Physician Associates

Jim Shannon Excerpts

Wednesday 7th February 2024 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests as a practising NHS consultant psychiatrist.

The UK has a severe shortage of healthcare professionals, amounting to more than 110,000 in England alone, coupled with a growing ageing population with an ever-increasing need for a strong and responsive health service. To address the shortage, the Government in England have introduced the NHS long-term workforce plan, with additional proposals also set out in the devolved nations.

NHS England’s plan sets out a wide range of mostly unfunded workforce measures, including doubling the current number of medical student places to potentially add 60,000 doctors to the workforce by 2036-37. Controversially, it also includes plans to increase the number of physician associates from approximately 3,250 to 10,000, an increase of over 300%, and anaesthesia associates from approximately 180 to 2,000. That is not to say that physician and anaesthesia associates should not have an important role in the future NHS workplace. However, at this time, serious regulatory and safety concerns relating to associates need to be addressed before the NHS seeks to expand their numbers and roles. Furthermore, standardised high-quality training pathways and a properly defined scope of practice are essential.

Physician associates, anaesthesia associates and surgical care practitioners are collectively known as the medical associate professions, and I may use the terms interchangeably. Physician associates and anaesthesia associates currently complete a two year postgraduate course and are employed in a variety of settings in the NHS, including GP surgeries, emergency departments, and medical and surgical settings, and they have also been introduced to mental health settings.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing the debate. The issue is massive—it is massive for me back home, as well—so I thank him for his reasoned and knowledgeable speech, as well as his contribution to the NHS over the years. Without an increase in the number of GPs and doctors, does he agree that the healthcare crisis we face will become an abyss? In small countries such as Northern Ireland, students cannot get places in our small medical schools and are training, working and living in other countries, which is a real loss to future stability. Does he agree we need to do more to keep our young medical staff rather than let them head to greener grass in far off fields?

[Dr Poulter]

I completely agree with the hon. Member. He advocates strongly for his constituents, as always, and for the need to better retain our medical workforce in general, our junior doctors in particular. The Government will have heard his comments. I am sure that things can be done to improve the current offer to junior doctors in England. Indeed, things can be looked at in Northern Ireland, too, with the restoration of political arrangements.

An agreement could be put in place that will properly renumerate junior doctors, and also look at the other terms and conditions of employment that are important in respect of retaining the medical and healthcare workforce. These situations are not always about pay; it is also about wider terms and conditions. The Government could certainly look in more detail at student debt, for example, as the Times Health Commission outlined this week, which may incentivise people to stay in medicine for longer.

We have diverged slightly into the broader healthcare challenges, so I will return to physician associates, which was the point of this evening’s debate. There are concerns about the regulation and training of this particular group in the medical workforce. Physician associates and anaesthesia associates are not currently regulated. There have been a number of recent high-profile cases of patient harm as a result of being seen by medical associate professionals, including, sadly, some deaths. We know, for example, of the tragic case of Emily Chesterton from Salford who died of a pulmonary embolism having been seen twice and had her deep vein thrombosis misdiagnosed as a musculoskeletal problem by a physician associate at her local GP practice.

Anybody who watches the TV programme “24 Hours in A&E” may have seen some fairly enlightening scenes in respect of the clinical skills of some medical associate professionals, including physician associates. There are many examples of poor clinical diagnosis and judgment, including, for example, making initial decisions to send patients with compound fractures home without an X-ray when the patient actually required surgery.

In my own clinical practice, I have worked alongside some very competent physician associates, but there is a high degree of variability in their training and skills. Only last year, I was forced to directly intervene to prevent patient harm following a paracetamol overdose by a patient who attended A&E. The physician associate incorrectly informed me that they did not require N-acetylcysteine treatment because their liver function test was normal, in spite of the fact that they were over the treatment line as a result of their paracetamol overdose. Of course, at that time, the patient’s liver function tests were normal, but they would not have been for very long. The consequences of that diagnostic decision by the physician associate could have been fatal. The key issue for me is that many physician associates do not know or have the self-awareness to understand the limits of their knowledge and practice, but this is perhaps understandable in a health system that fails to adequately regulate and indeed define its scope of practice.

There are many other areas of concern that have been highlighted in a recent British Medical Association survey of 18,000 doctors, an overwhelming majority of whom work with physician associates. In November 2023, due to severe concerns around patient safety, the BMA called a halt to the recruitment of medical associate professionals to allow proper time for the extent of patient safety claims to be investigated and the scope of the role to be considered.

When the physician associate role was introduced, it was clearly seen as part of the solution to a shortage of doctors, which currently stands at in excess of 8,500. By freeing up doctors from administrative tasks and minor clinical roles, it allowed them to see more complex patients and get the training required to become excellent consultants or GPs.

Unfortunately, physician associates and anaesthesia assistants have been employed in the NHS in roles that stretch far beyond that original remit, and in many cases that were reported in the recent BMA survey that I mentioned, they appear to be working well beyond their competence. That has raised serious patient safety concerns—I gave some examples earlier—and led to calls to review the role, limit the scope of practice, and protect training for the doctors that the NHS desperately needs. When consultant time is taken by supervising physician associates, that is to the detriment of training and supervising junior doctors. That has not yet been addressed or even considered in the NHS England workforce plan.

Pharmacy First

Jim Shannon Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

Absolutely, and I am always happy to discuss that further with my right hon. Friend.

[Jim Shannon (Strangford) (DUP)]

Northern Ireland’s minor ailments scheme, and this Pharmacy First initiative, are acknowledgments that GPs can spend up to 40% of their working day on minor ailments, but the scale in Northern Ireland is different from what has been proposed for England. Is there capacity for a UK-wide roll-out of Pharmacy First to take pressure off our GP services? If there is, that would be the right thing to do.

Internationally Recruited Health and Social Care Staff: Employment Practices

Jim Shannon Excerpts

Wednesday 31st January 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate.

I thank the right hon. Member for Spelthorne (Kwasi Kwarteng) for leading the debate and setting the scene so very well. I have to put on record our thanks to all the wonderful health and social care staff, who, as we all know, go above and beyond the terms of looking after us and our constituents; they give a wealth of ability, energy and time, and regardless of where we are, the job they do is undeniably challenging. We thank them dearly, and we mean that.

It is also always great to be here in Westminster Hall to give a Northern Ireland perspective, as I always do in these debates. Health is devolved back home, so the processes there are slightly different. I will also make a couple of important points—everybody’s points are important—to remind hon. Members that although we are discussing internationally recruited health and social care staff, some of our own people here who wish to do the same job are restricted from doing so.

In November 2022, Northern Ireland welcomed 133 new international nurses, mostly from India and Zimbabwe, who took up permanent posts across Craigavon, Lurgan and South Tyrone hospitals. At such a challenging time for the health and social care sector—with ongoing demand for services, issues within the workforce, and lots of developments—ensuring sustainable care for others should be at the forefront of our priorities.

I am keen to say that there are clearly issues in terms of entry requirements and placements for those wanting to study nursing, medicine and so on in Northern Ireland universities. I suspect that the same problems occur in other parts of the United Kingdom. I am aware of so many people who wanted to be a nurse or in medicine, and wanted to stay in their own country to do so, but did not gain the entry requirements needed or there were no places for them. Whenever the Minister responds to the debate, perhaps she could tell us what discussions have taken place with those universities to ensure that the opportunities and number of places are increased—in Northern Ireland and across the whole United Kingdom.

For example, I have a constituent who attained 10 A* grades in her GCSEs—my goodness, this is a smart lady! She also completed her gold Duke of Edinburgh award and went to on to help with healthcare in small communities in Africa; that is very commendable. By the way, I know this lovely young lady well, and she will go far and do well. In her A-levels, she got 3 A* grades and one A, and she attended interviews but did not receive a place in university in Northern Ireland. If she had, she would have stayed in Northern Ireland. Whenever we talk about recruiting internationally—we should be doing so, and highlighting that issue—we also have to highlight the fact that we have talented people at home who wish to stay, but there is not an opportunity for them to do so.

Ultimately, that young girl went to Wales to study, with a further £5,000 of debt for each year of her degree. She is now a junior doctor in Cardiff, but the point is that she should have been given that opportunity in the place where she wanted to live, work and serve. The question for me is: will she ever come home to Northern Ireland? While Wales has gained her, Northern Ireland has lost her. I am all for securing our health and social care workforce, and if that means going international, let us do that; but there is also a source of talent back home.

There seems to be an issue with those who want to study nursing in their own country but are unable to do that because of placement issues, so will the Minister tell us whether that is one reason why we are struggling to maintain a steady workforce? If we can train them back home and keep them, we will not have to source them internationally. It all comes down to funding, which comes from Westminster. We need to increase the number of spaces that universities can facilitate. With great respect, I ask the Minister whether it is possible to engage with the Department for the Economy back home in Northern Ireland. Hon. Members have heard the news today: the Northern Ireland Assembly will be up and running, hopefully shortly. What can be done to give local students more opportunities to study in their own country?

Northern Ireland offers wonderful opportunities for international recruitment. We recruit internationally all the time. The number of people on the permanent register in Northern Ireland who were initially registered outside of the UK increased to 3,794 in 2022-23 from 3,399 the previous year—an increase of 400 international nurses. We recruit internationally and are pleased with the contribution, ability and talent they bring to Northern Ireland. I welcome the wealth of experience they bring, but I want also to be a voice for those students from Northern Ireland who cannot get a place and therefore have no choice but to leave Northern Ireland and study, work and live elsewhere.

Will the Minister engage with the Department for the Economy back home in the Northern Ireland, with the Assembly, and with local universities such as Queen’s University Belfast, Ulster University and Magee university, to see what more can be done to facilitate greater placement opportunities for Northern Irish students in our local universities and, ultimately, to ensure that they take up nursing and medicine opportunities in Northern Ireland? The health service can only gain from that, and it would reduce the numbers of people we have to source internationally.

Type 2 Diabetes: Availability of Drugs

Jim Shannon Excerpts

Tuesday 30th January 2024 Westminster Hall

[Christine Jardine (Edinburgh West) (LD)]

I beg to move,

That this House has considered the availability of drugs to treat type 2 diabetes.

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

I am grateful for the opportunity to speak about what is a vital and, I think, under-recognised issue. I wish I did not have to, and that all the necessary medicines were available for all of the serious, life-changing conditions we face, but the reality at the moment is that they are not. Specifically, I would like to talk about type 2 diabetes, which is more common than type 1 and can go undiagnosed for years.

To be clear about what we are talking about, if someone’s body does not make enough insulin or what it makes does not work properly, the result is high blood sugar levels—type 2 diabetes. If untreated, that increases the risks of serious problems with their eyes, feet, heart and nervous system. High blood sugar levels can cause serious complications, potentially at great cost to individuals, but also to the national health service. The reality is that any of us can develop type 2 diabetes, but it mostly affects people over 25, and often those who have a family history of it.

What about treatment and medication? We know there is currently no cure, but we also know that type 2 diabetes can be put into remission by losing weight. We all know that eating well and exercising are the key to a healthy lifestyle, and that is never truer than with preventing and reversing the onset of type 2 diabetes.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing the debate forward. I am a type 2 diabetic—I declare an interest as such—and when I was diagnosed some 13 or 14 years ago, I went on a weight loss course right away. The doctor told me, “You lose weight!” I lost about 4 stone, and I have kept it off, but that did not stop the diabetes in its entirety. I still have it, and I still have to be very careful about what I eat.

The point I want to make is that there are recent indications that certain diabetes treatments can also be successful for weight loss, but weight loss is really important at least for the first stage of diabetes, and priority for such treatments must be given to those with type 2 diabetes before, with respect, those who are finding success with them for weight loss. How can the Minister and our Government encourage such guidelines to be firmly set in place?

[Christine Jardine]

I thank the hon. Member for that intervention, because that point is at the heart of the matter. We have to ensure that the supply of drugs, which is short at the moment, is prioritised for those who need them for important health reasons.

A healthy weight, as the hon. Member said, and keeping active make it easier for someone’s body to manage their blood sugar levels and help prevent insulin resistance, which can lead to type 2 diabetes. Research has shown that, for some people, a combination of lifestyle changes can reduce the risk of type 2 diabetes by about 50%, but sufferers may also need to take diabetes medication such as metformin and insulin, as well as making changes to their lifestyle.

In the UK, 4.6 million people have type 2 diabetes and around 13.6 million are at risk of developing it. People often need help, such as intervention and medicines. Last year, I called on the UK Government to take action on the shortage of medicines for type 2 diabetes patients, after a constituent came to me concerned that her treatment and her health would be impacted by a shortage of the diabetes drugs she needed. They are known as GLP-1 RAs—glucagon-like peptide-1 receptor agonists—and include one of the most common drugs, semaglutide.

As for many other manufactured drugs, there is currently a supply problem with semaglutide. In this case, the problem has been made worse, as the hon. Member for Strangford (Jim Shannon) said, by the fact that the same drugs are effective for weight loss. The very thing that semaglutide does to help diabetes patients is making it difficult for them to access it.

I wrote to the Scottish Government, who told me they did not expect the supply to return to normal until mid-way through this year. I appreciate that that is not the most helpful response, but in some ways it is understandable, because medicine supply and licensing is a reserved matter. That is why I am raising it with the UK Government. We have seen issues with drug shortages beyond diabetes, and that is why I am so concerned at the slow response to the lack of medication.

Patients find themselves stuck between the proverbial rock and a hard place. In Scotland, they have the Scottish Government unable to act, and they perceive the UK Government to be very slow to act. It seems that neither Government have realised how potentially serious this situation could be for patients who use these drugs daily. For a patient to be in a position where they do not know whether they can get what they need to help them get well and keep them healthy is simply not acceptable. I have heard from people in my constituency and beyond about the impact that the situation is having on their lives.

--- Later in debate ---

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

It is a pleasure to see you in the Chair, Mr Pritchard. I thank the hon. Member for Edinburgh West (Christine Jardine) for raising such an important issue. I want to begin by emphasising that I understand that medicine supply issues are a significant cause of frustration for many of our constituents across the United Kingdom. I also recognise that there have been particular challenges recently with certain medicines. Without diminishing those challenges, it is important that we set them in context.

There are around 1,400 medicines licensed in the UK, most of which are in good supply. The Department is regularly notified of supply issues; thankfully, the vast majority of those can be managed with minimal impact on patients. The medicine supply chain is highly regulated, complex and global, meaning that there can sometimes be supply issues that affect the UK, along with other countries around the world.

There are a number of reasons why a limited number of medicines might be subject to a disruption in supply, such as manufacturing difficulties, regulatory non-compliance, access to raw materials or distribution problems. We cannot always prevent supply issues occurring, but where they do the Department has a range of well-established processes to manage them and help mitigate the risk to patients.

Where there are concerns about supply, they largely, although not exclusively, concern medication to treat the most common conditions. That is exactly the case with what we are talking about today—diabetes—a condition experienced by more than 4.9 million people across the UK. Action on diabetes will be included in the major conditions strategy, as it is an important risk factor for cardiovascular disease. If someone has diabetes, they are twice as likely to have heart disease or a stroke than someone who does not have diabetes, which goes to the heart of what the hon. Member for Edinburgh West said about the importance of ensuring diabetics get their medication.

[Jim Shannon]

I thank the Minister for his comprehensive and helpful response. Some years ago, when I first came to Parliament there was a diabetes strategy for the whole of the United Kingdom of Great Britain and Northern Ireland. If the Minister could look at it, I think a renewal of that particular strategy would help. It was agreed here at Westminster, but took in all the regions of Scotland, Wales and Northern Ireland. It was a marvellous objective to address diabetes and it seemed to work. I would like to see it happen again.

[Andrew Stephenson]

The hon. Member makes an important and powerful point, as usual. As he knows, I am a proud Unionist and am keen for us to do as much as we can in collaboration. I recognise that health is a largely devolved matter. However, since I joined the Department of Health and Social Care in October, I have visited Northern Ireland, Scotland and Wales, I have talked about how we can collaborate more closely on things such as research and innovation, and I am sure that we can do more together where the devolved Governments agree. Last night we had encouraging news. Hopefully we will have power-sharing arrangements back in place in Northern Ireland so that we can work together collaboratively to deliver those benefits for patients.

I will finish the point I was making about the major conditions strategy. That strategy aims primarily to improve care and health outcomes for those living with multiple conditions, and it will be centred on prevention. We have heard from a wide range of stakeholders, whose views are informing the development of the strategy. I will meet Diabetes UK this week to continue that engagement.

With regards to the availability of drugs to treat type 2 diabetes, as the hon. Member for Edinburgh West set out, there has been a significant global supply issue affecting glucagon-like peptide-1 receptor agonists—GLP-1RAs—with the shortages driven by an increase in demand for such products for licensed and off-label indications, meaning that the medicine is being used for a different use from that stated on its licence.

I will set out the steps we have taken to manage those issues. We have continued to work with suppliers to take action to resolve the issues as quickly as possible, including expediting deliveries and boosting supplies. In July last year, we issued guidance for healthcare professionals, which took the form of a national patient safety alert on how to manage patients during the supply disruption. Clinicians and prescribers were directed not to initiate new patients on these medicines, which were to be used only to treat their licensed indication, protecting supplies for diabetic patients. Guidance was supported and echoed in a statement issued by the professional regulators.

One of the particular shortages affecting the market at the moment is Ozempic, which is the brand name for semaglutide, which is licensed to treat type 2 diabetes. Wegovy is the same medicine—semaglutide—but licensed specifically for weight management and is generally used at a higher dose than Ozempic. Obesity-related conditions can be serious, so it is right that we support people living with obesity to lose weight, and Wegovy is one option for those with severe obesity and comorbidities. However, it became available for prescription in the UK only on 4 September 2023, having received approval for use on the NHS for weight management in March 2023.

We believe that supply issues with Ozempic have in part been contributed to by off-label prescribing of that medicine for weight loss ahead of Wegovy’s launch. However, the strong and clear guidance that we provided on the use of those treatments only for their licensed indications and our ongoing work with the industry has helped to protect supplies for diabetic patients.

As a result of our continued intensive work with the supply chain, I am pleased to inform hon. Members that the supply position of that particular drug has improved. Supplies of Rybelsus have been boosted to support demand from new patients with type 2 diabetes, patients switching from Byetta injections and patients switching from Victoza injections. The national patient safety alert was amended on 3 January to reflect that positive development. The professional regulators have issued a second statement to highlight that update.

I am also delighted to highlight the fact that the Medicines and Healthcare Products Regulatory Agency gave regulatory approval in the last few days to Mounjaro, an injectable medicine for adults with type 2 diabetes. That will bring an additional treatment option and will mean that more diabetic patients will have access to the medicines that they need.

Sadly, supply is not expected to return to normal due to the issues with certain products, but we will continue to work with the manufacturers, the NHS, the MHRA and others working in the supply chain, to help ensure that, overall, supplies of GLP-1 RAs are available for patients.

[Jim Shannon]

I think the hon. Members for Edinburgh West (Christine Jardine) and for Wansbeck (Ian Lavery) and I would be interested know about the other option—if I caught you right, Minister—that you mentioned, which is in the form of an injection but is not insulin. Just so we know, is it a different system?

[Andrew Stephenson]

Sorry, was the hon. Gentleman asking about the approval of the new drug, Mounjaro, which I just mentioned?

[Jim Shannon]

Yes, I am trying to understand, because I am not aware of it, and neither are the hon. Lady or the hon. Gentleman. It is not insulin for type 2, is it? The Minister mentioned an injection system.

[Andrew Stephenson]

It is an injectable medicine for adults with type 2 diabetes. It was recently approved by the MHRA. To put a little bit of extra information out there, the National Institute for Health and Care Excellence recommended Mounjaro, the same drug, for the treatment of patients with type 2 diabetes who meet specific criteria. The NHS in England is therefore now legally required, in line with NICE recommendations, to fund its use for eligible patients. The availability of that new medicine in Scotland is, however, a matter for the devolved Administration. The Scottish Medicines Consortium, which makes decisions on the use of medicines in Scotland, has not yet published guidance on Mounjaro. It will be a matter for the SMC as to whether that becomes an option in Scotland.

As I was saying, Mr Pritchard, unfortunately we expect supply chain issues to continue for the rest of the year. Throughout the management of this issue, our guidance has been supported by additional advice issued in Scotland, Wales and Northern Ireland, which has, critically, reinforced the messaging provided by the national patient safety alerts.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Andrew Stephenson]

My right hon. Friend makes an important point. Diagnostic checks are a key part of the cancer pathway and the 150 community diagnostic centres opened by this Government, including the one at the Finchley Memorial Hospital, will provide earlier diagnostic tests, support earlier diagnosis and bring down waiting times, benefiting millions of patients. These centres have delivered more than 6 million additional tests for all elective activity since July 2021 and we expect the Finchley Memorial Hospital CDC to provide over 126,000 tests for elective care in the next financial year.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for that response. Research and development is very important; it means we can find more cures for cancer. My father, who is dead and gone, survived cancer on three occasions; that happened because of advances in finding cures. What is being done to work alongside those in research and development to ensure that even more cancers can be cured and we can go from a 50% rate to perhaps a 60% or even 70% rate for those who live longer?

[Andrew Stephenson]

I was delighted that one of my first visits in the new year was to Northern Ireland to see some of the life sciences companies, particularly those based around Queen’s University Belfast. That sector in Northern Ireland is flourishing. We are keen to support companies working in research and bring together world-leading universities such as Queen’s with the private sector and the NHS to deliver improved outcomes for all patients across every part of the United Kingdom.

Hospice Funding: Devon

Jim Shannon Excerpts

Wednesday 17th January 2024 Commons Chamber

[Simon Jupp (East Devon) (Con)]

I am delighted to have secured today’s important Adjournment debate on hospice funding in Devon. I welcome the Minister and colleagues to the debate.

A few years ago, at a dinner hosted by the Rotary Club of Exeter, I was sat between the Bishop of Exeter and Dr John Searle, the founder of Hospiscare, a brilliant local independent charity providing specialist care to people across our county. I must confess that it was a surreal experience for this 30-something-year-old from Devon who is more comfortable in a pub than at black tie dinners. They both spoke to me about local hospice services and the good work they do in Devon. Dr John Searle sadly passed away last year, and I pay tribute to his work, his compassion and his determination. Our society would be so much better off if we had more people like John, and I will always treasure the conversation we enjoyed.

Hospice services in Devon provide incredible support and comfort to those suffering from a terminal or long-term, life-limiting condition. Patients often have multiple conditions and complex needs, and often require a high level of support. As the Member for East Devon, I am acutely aware of the work and impact of hospices locally. Several charities provide hospice services across East Devon, and I want to pay tribute to the ones based in my constituency, Sidmouth Hospice at Home and Hospiscare. Sidmouth Hospice at Home has a day centre in Sidford, with a 24/7 specialist nursing team working with local NHS dementia services teams who benefit from the use of their building. I live in Sidmouth—they do us proud.

[Jim Shannon (Strangford) (DUP)]

On that point, will the hon. Gentleman give way?

[Simon Jupp]

I will.

[Mr Speaker]

Is the hon. Gentleman’s intervention to do with Devon?

[Jim Shannon]

It is to do with the hospices and charities that the hon. Gentleman referred to.

[Mr Speaker]

This debate is about funding in Devon. I am sure the hon. Member for Strangford could say something that relates to funding in Devon.

[Jim Shannon]

Thank you, Mr Speaker. The hon. Gentleman is right to refer to hospice funding in Devon, but while the hospice funding and charity giving in Devon is good, I suggest that it may be even better in Strangford. Each year in Northern Ireland, our fundraisers add £15 million to the four hospices; without that money, those hospices could not function. Does the hon. Gentleman agree that the Government must stop relying on people’s charity to fill the gap, and increase funding immediately to meet that need? I know that his charity givers in Devon do well, but the ones in Strangford do equally well.

Illegal Vapes

Jim Shannon Excerpts

Tuesday 16th January 2024 Westminster Hall

[Peter Gibson (Darlington) (Con)]

I beg to move,

That this House has considered the matter of the use and sale of illegal vapes.

It is a pleasure to serve under your chairmanship, Sir Mark, and I am pleased to have secured this debate, in order to highlight my concerns about the use and sale of illegal vapes.

As a country, we should be pleased with the progress that we have made in reducing smoking, with smoking rates falling to their lowest since records began; now, only 12.9% of the population smoke. In some part, this progress is down to the wide array of nicotine replacement products: patches, pouches, gum, and of course, in more recent years, vapes.

However, despite vapes being an effective alternative for adults to use in order to quit smoking, we must be concerned about the risks they pose to children and non-smokers. Vapes are not risk-free. Nicotine is a highly addictive substance, whatever means are used to absorb it, and there remain unanswered questions about the longer-term use of vaping. As Professor Chris Whitty, the Chief Medical Officer, has said:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape.”

I have concerns about vaping that I wish to raise with the Minister in this debate. They are threefold: first, the availability of vaping products to children; secondly, the sale and supply of illegal vaping products to children and adults; and thirdly, the organised crime and exploitation that lie behind the illegal products.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. Many people see vaping as an alternative to smoking and it probably is, but that does not mean that it is, in some cases, any less destructive. Indeed, it has become an overnight epidemic, with vape shops popping up, including in Newtownards, the main town in my constituency. My concern has always been about the regulation of these pop-up shops; they come here and they disappear, only to pop up somewhere else.

Does the hon. Gentleman share that concern and agree that there must be a licence to sell vapes, which should be vigorously checked by the local council to ensure that laws are being adhered to, so that the things he has expressed concern about regarding children gaining access to vapes cannot happen?

[Peter Gibson]

It would not be a Westminster Hall debate without an intervention from the hon. Gentleman. He anticipates two of the points that I am about to come on to in my speech—first, the popping up of these shops; and secondly, the need for licensing. So, I thank him for his intervention.

Legally supplied cigarettes have reached a price that puts them beyond the reach of children’s pocket money. That has been brought about by a raft of measures, including a ban on smaller packets, a ban on advertising, plain packaging, concealed displays and raising the legal age to buy cigarettes to 18. However, we have seen a worrying trend of children taking up the habit of vaping; the latest figures show that some 20% of children have tried vaping.

Those children have taken up the use of a product that is designed to help people to quit smoking, but—this is the important point—they themselves have never smoked. We know that the flavours, packaging and design of vapes are attractive to children, and that vapes are on very visible display in shops, in contrast to the cigarettes that they are designed to replace.

As with the sale of cigarettes, the sale of nicotine-related products is restricted to people over 18, but that restriction is clearly not working. To my mind, many of the measures that we introduced to curtail smoking need to be considered again in addressing this problem.

I have met the parents of children who are addicted to vaping. It is not uncommon to see children vaping in the street and the whole disposable vape industry is visibly responsible for the increase of litter on our streets, which local authorities face huge difficulties in dealing with and which increases the risk of fire in general waste collections.

The Local Government Association is deeply concerned about what to do with the almost 200 million disposable vapes that are thrown away every year in our country, and we should all be concerned about their environmental impact. However, my primary concern is the use and sale of illegal vapes, which do not always comply with our legislation and often have much higher concentrations of nicotine. They are sold with much higher capacities than their legal equivalents. It is estimated that a staggering one out of every three vapes sold in the UK is illicit. They are being sold with no care whatever for the user.

In the north-east, we have seen tragic cases of young children hospitalised as a result of using high-strength illegal vapes. The sale of these products is often concentrated in pop-up mini-markets, which are easily identifiable and distinguishable from reliable and traditional corner shops. Once upon a time criminality hid away, but these operators hide in plain sight. These shops appear quite rapidly, with blocked out windows, vivid lighting and a sparse supply of genuine goods on the shelf and are often, although not always, also selling illegal tobacco products.

I want to put on the record my thanks to Phoebe Abruzzese from The Northern Echo in Darlington for her campaigning journalism on this issue, and I am pleased to be working with her to highlight this problem.

Smokefree Future

Jim Shannon Excerpts

Thursday 11th January 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I thank the hon. Member for Harrow East (Bob Blackman) for securing it. As with most subjects he chooses to discuss in Westminster Hall, I can echo most of what he says—not on all occasions, but on most. I am very pleased to be here to support him.

I am also pleased to see the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) in her place and I look forward to her contribution —we have been friends for a long time. I am especially pleased to see the Minister—the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom)—in her place. She came to speak at an association dinner in my constituency, and she was greatly and well received. In fact, not only was she well received, she left a lasting impression on my constituents. I would fear it if the right hon. Lady came to Strangford to run as a candidate—I say that in jest; I very much appreciate the right hon. Lady.

As chair of the all-party parliamentary group on respiratory health, I have spoken many times about my strong support for the UK Government’s Smokefree 2030 ambition and my desire for Northern Ireland to follow the other UK nations in setting our own smoke-free target. Smoking is a terrible addiction that devastates communities across the United Kingdom and will continue to do so unless we take action. I welcome the action that the Government have taken, and my hon. Friend the Member for North Antrim (Ian Paisley) eloquently and forcefully outlined the position for Northern Ireland and the issues that we need to address.

I welcome the Prime Minister’s world-leading commitment to create a smoke-free generation. I was also pleased to see that the Government’s recent consultation on creating a smoke-free generation and tackling youth vaping was held in conjunction with the devolved Administrations. The Government recognised that it was important to bring the four regions together. The Government understand the issues and I hope that the Minister will address some of the issues to which my hon. Friend the Member for North Antrim referred. Northern Ireland and the devolved nations have responsibility for their own public health policies, but we will be successful in achieving a smoke-free future across the UK only if we work together. It is no secret that I always refer to the United Kingdom of Great Britain and Northern Ireland as “better together”. None of my Scottish colleagues is here today, which is a pity; if they were, I would be saying the same thing to them.

I commend the Minister for her vocal support for tobacco controls since being appointed. She was very clear in calling out attempts by tobacco companies to undermine the smoke-free generation policy. That was a clear direction, straight from our Minister and our Government. As the Minister knows, healthcare services are under severe pressure across the United Kingdom. Smoking is the leading preventable cause of death and disease in Northern Ireland; it killed some 2,200 people and was responsible for 35,000 hospital admissions in 2022. Smoking is responsible for more than seven in 10 cases of lung cancer and a similar proportion of cases of chronic obstructive pulmonary disease. The estimated hospital costs for treating smoke-related diseases in Northern Ireland are £172 million. It has a big impact on the Northern Ireland health sector.

There remain significant inequalities in smoking prevalence: those living in the most deprived areas are two or three times more likely to smoke than those living in the least deprived areas. The hon. Member for Harrow East referred to that, and perhaps the Minister could give us her thoughts on it. Inequalities in smoking prevalence also persist among other groups, particularly those with mental ill health: probable clinical depression is four times more common among current smokers than among those who have never smoked. If we do not take urgent action to reduce smoking rates, our already overburdened health service will continue to be put under huge pressure from smoking-related diseases for years to come.

As the analysis for the APPG on smoking and health demonstrates, smoking not only impacts healthcare services but severely undermines economic productivity. The hon. Member for Blaydon (Liz Twist) and I have shared many platforms where I have made that point. The economic impact is clear: smoking places a burden on public finances that far outweighs the income from tobacco taxes, because it reduces direct tax income and increases social security costs.

I also commend “A Vision for a Smokefree Northern Ireland”, which was published by ASH NI and Cancer Focus NI. The vision calls for Northern Ireland to have a smoke-free target of 5% smoking prevalence by 2035. If only that was achievable. It is good to have a goal—we always need a target to aim for—and I hope that we can rectify that soon. Northern Ireland has the highest rates of smoking in the UK. We are nowhere near to being on track. Indeed, we are on track to achieving 5% smoking prevalence by 2042, so it is a brave while away. Therefore we must step up all our efforts, both at the devolved level and at the UK level, if we want to achieve a smoke-free future, which will mean redoubling our efforts to prevent children and young people from starting smoking and supporting existing smokers to quit and stay smoke free.

“A Vision for a Smokefree Northern Ireland” also highlights the importance of strong enforcement to tackle the scourge of illicit tobacco and vaping products, to which my hon. Friend the Member for North Antrim referred. It is one of the big issues for us in Northern Ireland. The sale of illicit tobacco undermines efforts to reduce smoking rates. It is concentrated among poorer smokers and disadvantaged communities, and contributes to higher rates of smoking. Retailers that 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, which needs to be addressed. That requires us to tackle not just the supply but the demand for illicit tobacco in communities where smoking is endemic.

The UK has made massive strides in reducing the trade in illicit tobacco over the last few decades. It has reduced the market share of illicit cigarettes from 22% to 11% in some 21 years. However, there is still more to be done. HMRC and Border Force are due to publish an updated strategy to tackle illicit tobacco. Again, that is not the Minister’s responsibility directly, but I am really keen to get some ideas. Northern Ireland, with its land border with the EU, is particularly geographically vulnerable to illicit trade run by criminal gangs. 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. I look forward to seeing the new strategy published in the near future. Maybe the Minister will give us some thoughts on the timescale and when we can aim towards that.

I will ask three or four questions if I may, Mr Sharma. Can the Minister confirm that the new illicit trade strategy will cover illicit vapes, which have become a significant challenge over the last few years and have helped to drive increases in youth vaping across the UK? I look forward to seeing the Government’s response to last year’s consultation on mandating inserts with information on stopping smoking inside tobacco packs. I hope that the measure will be introduced on a UK footprint, benefiting my constituents in Strangford. It is another way of tackling the disease and the problem. It has been required in Canada since the year 2000, where there is substantial evidence showing that inserts are effective in encouraging smokers to quit. The evidential base in Canada shows that the measure has been effective. I think we should be taking every effort to ensure that it happens here.

The Government’s guidance states that responses should be published within 12 weeks or an explanation should be provided as to why it has not happened. Again, if the Minister does not mind, I will ask about that. The 12 weeks was up on Tuesday past. I do not know whether the Minister is able to deliver the news and information we are looking for in the debate today, but I would like to have some update if at all possible. When the consultation closed on 6 December, the Government said that the next steps would be published in the “coming weeks”. That is where we are; we are in the coming weeks, and it would make sense to publish both responses at the same time. To delay the speculation, I would appreciate some clarity.

My second question is: can the Minister confirm when the response to the consultation on pack inserts will take place, and whether legislation to take that important measure forward will be included in the forthcoming tobacco and vapes Bill? I hope that it will be, because deterring children and young people from taking up smoking is vital if we are to create a smoke-free generation. I endorse the Prime Minister’s request, as does the House; we see it as a positive way forward, and the introduction of the warnings would be very positive. The APPG on smoking and health recommended that in both its 2021 and 2023 reports. It seems that the inserts would require only small amendments to the existing regulations—I am not a legislative person, but I have been told that that is the case—not new primary legislation, so we could probably do it easily.

There is a growing body of international evidence supporting the effectiveness of what are known as “dissuasive cigarettes”, particularly in making cigarettes less attractive to younger adolescents and those who have never smoked. Again, the Canadian Government recently announced that Canada would be the first country to introduce dissuasive cigarettes. It is quite interesting. I gave the example of what Canada did in the year 2000, 23 years ago, which is what we are looking towards today. Canada is doing it now on dissuasive cigarettes. May I suggest, Minister, with respect, that it may be time for us to do the same thing now, rather than waiting 20 years to do it?

I recognise that the Government already have a substantial legislative programme to enact before the next election. I understand that they are pushed for time and it is difficult sometimes to get everything in on both smoking and vaping. However, I ask the Minister to at least commit to consulting on warnings on cigarettes, to start the clock ticking on that simple and sensible measure. The UK waited for over 20 years after implementation by Canada to consult on cigarette pack inserts. We should not wait another 20 years after Canada implements warnings on cigarettes before we consult on this important measure.

Thank you, Mr Sharma, for giving me the chance to speak, and so early as well. I look forward positively to the Minister clarifying the issues that I have raised as everyone seeks to work together to find a healthier, stronger and smoke-free United Kingdom of Great Britain and Northern Ireland.

--- Later in debate ---

[Dame Andrea Leadsom]

I am very happy to write to the hon. Gentleman on that point to give him absolute clarity.

I thank the hon. Member for Strangford for his contribution today. I very much enjoyed the visit that I made to his constituency, which was a long time ago—indeed, many years ago. He spoke about the importance of the four nations working together. I completely agree with him; the UK is much stronger together. I hope that in my remarks I have answered his other questions.

I also thank the hon. Member for Blaydon for her support for the Bill and for pointing out that it is vital, particularly in the north-east where smoking prevalence is higher than average in many other parts, that we really take steps to tackle the issue. I echo her expression of gratitude to local councillors, the NHS and to Fresh, the charity in her constituency, for the work that they have done to try to tackle smoking.

As I have said to the hon. Member for Birmingham, Edgbaston, I hope we can work together constructively to ensure that we introduce these changes as soon as we can.

In closing, I will quickly address the New Zealand Government’s announcement that they will no longer introduce the smoking measures that had been planned there. There have been many calls, not least from the tobacco industry—I wonder why!—for us to row back on our plans following that decision. In response to those calls, I stress that the New Zealand plans included a licensing scheme to limit quite significantly the number of retailers able to sell tobacco and plans to limit the amount of nicotine in consumer products. Our Government are introducing a smoke-free generation, by protecting future generations from the harms of smoking while leaving current adult smokers the freedom to continue smoking if they choose to do so.

[Jim Shannon]

I thank the Minister for her response to the debate. In my contribution, I gave a couple of examples from Canada that we had followed here, and I urged the Government here to follow the new ideas in Canada to dissuade people from smoking. Has she had an opportunity to look at some of the Canadian legislation? I am very simple: if I see something good, I think, “Let’s do it”. If it works there, it should work here as well.

[Dame Andrea Leadsom]

I absolutely agree. We should always keep an eye on what other nations are doing.

I reiterate that our position remains unchanged. This will be world-leading, and we want to be a trailblazer in the absolutely crucial area of protecting future generations; protecting the health of our nation; protecting our future children and babies; and, at the same time, protecting our NHS. Let other nations follow our example. I look forward to working with colleagues right across the House as we bring that to fruition, and I thank them for their contributions.

NHS Dentistry

Jim Shannon Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I must make some progress.

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Wes Streeting]

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

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

Sexual Harassment of Surgeons and Other Medical Professionals

Jim Shannon Excerpts

Wednesday 13th December 2023 Westminster Hall

[Rosie Duffield (Canterbury) (Lab)]

I beg to move,

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Rosie Duffield]

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

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

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

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

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

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

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

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

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

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

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