Antimicrobial Resistance

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

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

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

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

[Kevin Hollinrake]

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

[Jim Shannon]

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

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

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

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

Adult Social Care

Jim Shannon Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

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

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

[Jim Shannon (Strangford) (DUP)]

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

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

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Jim Shannon]

I should have said “the hon. Lady”.

[Madam Deputy Speaker]

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

NICE-Approved Products: Patient Access

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

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

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

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

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

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

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

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Anne Marie Morris]

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

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

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

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

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

Public Health

Jim Shannon Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

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

[Jim Shannon (Strangford) (DUP)]

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

[Maggie Throup]

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

Access to Salbutamol Inhalers

Jim Shannon Excerpts

Monday 29th November 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

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

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

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

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

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

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

Covid-19 Update

Jim Shannon Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

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

[Jim Shannon (Strangford) (DUP)]

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

[Sajid Javid]

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

Alcohol Harm

Jim Shannon Excerpts

Thursday 25th November 2021 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I beg to move,

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

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

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

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

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Derek Thomas]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Mr Speaker]

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

[Jim Shannon (Strangford) (DUP)]

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

[Sajid Javid]

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

Health and Care Bill

Jim Shannon Excerpts

Report stage & 3rd reading
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt]

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Jeremy Hunt]

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

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

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

--- Later in debate ---

[Carla Lockhart (Upper Bann) (DUP)]

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

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

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

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

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

[Jim Shannon]

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

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. That intervention is quite long enough.

--- Later in debate ---

[Sajid Javid]

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

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

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

[Jim Shannon]

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

[Sajid Javid]

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

--- Later in debate ---

[Jim Shannon]

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

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

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

[Mrs Miller]

Will the hon. Gentleman give way?

[Jim Shannon]

I have almost finished my speech.

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

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

Health and Care Bill

Jim Shannon Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Mary Kelly Foy]

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

[Jim Shannon (Strangford) (DUP)]

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

[Mary Kelly Foy]

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

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

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

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

--- Later in debate ---

[Alex Norris]

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

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

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

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

[Jim Shannon]

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

[Alex Norris]

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

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

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

--- Later in debate ---

[Richard Fuller]

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

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

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

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

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

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

[Jim Shannon]

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

[Richard Fuller]

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

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

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

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

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

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

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

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

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