these issues. I have always been an avid believer in the idea that no nation in this United Kingdom should be left behind, and I know the Minister has always been committed to that; whatever the subject of a debate, he encapsulates my thoughts on how important it is to work together.

There will be challenges for medicines in the cancer drugs fund. Following the update of NICE’s methods and processes, medicines currently in the cancer drugs fund will be measured against different criteria to those used when those medicines entered it. That could mean that, for some medicines, the likelihood of recommending routine NHS access is significantly reduced, so we need some reassurance on that.

The cancer drugs fund is a source of interim funding for cancer drugs in England. It provides access to promising cancer medicines via managed access arrangements. The Northern Ireland Department of Health confirmed in 2018 that medicines approved by NICE for use through the cancer drugs fund will be equally accessible in Northern Ireland through a separate budget pot, which I urge the Minister to defend against any future budget cuts. I know that is not the Government’s intention, but it would be nice to have that reassurance today so that we can report it to everyone involved back home.

Given that medicines are to be reappraised under the NICE guidelines, they will not be appraised against the same criteria. I have ascertained that NICE is not presently considering any flexibility for medicines in that situation. For certain medicines, that will mean that the likelihood of recommending routine NHS access will be further reduced, and probably one of the major asks in this debate is to ensure that that does not happen.

The Government confirmed that 43% of medicines currently in a period of managed access through the CDF include the end-of-life modifier. Issues remain around who can access what medicines. New patients will not be given access to cancer drugs fund-approved drugs if they are not originally taking the drug at the first NICE regulation. Sometimes there needs to be flexibility in how drugs are allocated. It is not just a black and white tick-box exercise—it never is. We need to focus on the circumstances of the individual, the patient and our constituents—I know from his responses to questions that the Minister understands that, and we seek reassurance that that would be the case. The issues I have outlined mean that new cancer patients have no access to old drugs, so future eligible patients will lose out on options in their treatment plan. We seek reassurance that, when it comes to their treatment plan, eligible patients are given options to ensure that they are not debarred by some paper exercise—if I can use that phrase, with great respect.

NICE must act to address the impact that updates to its methods and processes will have on medicines currently in the CDF, especially in Northern Ireland, where these methods are usually followed to the rule. Ensuring that medicines in the CDF can be assessed against the same criteria under which they were initially recommended for use in the NHS will increase confidence for cancer sufferers that the medicines to which they so desperately need access are available. If the Minister has one positive reply for us today, that is the one we would ask for, because we know that it would bring relief to many people right away.

There will always be issues surrounding cost and the cost-effectiveness of financing a drug. The 2019 voluntary scheme for branded medicines pricing and access is an agreement between industry and Government that aims to meet the need to keep the NHS medicines bill affordable. I know there is a need to do that, but there is also a need to make the medication and drugs available, with the ambition to grow the life sciences sector as well, which we must do and have done before. The partnership between Government, pharmaceutical companies and universities is one that I recognise from Queen’s University Belfast and Ulster University in Northern Ireland. Those two universities have great relationships and partnerships with pharmaceutical companies that are to the fore of finding new cures for disease.

The scheme operates through rebate mechanisms, where companies pay a percentage of their net sales back to the Government. Historically, the rates in the voluntary scheme have averaged well below 10% of revenues, but as of 2023 they are 26.5%—wow! That rapid rise was driven by several factors, including the post-pandemic demands on the NHS and the fact that the UK is now widely out of line with comparator countries. Not only does the current level of repayment risk costing the UK economy far more than it saves, but it has an incredible impact on patients’ access to medicines. Again, we need some reassurance from the Minister on that.

For the UK to continue to be an attractive destination for clinical development, which brings benefits to all areas of the United Kingdom of Great Britain and Northern Ireland, a solution to the cost challenge must be found. In presenting the facts of the case and the evidential base, all of us present are very much solution-based, and our questions to the Minister will be about finding solutions.

Further combination therapies have been instrumental in combining medicines to attack different types of cancer and cancerous cells. There are still multiple unresolved issues around the value assessment, which I will briefly list, and I thank Sanofi for making me aware of this information before the debate—indeed, some organisations have been incredibly helpful in giving us a train of thought and a focus for requests, and hopefully we can be solution-driven.

Combination therapies undergoing appraisal can be found not to demonstrate cost-effectiveness or value for money. Furthermore, pricing barriers have proven problematic for manufacturers when two therapies are involved. The manufacturer of the new medicine has no influence over the price of the new therapy, meaning the total cost may go over the cost-effectiveness threshold. We all regularly meet lobby groups and pharmaceutical companies, which tell us that the NICE process is making it difficult for them to advance their medicines to provide relief and find a cure. I know that Governments have to be responsible and do not have the power to spend money willy-nilly, but it is important that we grasp what the manufacturers and pharmaceutical companies are trying to achieve.

Combination therapies can offer people suffering with cancer a better quality of life, a better response to treatment and—this is really what it is all about—a better chance of survival, which is so important. The UK must learn from countries such as Spain and the US in creating a more cohesive and agile path from pre-trial to treatment. Those are just two countries that have an excellent methodology for trying to advance. Hopefully, the Minister will reassure us that we in the United Kingdom are doing the same as other countries. The US dominates certain research, such as in immunotherapy, followed by China. The UK is in third place, with a global share of approximately 5%. Third place is not bad—it is a bronze medal—but we would like to move a wee bit further beyond that, and I think it is possible. The ideas are here, the technology is here and the will is here. We just need to drive it.

We must learn to strengthen links between UK academia, clinical medicine and industry, at a time when it is being reported that the number of industry-backed clinical trials has decreased by 41% since 2017. I know there has been a focus on covid, with everybody trying to find the cure, but let us get back to where we were before and lead the way again. I do not see how we can say that we are doing more to expand the variety of medicines that we offer patients, when the number of trials has declined by almost half.

I cannot emphasise enough how important it is that we ensure that the United Kingdom remains an environment where companies want to bring medicines forward for NICE appraisal in the first place. Being able to approve access to innovative cancer medicines is critical if we are to improve patient outcomes. The UK currently ranks 16th out of 18 comparable countries for five types of cancer, and it is important that we address the challenges with appraising cancer medicines to ensure that patients continue to access the new, innovative treatments in the pipeline. It is so important to get that pipeline concluded and the product line out the other end.

What is the solution? First, it is about exploring and adapting to the challenges and issues that must be overcome in terms of costing, combination therapies and fairer price negotiations for manufacturers and the NHS. The UK Government—our Government—must, in collaboration with NICE and the NHS, work with industry and patient organisations to develop and trial a sustainable solution.

Cancer has killed too many in recent years. Advances in medication and medicine have increased the likelihood of survival—not when my dad had cancer 40-odd years ago, but today. Cancer affects too many loved ones; there are too many horror stories, which we, as Members of Parliament, hear regularly. We do not always get the good stories; it is usually the bad stories about what has gone wrong. As MPs, our duty is to bring them forward on behalf of our constituents and highlight them, as we have done today.

The NHS can work closely with the cancer drugs fund to improve patient access to the good and decent drugs that will help them, and ensure that nobody is left behind. I sincerely thank all the organisations that have been in touch with me and others ahead of the debate on an issue that is so important and affects so many. I say a special thank you to Sanofi for its efforts and support and for answering my questions and queries.

We in this United Kingdom of Great Britain and Northern Ireland have real potential to ensure the best outcomes for constituents and patients. I look to the Minister for reassurance, which I am sure is coming, that we will continue to do all we can to work with the devolved nations—Scotland, Wales and Northern Ireland—and NICE to improve people’s lives. Our job is to do just that. If we can improve people’s lives and help them to live longer, what a joy it will be to have those answers.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their contributions, which I will quickly go through. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) for sharing her personal experience, which greatly affected us. She referred to brain tumours—glioblastoma—and the drugs available on the NHS, the survival rate and her heartfelt request for betterment, and the cajoling of legislators that needs to happen.

Drug companies need to change to help cancer patients. Trials need to be encouraged in the NHS and an oncology person needs to be available in meetings. That is a really good idea, because it gives focus. The hon. Lady also said the NHS needs more awareness and training for brain tumours. I wrote down, “Try something new now.” She also referred to the political will for change. The Minister clearly summed up for us all that this is not about politics; it is about patients. The hon. Lady put forward that point very well.

I thank the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts)—I hope that is close to the right pronunciation—for coming along. She put forward a simple request; the Minister responded, and there will be a meeting. If we come up with solutions, we should push for them, and the right hon. Lady has a solution that will benefit us all.

The hon. Member for Chatham and Aylesford (Tracey Crouch) was a guest speaker at one of my DUP association meetings a few years ago; we had her down at the women’s football team in Comber. She knows I have always had a soft spot for her, and I am pleased to see her here making a heartfelt, personal contribution. She referred to the global survival rate for brain tumours, with the USA at 26% while the UK is at just 10%. Other points related to early diagnosis, pharmaceutical companies, better outcomes, the NICE change to the severity modifier, and the difficulties with drugs.

The hon. Lady summed the debate up so very well, and she centred it on the patient. Central to all this—the drug companies, the NHS, the political aspirations of the parties represented here—is the patient. That is critical, and that is what this debate is about. You know that, Mrs Harris, I know that, and the Minister has clearly accepted it. I thank the hon. Member for Chatham and Aylesford for providing that focus that we all needed.

My friend the hon. Member for Midlothian (Owen Thompson) referred to the contraction in funding and its impact on the pharmaceutical companies, on the availability of medicines to GPs and, ultimately, on patients. It keeps coming back to the patients; they are central. I thank the hon. Gentleman very much for his contribution.

I love having debates with the hon. Member for Denton and Reddish (Andrew Gwynne), because we are always on the same page, as we clearly were today. He grasped the issue and summed it up so well. He talked about priority access to innovative medicines, and referred to brain tumours and cancers too. However, he mentioned, as I did, that clinical trials, with businesses and researchers working together, are down by 41%. We really need to address that. The UK has dropped from fourth to 10th in the global rankings. We need to regain that higher position; the hon. Gentleman underlined that. It is not about moving up the rankings for the sake of it; it is about moving up the rankings to regain the position that we had. We understand the reasons for our drop in the rankings, which include covid; the Minister responded well in that regard. It is not about blame; it is about regaining that higher position. The hon. Member for Denton and Reddish also referred to the unacceptable gap in medicines, which must be addressed to make the UK a world leader once again.

It is a pleasure to attend any debate with the Minister, and I thank him for his answers today. He referred to something that should make us focus: there are 780 new cancer cases each day—wow! I had never heard that figure until today. We hear the bigger figure—the 200,000 or 300,000—but I had never heard that daily statistic. As we have been sitting here, there have been diagnoses across this great United Kingdom.

Again, the Minister summed the situation up: brain tumours do not get the attention that they deserve. He referred to a 26% increase in cancer diagnoses in the last year. I loved his positive answer—160 diagnostic centres approved by 2025, with 4 million extra checks. We heard about a 92% approval rate for new drugs, and about clinical trials. Covid changed things, and we must regain our place in the rankings. There is a need to improve and to go faster—how well that was summed up. I thank everyone for their contributions, and I especially thank the Minister for the positivity of his response.

Question put and agreed to.

Resolved,

That this House has considered the matter of appraisals for cancer medicines.

New Hospital Programme and Imperial College Healthcare NHS Trust

Jim Shannon Excerpts

Tuesday 13th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to speak in this debate, and I congratulate the hon. Member for Hammersmith (Andy Slaughter) on securing it on this issue. He is indeed a hardy, dedicated and assiduous MP. I say that in all honesty, because I think the good people of Hammersmith have an excellent MP, and they should be very proud of the efforts he makes on behalf of his people in the Chamber and Westminster Hall.

This debate is about the new hospital programme, which applies to the UK mainland. I have come along to add my support to the hon. Gentleman, as I do for many right hon. and hon. Members, here and in the main Chamber. That is my purpose for being here. I am also here to discuss the new hospital programme, which was announced at the 2019 Conservative manifesto launch and would have delivered 40 new hospitals in the UK by 2030. I understand the reasons for the delays—the covid pandemic has focused attention elsewhere and taken away much of the funding—but there is a real need, and hon. Members have made that case today on behalf of their constituents.

I also understand the position of the hon. Member for Hammersmith on the refurbishment works at Charing Cross and Hammersmith Hospitals. As MPs, we want the best of care, access and opportunities for our constituents, and delays to any work are often frustrating, so I understand the request very well, and support his position and his ongoing commitment to his constituents.

I am pleased to see the Minister in his place. He responded to the first debate in Westminster Hall this morning on cancer very well. If he answers hon. Members in the same way in this debate as he did in that one, they will be more than satisfied. With the support of the new hospital programme, Imperial College Healthcare NHS Trust is beginning the next phase of redevelopment planning work for its three main hospital sites, all of which are included in the 40 new hospitals that the Government have committed to building by 2030.

I will quickly give a Northern Ireland perspective: what is happening here is also happening back home. It is important that we all remember that the demands for hospital care and better hospitals are not just in London; they are across the whole of this great United Kingdom of Great Britain and Northern Ireland. Northern Ireland has around 3% of all hospitals, with 40 across the Province.

In a constituency neighbouring mine, Belfast East, we have Ulster Hospital, which is the main hospital for us and is currently undergoing a £261 million revamp being done in stages. I believe that we are now going into section C of this refurbishment. So far there have been developments to a 30,000-square-metre in-patient block that is six storeys high, with a day surgery unit, an endoscopy unit, an angiography unit, and a cardiac investigation unit, with 12 in-patient wards. It is very much a modern hospital and very much of the modern programme that we have in Northern Ireland. The Minister is not responsible for that, but I just wanted to put it on record.

In order to clear our waiting lists, it is crucial that we do all we can to update outdated and old facilities. For a modern society and a fully functioning working hospital, things need to be modern and up to date. That is what the hon. Gentleman has asked for, and that is important. Hospital waiting lists in Northern Ireland are supposed to be banished by 2026—that is pie in the sky, in all honesty—according to a roadmap set out by the former health Minister, Robin Swann. More than 330,000 people are on some sort of waiting list in Northern Ireland and the new elective care framework proposes a £700 million investment over five years. It is important that the Government are committed to the requests of the hon. Member for Hammersmith and the hon. Member for Westminster North (Ms Buck), and to other requests that will follow.

[Sir Mark Hendrick (in the Chair)]

Order. Health is devolved in Northern Ireland, and the focus of this is very much on—

[Jim Shannon]

That is what I have done in my comments, Sir Mark. I just want to give you the example of Northern Ireland—

[Sir Mark Hendrick (in the Chair)]

But it is not a speech about the Northern Ireland health service, surely.

[Jim Shannon]

I have every hope that the Department of Health and Social Care will be able to give us timely updates on hospitals in England. This is a discussion I always have with those in the devolved Assemblies. We must—I conclude with this—do our best for our constituents and ensure that the collective facilities are in place to serve their needs. I hope the work in the constituency of the hon. Member for Hammersmith will commence soon as some reassurance for his constituents. He put his case forward—the Minister, I am sure, will respond—and I support him in what he has requested.

Stem Cell Transplant Patients

Jim Shannon Excerpts

Monday 12th June 2023 Commons Chamber

[Mark Tami]

I thank my hon. Friend for making that very important point. I was talking about how much the costs were back then, but clearly people going through the process now are experiencing what we term the cost of living crisis, which is affecting everyone.

[Jim Shannon (Strangford) (DUP)]

rose—

[Mark Tami]

I see that the hon. Member—I will call him my hon. Friend—wants to intervene.

[Jim Shannon]

I congratulate the hon. Gentleman on bringing forward the debate. I spoke to him before, because I realised that he was bringing forward an issue close to my heart, not personally but for my constituents. The Anthony Nolan charity does spectacular work throughout all of the United Kingdom of Great Britain and Northern Ireland, including my constituency of Strangford.

The most recent statistics show that 70% of patients—some of them are from Strangford—have considered returning to work earlier than advised due to financial concerns, jeopardising their recovery. Does the hon. Member agree that there is an incredible delay in assessments and decisions for social security at the moment, and that if more effort were made by the Government and the Minister to ensure that they were done on a timely basis, some undue stress would be taken off people awaiting transplants? Ultimately, they would not feel that they had no choice but to go back to work when clearly they should not do so.

[Mark Tami]

I thank my hon. Friend for that point. He is entirely right. As part of the transplant process, the immune system is effectively wiped out. That is a necessary part of the treatment, but clearly it leaves the patient fairly defenceless to infections. Once the donor stem cells are given, they will slowly build up a new immune system inside their body, but that takes time—it does not happen overnight—so those patients are often very vulnerable to infections. He made the point that if they put themselves into a dangerous situation because of financial pressure, the worst could happen to them—or at the very least, they could fall back into the medical setting that they were hoping to remove themselves from.

As part of the process, patients strictly isolate themselves in a hospital room for weeks—sometimes months—on end. Even after they leave, they are often weak and, as a result of their inability to work, their household income will obviously suffer. When patients are well enough to be sent home from hospital, there is still a long, gruelling and costly recovery ahead, whether they are the main wage earner or another member of the household, because obviously everyone else has to support them, whether in a caring role or otherwise.

--- Later in debate ---

[Neil O’Brien]

I would agree with the hon. Gentleman. I was talking about one scheme, the healthcare travel costs scheme, but patients might also be eligible for non-emergency patient transport, on which we spend about £500 million a year across England. We will continue to look closely at the future of that, not least because of the hon. Gentleman’s comments this evening.

[Jim Shannon]

Patients in my constituency who come to me feel almost compelled to go back to work because they do not have the finances, but they cannot do so because they are not fit enough. Could the Minister’s Department ensure that those people who find themselves in difficult financial circumstances have someone to speak to who could perhaps direct them through the process so that they can get help?

[Neil O’Brien]

The hon. Member makes a good point, and I am happy to continue this conversation with him after the debate. He always provides thoughtful ideas and I am keen to continue talking about that one with him.

For those people who are going through all this at the moment, I have mentioned some of the schemes that are available for transport, such as the healthcare travel costs scheme and non-emergency patient transport, but we will continue to look at those to make sure that they are adequate to get patients to the specialist treatment they need.

In closing, let me again thank the right hon. Member for Alyn and Deeside for securing today’s really important debate and for his thoughtful contribution. Stem cell patients and their families and carers show tremendous courage in the face of incredible challenge, and we will continue to do whatever we can to support this vulnerable community.

Question put and agreed to.

Obesity and Fatty Liver Disease

Jim Shannon Excerpts

Thursday 8th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Mr Hollobone; it is always a pleasure to serve under your chairmanship. It happens very often that you and I are here in Westminster Hall, but perhaps for different reasons and to participate in different ways.

I thank the hon. Member for Caerphilly (Wayne David) for leading the debate. It is always a pleasure to hear his calm voice, and today he put the case forward admirably. It is also a pleasure to follow the hon. Member for Erewash (Maggie Throup), who brings a vast stock of knowledge from her former role and her deep interest in these subjects. Whenever she speaks in Westminster Hall or the main Chamber, it is always with facts, evidence and a determination to get the answers.

As the vice-chair of the APPG on liver disease and liver cancer, I am pleased to be here to draw attention to the liver disease crisis, but I am not pleased that there is a crisis of liver cancer in Northern Ireland. One of the great things about the Minister—I do not say this to give him a big head or anything—is that whenever we ask him questions, his first intention is clearly to respond in a positive fashion. That being the case, I have a couple of asks for him.

I am also pleased to work alongside the two shadow Ministers, the hon. Members for Linlithgow and East Falkirk (Martyn Day) and for Bristol South (Karin Smyth). I was saying beforehand to the Labour shadow Minister that very often—most Thursdays—she, the Minister and I, and sometimes others, have this shift in Westminster Hall. We are always pleased to come and to participate. As we look forward, I hope that we can work together and emerge with a good practice for obesity prevention and the early diagnosis of fatty liver disease, which I hope can be replicated across the whole of this great United Kingdom of Great Britain and Northern Ireland.

I was delighted to sponsor the British Liver Trust’s “Check your liver health” event in Portcullis House in January. The hon. Member for Caerphilly referred to that event. The turnout was great; he was absolutely right. I thank all MPs who took the time to attend. I personally got the all-clear. That does not mean that someone can sit back and say that everything is all right; they have to continue to do the right things, so that they do not fall back.

I would like to give some background on the situation in Northern Ireland. I always like to give a Northern Ireland perspective, because I believe that that enriches the debate, even though it probably replicates what everybody else is saying as well. When the SNP shadow Minister speaks, he will give Scotland’s perspective, and I very much look forward to hearing that also. In Northern Ireland, nine out of 10 liver disease cases are preventable. That is the point that we start from and it is what the hon. Member for Caerphilly said in his introduction: we can prevent liver disease if we eat right—if we have the correct diet—and we exercise, so it is really important that we do that. There is also the question of alcohol. I am not against anybody drinking alcohol, but if people do that, they should do it in moderation.

Liver disease deaths have doubled in the last two decades, which contrasts with the trends in other chronic diseases, which have decreased or stabilised. While liver disease and liver cancer have increased, other diseases have fallen. We cannot ignore that. There is an onus on Government. Government cannot do everything for everybody, but they can raise awareness and perhaps give some of the direction that is needed. It is important to recognise the trend.

Liver disease deaths in Northern Ireland increased by 39% during the period encompassing the pandemic—between 2018 and 2021. That was primarily driven by obesity and alcohol misuse. The pandemic was part of the reason for that, but there is also an onus on all of us individually, including me. We need to exercise and do the right things. Northern Ireland does have a non-alcohol-related fatty liver disease and haemochromatosis pathway in development, so there is a policy by the HPSS—health and personal social services—in Northern Ireland, but progress is slow.

I am, as always, keen to ensure that the Minister here uses his good offices to encourage the devolved Administrations to be active, and I am sure that that will be the case. The Minister himself is proactive. I know that he has had regular contact in all his ministerial roles—in Education and now in Health—and I hope that discussions with those in Northern Ireland continue. Has he had an opportunity to have discussions with the Department of Health back home in Northern Ireland? If not, may I request that he do that?

I have spoken before on the importance both of raising awareness of the risks of obesity and of early diagnosis. People with excess weight and fatty liver disease are at higher risk of cardiovascular disease and a wide range of cancers. People who are obese are two times more likely to develop liver cancer, three times more likely to develop colon cancer, two and a half times more likely to develop high blood pressure and five times more likely to develop type 2 diabetes. I declare an interest as a type 2 diabetic. I will give an idea of what that involves. When I was diagnosed as a type 2 diabetic some 15 years ago, I weighed 17.5 stone. I was a big fat puddin’—I am talking about myself, so I can use this terminology. I lost some four stone and have kept that weight off. But people have to work at it; that is what the hon. Member for Caerphilly was saying. Diet control helped for a while, but my diabetes—this debate is not about diabetes—is now medication-controlled. It is important that people are aware of that issue. That included me, who came through that particular episode some years ago.

British Liver Trust research reveals huge geographic variation in access to patient care pathways for the early diagnosis and management of liver disease in primary care. Furthermore, removing stigma surrounding the impacts of liver disease is crucial. That is why it is important that we all recognise that we have to encourage people. It is so alarming that 49% of liver patients surveyed by the British Liver Trust in October 2022 reported experiences of stigma from healthcare professionals. When someone comes to our office, our job as MPs is not ever to be judgmental; it is to help the person with whatever the issue may be. I think that there is a case for healthcare professionals to have the same attitude when people come to them. This should be not about judgmental attitudes, but about saying, “What can we do to help?” People should look at it that way.

I congratulate the Royal Victoria Hospital liver support group in Northern Ireland on its recent 25th anniversary. Its chairman, Jim Kilpatrick, is a constituent in a neighbouring constituency, and he is a passionate campaigner who has been instrumental in improving support for patients in my constituency of Strangford—indeed, in all areas. I commend him for that and for the support of carers across Northern Ireland. There was a debate in the Chamber earlier about carers. I think we all have experience of that—I know my family have. Jim Kilpatrick presents an understanding and supportive stance on behalf of the support group, persuading, assisting and making life better, as well as focusing attention on and driving the strategy. The Royal Victoria Hospital liver support group is a network of volunteer liver patients and their carers who provide confidential, compassionate, emotional and psychological support for all adults, teenagers and children coping with a liver condition. Their vital work is a lifeline to my constituents and patients across Northern Ireland.

Liver disease is a silent killer, largely asymptomatic in its early stages. Three quarters of patients are diagnosed with cirrhosis in hospital, when it is too late for effective treatment. The hon. Member for Caerphilly emphasised the need for early diagnosis, and he is right. Risks can be drastically reduced through early detection and through diet, exercise and drinking in moderation. Let us be honest—there should be moderation in everything. It is so important that we raise awareness.

I give sincere thanks to the British Liver Trust, which has been in constant contact with my office and has been so insightful in the information it has provided. I want to put on the record how grateful I am to the trust for providing me and my staff with the information to prepare for this debate. I look forward to working with it in future as we collaborate to address this important issue and improve the health of constituents. I am convinced that the trust would be keen to work alongside the Minister and his Department. Has he had an opportunity to discuss these matters, to work in partnership and to help each other.?

I am also keen to receive an assurance that any co-ordinated plan or strategy here on the mainland can be delivered by the regional Administrations, including the Northern Ireland Assembly. I am confident and convinced that the assurances I seek will be given. I say this not as a political comment, but when it comes to many things, particularly health, one of the great things is that we can work collaboratively and better as the United Kingdom of Great Britain and Northern Ireland. It is always better to share our details, our practices and our experiences. By doing so, we can move forward together and make sure that across this great nation we can all improve our health.

--- Later in debate ---

[Will Quince]

My hon. Friend is absolutely right; we are constantly learning more. At the moment, I do not think there is a definition of an “ultra-processed food”. There has been a lot of work. We are learning more and more about the issue and it has recently exploded into the public domain. We need to ensure that more people are aware of and being educated about what is actually in their food, and that they are looking at labels. If we go back 20 years, we were all very much alive to E numbers —does everyone remember E numbers?—which no one looked at before. Now, we often look over the back of the packaging to see the number of E numbers in our products. The more that the public are educated and informed so that they can look out for these things, the better. My hon. Friend the Member for Harborough will be happy to discuss this further with my hon. Friend the Member for Erewash. I know that ultra-processed foods are an issue about which the public are concerned, and we certainly have more to do on food labelling.

[Jim Shannon]

The Minister always brings good responses. The SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), made a comment that I endorse totally, because it is something that I hear from my constituents every week. With respect, many people can look at the labels and see what they mean, but what do they look at first? They look at the price, because they are trying to make a meal for their family. What drives them will be, “What can I afford to do?” I am conscious that the Minister has been very constructive in his responses, but there must be a wee bit of reality as well.

[Will Quince]

I thank the hon. Member for that intervention. He is absolutely right; not everyone has the luxury to make choices, and they will often have to go for the cheapest products or products that are available in their area when others might not be. That is why it is so important that we continue the work with industry on reformulation.

Personally, I have been more of a convert to Government action in this area. The soft drinks industry levy has been hugely successful. The industry was already doing a lot of that work. Nevertheless, the levy has nudged and pushed it further in the right direction—but there is more work to do.

I would push back ever so slightly on a couple of the comments that have been made today about industry not wanting to do this. It is not moving at the pace that we want, expect and need it to, but it is doing it. The sugar content of cereal is down by about 15%, and it is down by about 14% in yoghurts and fromage frais. We need industry members to go further, but they are doing it because they are responding directly to what their customers and consumers are telling them they want, and to people actively choosing healthier products. However, we have more to do on reformulation and working with industry.

We will also introduce restrictions on the advertising of less healthy products before 9 pm. I will answer the question on that from my hon. Friend the Member for Erewash in just a moment. The major conditions strategy call for evidence is open, and, as I said, my hon. Friend the Member for Faversham and Mid Kent will gladly meet colleagues to discuss that.

There is also the piece of work around supporting people with weight management, such as the NHS digital weight management programme, the weight loss drug programme and pilot that we announced yesterday, which I just spoke about, and the better health campaigns—including the NHS weight loss app Couch to 5k, which, if anyone has not tried it, is a great way of getting into running, and Active 10. There is also the NHS health check, which includes checking on BMI, encouraging people and giving them the tools to take control of their health.

Then there is the research piece. As I say, this is one of our healthcare missions. Obesity is right there at the top; we want to see the newest and most innovative products and medicines coming forward and being used first in this country.

The hon. Member for Bristol South is absolutely right that this cannot just be an issue for the Department of Health and Social Care; it must be a cross-Government issue. I remember when I was the Children’s Minister and had responsibility for school sport: looking at school sport investment and premiums, at the upskilling of primary school PE teachers in particular, and at the holiday activities and food programme, which was specifically targeted at children in receipt of free school meals.

I remember visiting some eye-opening educational programmes. In one example—I would love to get a number of parliamentary colleagues to try this experiment—there was range of soft drinks, from a Monster energy drink through to flavoured water, and a big box of sugar cubes. The children were asked to put against each product the number of sugar cubes they thought it contained. You would be amazed, Mr Hollobone, how many children put six cubes against the water and very few against the Monster or the full-fat Coke, despite the can of Coke containing something like six cubes of sugar. In schools, we are also promoting the daily mile, the healthy schools programme and healthy school meals. That is all important work, but do we need to do more? Of course we do.

My hon. Friend the Member for Erewash asked about the delay to policies, specifically to the restrictions on advertising and promotions. I understand her frustration but the delay to advertising restrictions allows the Government and regulators to carry out certain processes necessary for the robust implementation of the restrictions. Those processes include carrying out consultations, appointing a frontline regulator, the laying of regulations and the drafting of guidance. She asked specifically when that is coming in; it will be in October 2025. She also asked about the volume price promotions ban, which was delayed due to the unprecedented global economic situation. I do not know the answer and I do not want to mislead her. The legislation states October this year, but I do not know latest position, so I will ask my hon. Friend the Member for Harborough to write to her.

National Carers Week

Jim Shannon Excerpts

Thursday 8th June 2023 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered National Carers Week and respite for carers.

I thank the Backbench Business Committee for allowing us time to debate in the House today the important issue of unpaid carers. I thank, in particular, those Members who supported my application for the debate, including the right hon. Members for Kingston and Surbiton (Ed Davey) and for Dwyfor Meirionnydd (Liz Saville Roberts), and the hon. Members for Bolton South East (Yasmin Qureshi), for Strangford (Jim Shannon), for Brighton, Pavilion (Caroline Lucas), for Motherwell and Wishaw (Marion Fellows) and for St Albans (Daisy Cooper).

As all hon. Members and those watching the debate will know, it is taking place during Carers Week, which is held each year to raise awareness of those caring unpaid for family and friends who are living with a disability or who are frail or unwell. It is led by Carers UK but supported by Age UK, Carers Trust, the Motor Neurone Disease Association, Oxfam GB, Rethink Mental Illness and the Lewy Body Society. I encourage everyone who does not already know to go and find out more about the brilliant work of all those organisations.

The latest census data from 2021 shows that millions of people—in fact, 5.7 million people across the UK—are currently providing some form of unpaid care for a friend or family member who, due to illness, disability, mental health or an addiction, cannot cope without their support. The majority of people providing that care are women. Indeed, many of us may be personally caring for someone, or will have someone in their family, or will know of friends or neighbours, who go to great lengths to support people they love. There are virtually no families untouched by this responsibility across the country.

I speak today as co-chair of the all-party parliamentary group on carers. I am a former Minister for care and had responsibility for unpaid carers when in Government. However, my first experience of this came when my mum was a carer for my grandmother, who was living with dementia. At the same time, I had just had my first baby—he is now 20. My mum was attempting to support me in bringing up a small baby and my grandmother who was living with dementia. She was part of the generation of sandwich carers we see across the UK, who are sacrificing their own health and wellbeing, their own relationships and their own profession to show such love and dedication for someone else.

We know that caring can be an incredibly profound experience. For many carers it is a very positive experience that enables them to build a very special bond with those they care for. In the vast majority of cases, it is driven simply by love. But we also know that it can take its toll on their own health and wellbeing. Caring can take such a different variety of forms. It can be anything from really intimate personal care to quite complex healthcare, right the way through to the emotional support of being a stable companion and providing encouragement to the person they care for. The care can be utterly lifechanging for those who receive it. One person said to me:

“The difference she makes to my life is unbelievable. She has given me back the freedom to actually go out and enjoy my life.”

However, we also know that caring can be extremely complex, and there is no denying that it can be exceptionally challenging as well. Indeed, too often the efforts that carers go to, to keep those they love safe and well, leaves people exhausted, burnt out and struggling to live a life beyond their caring responsibilities. As a result, many carers are extremely concerned and worried about the future. Beverly told me about her caring responsibilities and the impact they have on her life. She said:

“I am a full-time carer to my son who has Down’s syndrome and my husband who has Parkinson’s. By full time, I mean every hour of every day, day and night. I do it because I love them and I want them to have as good a life as possible. It is a never-ending round of jobs like cutting meals, making sure meds are taken, washing, appointments, making sure they are appropriately washed and dressed—and that is without having elderly parents to support. The sad thing is that you also forget to look after yourself.”

That is one of the biggest messages I want to get across today. Many carers like Beverly find that their relationships are impacted by their caring responsibilities because of a lack of support and recognition. That can lead to social isolation and mean that carers who are struggling to balance paid work and unpaid care have to leave the labour market or reduce their hours of work.

There are also significant financial costs associated with caring. Carers often use their own incomes and savings to pay for support services and care equipment for the people they care for. We also know that carers can face poorer health outcomes than non-carers, with a high proportion struggling with their own physical and mental health problems, and experiencing very low levels of wellbeing.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. She is right that there are so many unpaid carers across the whole of the United Kingdom of Great Britain and Northern Ireland. My brother was involved in a motorbike accident some 19 years ago, and my mother, my wife and my son all look after him. Conservative estimates say that £162 billion per year is saved through unpaid care. That is just one example of the vital nature of carers. The hon. Lady refers to the impact on those who care: the pressures psychologically, financially, emotionally and physically. Does she agree that some consideration must be given by Government for respite care? I know how important that is to some of my constituents. I suspect she will confirm that when she replies to me, but I think something needs to be done there.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right. Respite care comes up time and again as one of the big asks for unpaid carers. They want to carry on doing the role they are doing. They deeply love the people they are caring for. They take a huge amount of personal responsibility and pride with the care they are giving, but they need that little bit of support. Around the time of covid, in particular, we saw many, many unpaid carers going on for months, years even, without the ability for any kind of respite. The figure he quotes is crucial: £162 billion a year is the value that unpaid carers are saving our health and care system. That is an incredible amount of money. It is like a whole separate, second NHS, saving that amount of money. The huge pressures placed on the other NHS we have result in delays for unpaid carers in obtaining the primary and secondary healthcare appointments that they need. The record demand for our social care services means that carers are not getting the support that they need.

I want to spend a little time exploring some of those challenges in more detail. Other Members across the House will add their own voices. As I noted earlier, many carers are struggling with poor mental and physical health. According to Carers UK research, one in five carers says that their physical health is bad or very bad, 30% suffer from poor mental health and over a quarter say that they often or always feel lonely. Carers provide many hours of support for the people they care for, but very few are able to take a break from their caring. That results in tiredness and, in some cases, exhaustion and burnout. As the hon. Member for Strangford said, worryingly, 41% of carers have not taken a break from their caring role in the last year. A carer called Anton told me about the strain that caring is placing on him:

“It is hard, often draining and mentally and emotionally painful work, bordering on damaging. Due to my responsibilities and the amount I am depended on, I am often anxious, feel hopeless and depressed.”

Carers are not getting the support that they need from our health and social care systems, as both systems are under intense and increasing pressure. Many carers have experienced delays in accessing healthcare appointments and services. One fifth of carers who request a GP appointment have to wait more than a month to see a doctor, and over a third have had to wait more than a year for specialist treatments or assessment. That causes additional stress and anxiety, and results in many feeling isolated or forgotten about.

This year, only a quarter of carers said that they had undertaken a carer’s assessment in England—a statutory right under the Care Act 2014. Of those who received an assessment, many were concerned that it did not lead to any improvements in the support provided to them. Could the Minister outline what she is doing to ensure that those carer assessments are not only conducted but conducted properly and that the outcomes are delivered? In fact, 39% of carers said that they did not even know what a care assessment was—that is the severity of the problem. A carer called Trevor told me:

“I get no support whatsoever. It has taken nearly 4 years to get a carer’s assessment from the Local Authorities which is now imminent. I have no expectations whatsoever.”

What is the Minister doing to communicate with local authorities to make sure that those important carer’s assessments take place? Debbie contacted me to tell me:

“I’ve had no support whatsoever. Support seems to consist of ticking a box to say I’m a carer but nothing more.”

It is just not good enough.

I want briefly to touch on the financial impact that caring can have. The cost of living means that carers currently face unprecedented demands on their finances. Concerningly, more than half of carers say that they are extremely worried about managing their monthly costs. A quarter told Carers UK that they are cutting back on essentials such as food or heating, and over three quarters said that the rising cost of living is the main challenge that they will face in the coming year. Many have been desperately trying to find ways of saving money, but that can be difficult because, quite often, the people they are caring for need life-saving care equipment that requires energy, or they need to ensure that the person they are caring for is kept warm. David told me about the financial impact that caring was having on him:

“I have been a full-time carer for my wife for over 10 years, and I’ve found that the money I get doesn’t even cover energy bills. It’s a constant struggle: all unpaid carers want is enough money to pay our bills and still have something left over to buy things when we need to. We are saving the country a lot of money by doing what we do and some recognition would be appreciated.”

[Dame Caroline Dinenage]

That is absolutely right. The Government have spoken about a social tariff for energy, but identifying who the carers are and how they can access that support is vital.

Gary told me about the financial struggles he has because of caring:

“After giving up a reasonable salaried job to care for my wife, we fell into severe financial hardship and were resorting to food banks. When the cost of living crisis happened, it was so bad I had to take up part-time taxi driving, which takes me away from my care role, in order to survive, but I can only earn so much due to the limits imposed or lose the carer’s allowance.”

That is adding additional stress and complexity to his life.

Supporting carers to stay in or return to paid work is essential. We want to ensure that carers can live a life free from poverty in older age, but 75% of carers who are working alongside their caring responsibilities are worried about juggling work and care. Increasing numbers of employers are recognising the importance of supporting carers in the workplace, and it is vital that they maintain flexibility so that people can continue to do their incredible juggling acts.

Nicola told me that she had to give up her career as an embryologist to care for her daughter, who has Angelman syndrome. She said:

“We have no family support, no help from the council and my daughter is awake for hours in the middle of the night, which means that we are unable to sleep and are completely exhausted. The only income I now receive is carer’s allowance. We solely rely on my partner’s income, which covers our bills. We have already moved to a cheaper house, but it is still extortionate as we live in Surrey and my partner has to commute into London daily.”

Lucy, who cares for her disabled son, who has cerebral palsy, told me:

“I have had to give up my job as a company director as his needs and required medical operations means I cannot keep a job any longer. I have gone from having a £40k+ job and am now claiming carer’s allowance.”

Finally, more needs to be done to support and help carers to recognise themselves as carers. Many are not doing so, which means they are missing out on the support they need. Research that the charities involved with Carers Week released on Monday found that 73% of people in the UK who are providing or have provided unpaid care in their lifetime—roughly 19 million people—have not identified themselves as carers. Research also shows that half of all carers take over a year to recognise that they are in a caring role, with over a third taking over three years to recognise themselves as carers.

That is particularly pertinent to young carers, who may not know that they are carers. In many cases, their situation can be misinterpreted. Schools can perceive young carers to be bad students because they are not paying attention, when in many cases they are just extremely tired and stressed by their caring responsibilities. Schools need to go much further to identify young carers in their midst and to support them.

In cases where a young person is supporting a parent with mental ill health, there is a stigma attached and they do not want to tell their friends. I remember meeting one young gentleman at a carers’ festival that is run every year, which is a wonderful way of supporting young carers to live life like normal young people and enjoy themselves. He told me that his mother had made many attempts to take her own life and that, as a very young child, he had to get used to phoning 999 for the ambulance to take his mum away and save her. He never told his school about this because of the stigma attached to it; he felt deeply isolated and ashamed. We need to double down on our efforts to ensure we identify young carers in schools.

[Jim Shannon]

I thank the hon. Lady for giving way; she is very generous. Figures mentioned in the press last week indicated that some 25% of those who care have mental stress, depression and concerns themselves. She has outlined that from a young person’s point of view—what she says clearly illustrates the need for Government to grasp the role of carers and the impact that role has on them.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right about the mental pressure put on carers because of the responsibilities they take on, but also because of the perceived lack of support or respite. It is important that we recognise that that can mount up and overwhelm people, and that they can experience burn-out and ill health.

I want to recognise the work of Governments across the UK and the range of actions they have taken to provide carers with more help and support. In England, the Government aim to support carers primarily through adult social care reform, but also provide support through the Better Care Fund. In the context of reform, I was pleased to note that there is a specific chapter on support for unpaid carers in the White Paper “People at the Heart of Care”, which states that the Government will

“build on the foundations of the carers action plan”

—which I published when I was Minister for Care—

“to set out a new strategic approach”.

I look forward to hearing more about that. Perhaps the Minister will give us further details about the timescales. I should also like to hear more about the £25 million investment that the Department of Health and Social Care has pledged to make in support of unpaid carers. I understand that the details will be announced shortly, but given that it is Carers Week, I should be grateful if the Minister could indulge us and give us a sneak preview of what might be coming up.

I should like now to think back, briefly, to the support that the Government provided to help carers through the pandemic. A number of measures were introduced, including a highly effective identification programme. The Government worked with local authorities, GPs and local carers’ organisations to identify new carers and ask them to come forward for the covid vaccine, for which they were prioritised thanks to fantastic lobbying work by Carers UK and the Minister—who was also the Minister at that time, although there have been a few bumps in the road since then. It is great to see her back in her place. The programme demonstrated an ability to identify carers that does not seem to be moving on into everyday life, and I should like to see that continue. The Government also relaxed some of the rules applying to claims for carer’s allowance, and I should like to see that continue as well.

Further significant steps have been taken in the last year. The Carer’s Leave Act 2023, which gained Royal Assent only last month, will provide dedicated employment rights for carers for the first time. I congratulate the hon. Member for North East Fife (Wendy Chamberlain), my hon. Friend, on her work in securing the passage of her private Member’s Bill, because the Act is a game-changer.

Despite those successes, however, I believe that much more needs to be done. Carers have contacted me to let me know about key areas in which they wanted more support. If the House will indulge me for a little longer, I will run through some quotations. Bryony told me that she wanted carers to be given more financial support:

“Carer’s Allowance should be higher to reflect the impact and reasons it is claimed. I didn’t choose not to work; I didn’t choose to lose a well-paid career. I will always choose my son, but the financial burden is destroying families.”

Tracy talked about the need to be able to take a break from caring:

“Respite is essential. If carers reach burnout, the person they care for could end up in care sooner. If you support the carer and they feel valued without having to worry about finances, they would be less stressed and able to cope day to day.”

Rebecca called for greater recognition for carers:

“I feel we are overlooked by all the groups in society. It makes you feel bottom of the pile in everyone's priorities.”

Sarah said that she needed better signposting to the support available to help carers with their responsibilities:

“It would be fantastic if there was a directory of support and benefits that are appropriate as soon as a diagnosis is recognised. For years we didn’t claim Personal Independence Payment and Disability Living Allowance for our daughter because we didn't know about it. For over ten years I didn’t know I was entitled to Carer’s Allowance. I also didn’t know for the last three years my daughter was entitled to elements of Universal Credit. This would have helped us as a family and taken the stress and pressure off for myself to be able to ‘fight’ in other areas of my daughter’s life.”

The testimonies that I have shared are my reason for being here today, and the reason I support the call from the charities that are backing Carers Week for the Government to establish a cross-departmental ministerial group to focus on the help that carers need. I was delighted to learn earlier this week of the Minister’s commitment to establishing just such a group. Carers’ issues do not fall solely within the remit of the Department of Health and Social Care; they are everywhere, involving everything from energy prices to the circumstances of the young carers we have spoken about, carers in employment and carers’ benefits. The establishment of the ministerial group will ensure that carers’ needs are understood and responded to at the highest level of Government, and will improve ministerial oversight of policies and measures that support unpaid carers.

It is my hope, and that of the all-party parliamentary group on carers, that this work will lead to the development of a full and financially supported national carers strategy. Such a strategy would help to ensure that we went further in respect of a range of measures to help unpaid carers, including improved data sharing to ensure that carers are identified and support and entitlements are not missed; better support for and identification of carers at key transition points—for example, when people move from children’s to adult’s services; more funding for social care to ensure that unpaid carers are given the support that they need once they have been identified; and a review of carers’ financial support and benefits, including carer’s allowance, to ensure that they are fit for purpose and prevent financial hardship.

I want to encourage all those in the House today, and those watching the debate, to involve themselves in the activities taking place during Carers Week, and to reach out to the thousands of people in each of our communities who do so much to support the people whom they love. I also want to encourage all Members who have not already done so to join the all-party parliamentary group—I hope you do not mind the quick advertisement, Madam Deputy Speaker—which I co-chair with Baroness Pitkeathley. We have some exciting plans for the coming year.

Let me end by saying what I say every year. While Carers Week is an important opportunity to recognise, for one week in the year, the extraordinary lengths to which carers go, we must also recognise that they go to those lengths every single day. Every week should be Carers Week. Day in day out, year in year out, carers work to ensure that their loved ones are cared for, are safe, and lead the best lives that they can. That is something that happens 52 weeks of the year.

Mental Health Treatment and Support

Jim Shannon Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

I could not be more proud to work with my hon. Friend in this space. He is a powerful advocate and I wholeheartedly support all his efforts, and those of Members across the House, to support people who are living with alcoholism, and their families. I thank him; we will continue to support his work.

[Jim Shannon (Strangford) (DUP)]

I commend the shadow Minister and the Labour party for bringing this issue forward. Support for mental health across this great United Kingdom of Great Britain and Northern Ireland is a massive issue, including in my constituency. For example, one of my constituents told me they finally found the courage to seek help for their mental health, only to be told by health professionals, “We can’t do anything for you just now as your condition is not severe enough yet—you have no thoughts of suicide.” Does the hon. Lady agree that supporting those with mental health issues at the earliest stage—right away—is more beneficial, instead of forcing them to wait until it may be too late? At that stage, the situation cannot be turned back.

[Dr Allin-Khan]

I thank the hon. Member; it has been a pleasure to work with him in every single debate about mental health that I have held in the past three years, since I started my role. He speaks to the important point that prevention is the watchword that counts when it comes to mental health.