Licensing of Medical Devices

Jim Shannon Excerpts

Tuesday 12th February 2019 Commons Chamber

[Owen Smith]

I am grateful to my right hon. Friend for her kind words. She is completely right to say that there are devices on the market here and across the world that are still causing grave medical problems for patients. The question we have to ask is: how did these things get on to the market in the first place? How have we got so many of these devices that are causing such significant problems? The common problem that unites mesh with all the other device scandals in our country and across the globe is the weakness of the regulatory system in the UK, in the EU and, to a lesser extent, in America, where the pathway for testing approval, marketing and surveillance of such devices just is not good enough.

How does the system work? It will shock people to hear that we do not have a central body that is responsible for checking out, authorising and licensing devices in the same way as for medicines. If a company in the UK wants to create a new prosthetic hip joint, it does so and then it shops around among a group of what are called notified bodies. These are effectively commercial organisations that are in turn licensed by the MHRA to be a body that checks safety and efficacy through the clinical data provided by the companies and then gives them their conformité Européenne—their EU kitemark. Once a company has received that mark, the device can be sold all across the EU.

Companies do not need clinical trial data in order to substantiate their claims that devices are efficacious and safe. Quite often—this is true of a remarkable proportion of the devices on the market—they do not even have to undertake first-hand clinical evaluations themselves and can rely on being follow-on products that go through a regulatory pathway that is termed as being “substantially equivalent” to the products that have gone before. For instance, there are examples of mesh on the market now that are the 61st iteration of an original licensed mesh that is no longer on the market because it was proven to be dangerous. There is no real mandatory post-marketing surveillance of these devices.

Given that the difficulty of randomised control trials versus placebo for a device—someone cannot put a wooden heart into one patient and a pacemaker into another in order to see which one works—means that there will be a degree of risk in testing such things in the real world, one would think that we would have a system that would test how devices are doing in the real world and get companies or the Government to monitor them, but we do not, which is in stark contrast to the regime for medicines. Changes are coming into effect, however. A new medical devices regulation was launched across the EU in 2017 and will come into effect in May 2020. It was introduced with the acknowledgement of many of the problems that I have highlighted.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate on an issue that is important to many of us. With the EU’s new medical device rules coming into place in May 2020, as he says, does he agree that the number of available notified bodies is already diminishing? The Government must be aware of that and must work to find a way to secure acceptance of UK notified bodies as part of any arrangement, allowing for the smooth transition of notified bodies and product certification.

[Owen Smith]

I agree in part with the hon. Gentleman. One thing that I did not say earlier is that there are 50 notified bodies across the EU, so if a company goes with its new artificial hip to one body and says, “Will you approve this for my CE mark, because I would like to sell it in the EU?” and the body says no, because it does not think the data is good enough, all the company has to do is go to the next notified body, and if it says no, the company can go to the one after that, and if the third body says no, the company can go to the fourth one. Neither any of the notified bodies nor the manufacturer are under any obligation to disclose that the device had been turned down earlier. I agree that fewer notified bodies would be a good thing, but there are big questions for us in the UK because we will have no notified bodies once we have left the EU.

There are other problems with the new directive, which is a strengthening of the regulations, but it is not strong enough. For example, it now says that companies should summarise their clinical trials data, that they should take clinical data that is, if possible, sourced from clinical investigations carried out under the responsibility of a sponsor—meaning something more akin to randomised control clinical trials—and that they should ordinarily have a quality management system and a post-market surveillance system that should be proportionate to the risk class of the device in question. However, the point is that none of those things is mandatory.



There is no mandatory requirement to conduct proper trials or to max out the tests that are done. There is no mandatory requirement to publish data. There is no mandatory requirement to publish all data, including negative data. There is nothing to stop the companies continuing to conceal data, or shopping around between different notified bodies, and there is nothing to stop the companies doing the bare minimum on surveying how their product is doing in the marketplace. The directive is a strengthening but, unfortunately, it is not the strengthening we need.

If we leave the EU, the directive will not necessarily apply in all regards in the UK. The Government have tried to respond to the concern voiced by others before me by saying that they will effectively apply the regulation in future, but that would bring difficulties in and of itself. As I said, we would effectively be accepting products that are kitemarked and approved elsewhere in Europe, and not by our own notified bodies, because we will not be part of that system any longer. I assume we will be using the European database on medical devices, which is designed to work right across Europe, but we will not be part of the expert panels that reflect on the findings reviewed through that database.

Crucially, I assume that the MHRA will be filling some of those gaps. It will already have an almighty job on its hands in trying to fill the gap on medicines once we are outwith the purview of the European Medicines Agency. I fear that devices will once again be the Cinderella of the medical game. We did not have regulations for devices at all before 1990, and we may find that we are playing catch up with the European Union in future.

Whichever way Brexit turns out, and in reflecting on the flaws in the regulatory system I have highlighted, I ask the Minister, first, to try to get the MHRA, or whatever replaces our current regulatory pathway, to go back to the first principles of protecting patient safety at all times. There is too much talk in Europe of maintaining our advantage over other markets as an early adopter of innovation. Well, early adoption can go wrong if the innovation has not been adequately tested, and mesh is a great example.

Secondly, will the Minister do what the Royal College of Surgeons has asked her and the Government to do and set up a national registry of all “first implanted into a man or woman” devices—the innovations—so that we can track what happens with those devices, as we should have been able to do with mesh? Thirdly, will the Minister make sure that whatever system we have imposes much more stringent obligations on companies to undertake the most rigorous tests in respect of such medicines? In any new system, we should rule out anything like the substantial equivalence model that has been deployed in Europe for so long. It seems crackers to have a system that is basically a paper-based exercise without any real-world tests.

Lastly, I would like our Government to follow the example of the Australian Government, where the Minister’s counterpart, Greg Hunt, issued a national apology to the many women whose lives have been ruined by the debilitating effect of pelvic mesh implants:

“On behalf of the Australian government I say sorry to all of those women with the historic agony and pain that has come from mesh implantation, which have led to horrific outcomes”.

Our Government should similarly apologise to women damaged by surgical mesh. Irrespective of how Brexit turns out, they should pledge to radically reform the regulatory pathway for this class of medicines in order to make sure that no patients, men or women, suffer, as patients have in the past, as a result of medical devices.

Non-surgical Cosmetic Procedures: Regulation

Jim Shannon Excerpts

Tuesday 12th February 2019 Westminster Hall

[Alberto Costa]

I thank my hon. Friend for that intervention. Yes, that is one of the core issues that I wish to raise today. The mark of a professional in our society is somebody who is regulated, who is trained, qualified and licensed, and who has ongoing regulation and development. However, in addition to that, in the private sector they must carry professional indemnity insurance, so that people do not sue men or women of straw and so that they have someone to sue when things go wrong.

My experience of non-surgical cosmetic procedures does not extend to Instagram celebrities or Kylie Jenner. Instead, I wish to inform you, Mr Hollobone, of the case of my constituent Rachael Knappier. First, I thank Rachael, her mother and her friend, who are all attending this debate here in Parliament. I also thank Rachael for her tremendous bravery and willingness to talk openly about the terrible injury that she sustained as a result of a botched non-surgical cosmetic procedure. I think Rachael has been a role model for hundreds, if not thousands, of people across the country who have read the articles in the British media about her trauma. They responded with sympathy, but most crucially an understanding of her experience, because—sadly—experiences such as Rachael’s are not confined to the few. Many hundreds of our constituents have suffered such botched procedures.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way and I congratulate him on bringing this issue to the House. This debate was supposed to be held a few weeks ago, Mr Hollobone, but unfortunately it did not take place then, so I have looked forward to this opportunity today.

Very recently, I was contacted by one of my local councillors on behalf of a registered nurse in my constituency who is asking for regulation of non-surgical cosmetic services to be made compulsory and not voluntary. Does the hon. Gentleman agree that we must understand the belief of someone who sees the terrible effects of these treatments carried out by those who are not medical professionals, and that we should put legislation in place to address this grave concern? Whenever nurses or my councillors come and tell me their concerns, there is a real need for legislative change.

[Alberto Costa]

I thank the hon. Gentleman for his intervention. I agree that regulation is required and that legislation should underpin that regulation; there should not be voluntary regulation. Indeed, I would go further and say that, although I do not profess to know what type of expertise somebody should have to carry out these procedures, the regulator should identify the training, the expertise and the qualifications required and what products should be permitted in the market.

--- Later in debate ---

[Alberto Costa]

The hon. Lady is exactly spot-on. It is beyond belief that somebody can inject someone else with a foreign substance and have no medical expertise whatsoever. That is the nub of the problem.

We see more and more young people seeking these types of procedures, and at younger ages. It is incumbent on the Government to act swiftly and decisively to ensure that proper regulation and protection are in place for our constituents, of all ages, before the situation spirals out of control.

According to data from Save Face, a Government-approved voluntary register of accredited practitioners, there has been an alarming rise in reports of botched cosmetic procedures in the UK. The number of complaints about unregistered practitioners of treatments such as lip fillers and Botox reached almost 1,000 last year, showing that there is a large gap in safety and proper process that must be bridged.

Further, there is a separate but inextricable link between the rise of non-surgical cosmetic procedures and the pressures that young people in our society feel. Members may have seen Sky News this morning about social media, selfies and changing one’s image. That is clearly a major issue, particularly among the younger generation. Social media also has a responsibility regarding advertisements for non-surgical cosmetic procedures that are particularly targeted at minors. Although it is a person’s prerogative to undertake any treatment they wish, they should be able to do so through the prism of an informed decision, and with the peace of mind that the treatment they receive has been tried, tested and regulated by a professional body.

Colleagues might have seen the news about Superdrug a week or so ago, in which NHS England’s medical director strongly criticised the trusted high street retailer for not conducting “medically responsible” checks before customers receive their treatment. Similarly, NHS England’s chief executive sternly warned ITV about screening advertisements for these types of treatment in breaks during programmes such as “Love Island”, which is hugely popular with young people. Many colleagues will be shocked, as I was, to find that anyone can carry out non-surgical cosmetic procedures, with no regulation or expertise whatsoever.

A multitude of small businesses, and even individuals, spread across Facebook and, especially, Instagram, offer their services to impressionable young people. Many of them have no corporate responsibility or regulation and there are therefore absolutely no safeguards for consumers. Although I appreciate that many colleagues may have never seen an episode of “Love Island”—I confess to being in that category; I do not even have an Instagram account—

[Jim Shannon]

That makes two of us.

[Alberto Costa]

Dreadful, shocking. [Interruption.] Resign? With immediate effect. Members may also inexplicably not even know the different between their Kylie and Kendall Jenners, but there can be no doubt that most of our young constituents do. Those things are staples of the young generation, and are prevalent reminders, and in some cases advocates, of these types of non-surgical cosmetic treatment.

The Times recently conducted an investigation in which an Instagram account was created purporting to be that of a 13-year-old. Almost instantly after the account had followed social media influencers and celebrities, posts promoting such procedures appeared in the app’s “explore” feature. That reveals the shocking ease with which our younger constituents can be exposed to these types of treatment, under the guise of their being the new norm in today’s society.

In addition, young people’s physical access to the treatments is of tremendous concern. Although the law rightly restricts tattooing and the use of sunbeds for those under 18, there is no age-related restriction for either surgical or non-surgical invasive cosmetic procedures. The Nuffield Council on Bioethics recommends that children and young people under the age of 18 should not be able to access cosmetic procedures unless there is a medically relevant reason to do so. With the prevalence and exposure of the procedures specifically aimed at the young and impressionable in our society, action is required to protect children.

Turning to the industry itself, I have repeatedly said that non-health professionals who provide non-surgical cosmetic procedures are not regulated in an appropriate statutory manner. There is, however, an independent voluntary Joint Council for Cosmetic Practitioners, which has launched two new registers, one for practitioners who meet the clinical standards required to provide the treatments and another for accredited education providers. In the absence of an obligatory statutory register, as a minimum there should be clear public information about the need to seek a practitioner who is, at the very least, registered with that independent voluntary regulator. Nevertheless, a voluntary independent register, however laudable, does not go far enough. Dermal lip fillers, as one of the more popular non-surgical cosmetic treatments, are a good case in point regarding the total lack of standards in respect of the administered products.

I am mindful of time, so will make a few closing remarks. It was mentioned that the Keogh review, undertaken by the coalition Government, expressed huge concern that nothing prevented entirely unskilled practitioners from offering invasive treatments using unregulated products. The review stated that

“dermal fillers are a crisis waiting to happen.”

Despite the Minister at the time of the review’s publication advocating that its recommendations be taken forward, sadly this is, apparently, not happening. I therefore ask both the Minister, who I know has been a champion of ensuring appropriate health and safety standards for consumers, and the Government to at least consider setting out a cohesive and comprehensive plan to properly regulate the non-surgical cosmetic industry.

My constituent Rachael has been forthcoming, and willing to discuss her experience, but many hundreds out there have suffered botched treatments and are embarrassed or unable to come forward. As Members of Parliament, we have a duty to our constituents, and indeed to all others who may consider these treatments, to provide public information and to ensure that the procedures are administered by trained, qualified and regulated individuals. We also must ensure that, yes, those individuals are able to work in a thriving and competitive industry, but also that consumers have choice and that professional indemnity insurance is obligatory, so that our constituents are protected when things go wrong and the taxpayer is not burdened through the impact on the NHS.

Orkambi

Jim Shannon Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin]

I suggest that the hon. Gentleman hears the rest of the speech before he expects to draw any conclusions.

Cystic fibrosis is a life-limiting genetic disorder. Patients with cystic fibrosis experience a build-up of thick mucus in their lungs. This can have a wide range of effects on their respiratory, digestive and reproductive systems. The disease is widespread in the UK. One person in 25 carries the faulty cystic fibrosis gene. Statistically, that is 26 Members of this House whose future generations could be affected by this cruel disease.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this debate to the House; there is such a good crowd in the Chamber tonight due to the importance of the issue. I also thank him for being an advocate of Orkambi not because I have had any dealings with the company, but because I have many constituents who are affected. One grandmother in particular has asked me to make a plea because the life not only of their grandchild, but the lives of the whole family, have been turned around by this drug. I want this drug to be available for families throughout Northern Ireland and the whole United Kingdom. Does he agree that this Crown licence is a way to get around the stalemate that is preventing CF sufferers throughout the United Kingdom of Great Britain and Northern Ireland from accessing this drug, which is proven to deliver tremendous improvement in quality of life?

[Bill Wiggin]

I am sure that the hon. Gentleman’s constituents will be grateful to him for raising the issue in the House this evening.

Every week, five babies are born with the disease, according to Great Ormond Street Hospital, and every week two young people die as a result of cystic fibrosis. The disease accounts for 9,500 hospital admissions and over 100,000 hospital bed days a year. There are two main ways to treat cystic fibrosis: conventional treatments target the symptoms, and precision medicines such as Orkambi tackle the cause of the condition. For conventional treatment on the NHS, the average waiting time to be admitted to hospital is 45 days.

Orkambi presents a relatively safer, more effective and clinically meaningful alternative. In treating the root causes, it reduces lung damage and cystic fibrosis-related diabetes, and improves pancreatic function. The drug has been approved by the European Medical Association, and the Food and Drug Administration in the United States. It avoids the high risk associated with organ transplants.

Orkambi treats the F508del mutation, which around 50% of people with CF in the UK carry. Essentially, the drug permits more chloride ions to pass into and out of the cells. This helps to keep a balance of salt and water in affected organs. Ivacaftor is one of the active substances in Orkambi. It increases the activity of the defective cystic fibrosis transmembrane conductance regulator protein, thereby making the mucus less thick. Decline in lung function is the most common cause of death for people with cystic fibrosis and, although not a cure, Orkambi has been found to slow the decline in lung function by 42% and reduce hospitalisations by 61%.

World Cancer Day

Jim Shannon Excerpts

Wednesday 30th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) on securing the debate and giving us all an opportunity to participate. This issue is very close to my heart. My father battled and had the victory over cancer three times during his lifetime, but watching him and my mother go through it was incredibly tough. My dad survived those three times due to the clinical and surgical skills of the doctor, the care of the nurses, who were excellent, and, as a man of faith, the prayers of God’s people. That is the experience of so many people throughout my constituency and throughout the UK.

Cancer is no man’s respecter and the reality is that in our lifetime one out of two of us in this place will have an experience of it. I was in touch with CLIC Sargent—indeed, it was in touch with all of us. It is a wonderful charity that is very active in my constituency and I am happy to support it. It gave me the following figures, which are simply heartbreaking. Some 4,450 children and young people under 25 are diagnosed with cancer every year. That is 12 children and young people every day. Those are extremely worrying figures. Around four in five children and young people survive cancer for five years or more, yet cancer remains the disease that is the biggest killer of children and young people in the UK aged from one to 24 years old.

Cancer impacts on young people and parents’ mental health. Undergoing cancer treatment is challenging, isolating and deeply personal. Young people’s ability to cope is often seriously affected by the emotional pressures and the mental health impact of a diagnosis and months of treatment. CLIC Sargent’s 2017 “Hidden costs” report found that 79% of young people felt cancer had a serious impact on their emotional wellbeing. During their cancer treatment, 70% of young people experience depression, 83% experience loneliness, 90% experience anxiety and 42% experience panic attacks. More than half of parents—63%—say they experience depression during their child’s treatment. It affects not only the child, but the family and the parents. More than a third of parents experience panic attacks and 84% experience loneliness.

I stand with CLIC Sargent, Macmillan, Marie Curie and all the other charities that are too numerous to mention, but which do great work. They are asking the Government to improve support for young cancer patients and their parents by making changes to the way benefits such as PIPs and DLA are accessed. The stories that I have heard from others in the Chamber, in my constituency and elsewhere, and in the news are disgraceful. I know that the Minister is not responsible for the DWP, but he does, I believe, have compassion and a heart, and hopefully he will pass these issues on to the Minister who is responsible. I have written to that Minister about these matters as well.

Not only do I need to see change; the system needs to see change. As treatment starts immediately and often takes place a long way from home, the costs start building up from day one. There must be a review of access to DLA and personal independence payments for young cancer patients, so that they can get their financial support backdated from the day of diagnosis. It is so important to have that financial support in place, because that worries the parents, the families, and everyone else at a time when they need that support most desperately.

Following the Prime Minister’s announcement in April 2018 of the establishment of a children’s funeral fund in England, I ask the Minister to further clarify when that fund will be introduced. Again, that is not his responsibility, but perhaps he can ask that question of the Minister who is responsible. Furthermore, will the Minister provide an update on what the Government are doing to ensure that parental bereavement leave, which would give all employed parents a right to two weeks’ leave if they lose a child, is ready to be introduced in 2020?

I will quickly mention the importance of partnerships between universities and businesses to develop cures for cancer and other diseases: Queen’s University Belfast does that extremely well, and that partnership works. I will also mention that I had the opportunity to speak with Bowel Cancer UK the other day. Every year in Northern Ireland, 1,100 people are diagnosed with bowel cancer and 400 people die. By 2035, 332,000 more lives could be lost to that disease in the UK. There are some things that Bowel Cancer UK has asked for, but I will not go into those in the time I have left.

These topics are heartbreaking, but they need to be addressed. I ask the Minister for a response, either in this place or in writing, on how changes are going to be made to support the families of children with cancer throughout the UK. How can we make these impossible, dark, soul-wrenching things a little bit better? We can make them better by using common sense, and using funding in appropriate ways to provide support as and when it is needed, lightening the load in the only way that we can. That will not take away the pain of watching a child go through this, or losing a child, but it will take away pressure that should not exist in the first place.

Children with Life-limiting Conditions

Jim Shannon Excerpts

Tuesday 29th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered support for children with life-limiting and life-threatening conditions and their families.

I am conscious that other people want to speak, so I will limit my time and give them a chance to contribute, Ms Dorries. I am pleased to see the Minister in her place. I spoke to her last week and before today’s debate. I thank the Backbench Business Committee for selecting this important debate and the Minister for her attendance. I also thank everyone who is here to speak on behalf of their constituents. This matter is not for my constituency alone; it needs to be addressed UK-wide in a co-ordinated manner. As for the magnitude of the issue, 49,000 babies, children and young people live in the UK with health conditions that are life-limiting or life-threatening, and the number is rising. There are 40,000 in England alone.

I have three wonderful children and three perfect grandchildren. They are the best in the world, but every grandparent probably thinks that about their grandchildren. Hearing the news that one’s child has a life-limiting condition and is likely to die young is devastating. My heart always goes out to those who hear such dreadful news. The children have complex and unpredictable conditions and often need round-the-clock care seven days a week. Families have to cope with the knowledge that their child will die before them, and daily life for the whole family can become extremely challenging.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I thank the hon. Gentleman for giving way and congratulate him on securing this debate. Will he join me in praising the children’s hospice movement, including Tŷ Hafan, which serves my constituency in south Wales, for their excellent work in providing care not only for the children but for the families who need support?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. He is absolutely right. By the way, several of today’s speakers applied for this debate along with me and I thank them also. Hospice care is important and I thank the hon. Gentleman for his contribution. Every one of us knows the role that hospices play in the lives of those who need help at a very difficult time. Although there are many excellent services, many families still have difficulty accessing the care and support that they need, which is why hospices are important.

Children with life-threatening conditions need palliative care from when their condition is diagnosed or recognised until the end of their lives. Families also need care and support throughout the trajectory of their child’s illness, including bereavement care after they have passed away. Palliative care for children includes, but is not limited to end-of-life care, and the two terms should not be used interchangeably.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. Gentleman recognise, as highlighted by CLIC Sargent, the financial cost? It might be the last thing that people think about when everything else is going on, but there is a huge financial cost. The costs associated with cancer treatment are estimated to be around £600 a month extra, and the travel costs are on average £180 per family. For some people that is a huge amount of money.

[Jim Shannon]

I thank the right hon. Gentleman for his intervention and reiterate the point he has made. The financial implications, restrictions and pressures are important. I know CLIC Sargent well. It does massive fundraising in my constituency and elsewhere. I appreciate its work immensely.

Children’s palliative care providers offer a range of services, including supporting families to manage their children’s pain and distressing symptoms; providing children and their families with lifeline short breaks; and offering bereavement support both before and after the child has passed away. Families want to be able to choose where they receive the lifeline children’s palliative care services that they rely on when they need and want them. They also want to choose who cares for their child and which treatments they receive.

Along with others, I am a vice-chair of the all-party group for children who need palliative care. We seek to educate, inform and motivate parliamentarians to take action to help transform the lives of children and young people with life-limiting and life-threatening conditions across the United Kingdom of Great Britain and Northern Ireland. We are supported to do so by our secretariat, Together for Short Lives, the UK’s leading charity for the 49,000 children living with life-limiting conditions and their families. In November 2017, the all-party group began a Select Committee-style inquiry into the extent to which the Government are meeting their choice in end-of-life care commitment for babies, children and young people. The Government are clear that that commitment applies to people of all ages who need palliative care. The commitment explicitly states:

“To support high quality personalised care for children and young people, commissioners and providers of services must prioritise children’s palliative care in their strategic planning”.

Prioritising children’s palliative care in strategic planning is so important.

In a report last October, the all-party group published what we found and what action we recommend as a result of our inquiry. Despite the end-of-life care commitment, the APPG has heard evidence from young people, families, services and professionals that the quality of palliative care that children and families can access is patchy—the reason for today’s debate—and depends on what part of England they live in. MPs and peers have stated that that is unfair and represents a wholly unjustified health inequality.

The APPG highlighted five areas of particular concern where many children and their families have limited access. The first is children’s palliative care out of hours and at weekends. They also need short breaks and respite. As MPs we know these things, but the respite that is needed is so important to give parents a break. Age-appropriate palliative care and smooth transitions to adult services must be smoother, simpler and less stressful. Specialist children’s palliative care teams led by level 4 consultants are needed, and we need advance care planning. Those five barriers explain why the Government's choice commitment is at serious risk of not being met, which is why we are having this debate.

I am very pleased to see the Minister and the shadow Minister in their places. I know they both understand the issues. That certainly came out in my discussions with the Minister last week. Today we hope to hear the responses that we need to satisfy our concerns.

The first area of concern is leadership and accountability. Almost half—46%—of clinical commissioning groups are failing to implement the Government’s choice in end-of-life care commitment and have no plans to do so, which is disappointing, but there are reasons for it. Only a third of CCGs responded that they are implementing the guidance, and a further 19% stated that their plans to do so are in development. Consequently, will the Government and NHS England consider appropriate mechanisms to bridge the children’s palliative care accountability gap? Furthermore, will the Government develop a system to monitor how sustainability and transformation partnerships, integrated care systems, CCGs and local authorities are supporting children’s palliative care in accordance with their legal duties? That is very important. Will the Government develop outcome indicators that measure the extent to which children with life-limiting conditions and their families can make choices about the palliative care that they receive? If so, will they reflect the outcomes set out in the National Institute for Health and Care Excellence quality standard for end-of-life care for infants, children and young people?

The second area concerns clarity. Will the Minister work with her colleagues at the Department for Education and NHS England to write to STPs, ICSs, CCGs and local authorities to clarify which parts of the health and care system in England are responsible for commissioning palliative care for children and young people aged 0 to 25? We always go on about data, but data is important to get a strategy that works. It is vital to make it clear who is responsible for commissioning short breaks and specialised children’s palliative care, as described by NHS England.

The third area is funding. Unfortunately, there has been a downward spiral in the trajectory of funding: 22% in 2016-17 and 2015-16 compared with 23% in 2014-15 and 27% in 2013-14. That downward trend worries us greatly. There was a wide range in the state’s contributions to voluntary care sector children’s palliative care providers’ charitable costs in 2015-16. The maximum contribution received by a charity in 2015-16 was more than half and the lowest was 2%. Like other members of the APPG, I was therefore pleased to welcome NHS England’s recent decision to commit to funding children’s palliative care in the long-term plan. However, I want to highlight the mismatch in the two announcements that NHS England made.

On 27 December, NHS England announced that up to £18 million would be available to children’s hospices through the long-term plan, of which £7 million would depend upon CCGs contributing another £7 million through match funding, which is fair enough, taking the total to £25 million. Yet in paragraph 3.41 of the plan, published on 7 January, NHS England said that the £25 million would be for local children’s palliative and end-of-life care services, including children’s hospices. Does the Minister recognise that the two NHS England announcements were confusing, and can she clarify whether the £25 million will be for children’s hospices only, or a wider group of services? We need answers to those points. I gave the Minister advance notice of all my questions. It was almost the highest number of questions I have ever asked a Minister at one time, even though I ask a lot of questions.

Can the Minister guarantee that the £11 million children’s hospice grant will be protected and increased as a result of the long-term plan, to reflect the growing demand and the complexity of care provided by those lifeline services, and will she guarantee that total NHS funding for children’s palliative care will not fall as a result of the long-term plan? Will she also monitor the amount of money that NHS England, clinical commissioning groups and local authorities are contributing to children and adult hospice and palliative care charities? If so, will she ensure that they bring about parity in the state’s percentage contribution to their charitable costs?

I often refer to the Scottish Government—in the best of terms, as well. I note that they have committed to bringing about parity and funding 50% of the agreed charitable costs of children’s hospices across Scotland. They often set the bar, and set an example for the rest of us to try to achieve. I know that my hon. Friends from the Scottish National party will speak to that, and I look forward to their contributions.

The funding challenges are being exacerbated by the Government’s decision not to provide voluntary sector providers that do not apply “Agenda for Change” pay and conditions with financial support in order to mitigate the recent pay rise for non-clinical NHS staff. Will the Minister provide financial support to help voluntary sector children’s palliative care providers, including children’s hospices that do not apply “Agenda for Change” pay and conditions, to mitigate that recent pay rise?

We have to mention the Government’s proposal to increase the proportion that employers need to contribute to the NHS pension scheme from 14.9% to 20.9%. That will also lead to children’s hospices incurring significant costs. I say very gently that there is an imbalance in what is happening. Although the cost of the increases for NHS organisations will be met by the Government through additional funding, the potential additional costs for charitable hospices will not be.

Children’s hospices are faced with the puzzling situation where NHS England is giving them more money with one hand while, through the pension scheme changes, the Government are taking it away with the other. We all have concerns about that. Will the Minister meet the significant costs that children’s hospices will incur as a result of the Government’s proposal to increase the employers’ contribution to the NHS pension scheme?

The APPG believes that the Government and NHS England should go further to ensure that children’s palliative care provided by the statutory sector, in hospitals and in the community, is funded equitably and sustainably in England. The National Institute for Health and Care Excellence calculates that by investing £12.7 million in implementing its guideline on children’s palliative care, non-cash savings worth £34.7 million would be released back into the NHS. Mathematics is not one of my stronger points, but it seems logical to do that. Will the Minister undertake a review of the palliative care available to children with life-limiting conditions in England as a matter of urgency, and will she develop a funded, cross-departmental children’s palliative care strategy for achieving better outcomes for children and families across the statutory and voluntary sectors?

There are too few professionals with the skills, knowledge and experience to provide children’s palliative care in hospitals, children’s hospices and the community. Those who are skilled, and have the ability and opportunity, do wonderful work. Will the Minister set out the steps that she is taking to develop and advance care plans with families? Shortages in children’s nurses, and generally in children’s palliative care, are particularly acute.

The final area is integration. Single, joined-up education, health and care assessments, plans and personal budgets for children and young people up to the age of 25 are available only to those who have a special educational need. The APPG is also unclear on how the Government’s approach to personalising palliative care for children and young people, which is underpinned by joint plans and budgets, correlates with the special educational needs and disabilities system. That is tremendously important to us all. I should be grateful if the Minister would tell us whether she plans to ensure that all 40,000 babies, children and young people in England with life-limiting or life-threatening conditions have the right to an integrated assessment, plan and personal budget.

Will the Minister commission a review of health and social care law, to strengthen and clarify rights and entitlements for disabled children and their families, including children with life-limiting conditions? That would help to bring about more integrated assessments and plans. Will she invest in supporting work to develop children’s palliative care managed clinical networks across England?

[Mark Tami]

The hon. Gentleman makes an important point. Does he agree that the Government need to speed up, and that they cannot apply the general criteria that they apply to everyone else? Those parents, those families, and those children need support straightaway, not after waiting for weeks—sometimes months.

[Jim Shannon]

I thank the right hon. Gentleman for his intervention and his wise words. I absolutely agree that we need to implement right away the response that families need. He is right: one size does not fit all. Every person’s case and circumstances are unique, so we need to respond with something that fits, quickly.

If not quickly met by the Government, those challenges will threaten Ministers’ ability to meet their end-of-life care choice commitment for children by 2020. We have to work to that timescale. We need that response to do away with the patchiness; there are parts where the Government are doing well and families get help, and other parts where they do not. I know that the Minister is committed to that, and hopefully her response will be helpful to all of us who are asking these questions.

We urge the Government to work with the APPG, and interested bodies and charitable groups, to implement the APPG’s recommendations. There has already been progress in the past few weeks. That is good news, and we are pleased about that. NHS England has decided to recognise children’s palliative care as an important priority in the NHS long-term plan.

I commend the Government, I commend the Minister for her commitment to the strategy, and I commend Health Ministers for the Department’s commitment to addressing health, and spending money on it. That is good news. Nobody in this House would not welcome that. I very much welcome it. Will the Minister assess the extent to which the NHS treats children’s palliative care as a priority, as it commits to in the long-term plan, and if so, how? Will she tell us a wee bit about how that long-term strategy and plan will work?

I think it is the hon. Member for Vauxhall (Kate Hoey) who says, “Jim Shannon gets more words into a minute than any other MP.” I am not sure that I have given my four-minute speech in one minute, but I have tried to compress what I wanted to say, and I gave the Minister my questions beforehand. There are hon. Members present who have a real knowledge of the subject matter. It is so important that we hear all their opinions as well.

I ask the Minister to update us on the progress that the Government are making in responding to all the APPG’s recommendations. I very much look forward to hearing her response. These children need help. The report is clear, and now we need to be clear on how the Government can and will make changes to ensure that these short lives, and the lives of loved family members, can be better. Sometimes we see only the child; we also have to see the families. I think the right hon. Member for Alyn and Deeside (Mark Tami) referred to that in his intervention. It is so important that we reach out and help. Our job as MPs is to do just that. We look to the Minister for the response that we all want.

[Several hon. Members rose—]

--- Later in debate ---

[Jim Shannon]

I thank you, Ms Dorries, for enabling all Members to speak today, and I thank the 17 right hon. and hon. Members who have spoken for their personal and incredible contributions, which came from every region of Great Britain and Northern Ireland. Their constituents should be proud of their elected representatives who made such significant contributions to the debate. I thank the Minister for her compassionate and understanding response, and for her obvious interest in and commitment to improving the situation. The meetings that she will hold will be an indication of how that goes. Today this House shone a light on an issue that has united us. Is it too much to hope that before the day is out, we may unite on other things as well?

Question put and agreed to.

Resolved,

That this House has considered support for children with life-limiting and life-threatening conditions and their families.

Cervical Cancer Smear Tests

Jim Shannon Excerpts

Monday 28th January 2019 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 225767 relating to lowering the age for smear tests for cervical cancer from 25 to 18.

It is a great pleasure to serve under your chairmanship, Sir Roger. Before I move to the substance of the debate, I want to say a little about the woman who started the petition, Natasha Sale. She died on 28 December last year. She was 31 and left four children. I have spoken to her friends this afternoon, and I think Natasha must have been a remarkable person, because it takes a remarkable person to decide, when they have a terminal diagnosis, that they will use their time to help others rather than to bemoan their fate. That is what Natasha did. In her petition, she said that

“it’s too late for me but it’s not too late for the next generation”.

I thank her family and friends, who encouraged people to sign the petition to get the debate today. I particularly thank Natasha’s family, who have kindly said they are happy with the debate going ahead. That, too, takes courage, and I am grateful to them.

Cervical cancer is something that all women fear. Like breast cancer, it strikes at the heart of how we see ourselves and how we define ourselves as women. Because of that, screening programmes have been introduced in this country. In fact, screening is changing so that women will be tested for the human papillomavirus before they get cervical screening, because most but not all cervical cancers are caused by HPV. Screening is currently on offer only to women between the ages of 25 and 64. Those between 25 and 49 are called every three years and those from 50 upwards are called every five years, yet the reasoning behind that offer is perhaps not often understood. Before the age of 25, not only is such cancer very rare, but changes in the cervix are very common. A test can produce false positives and lead to unnecessary treatment and anxiety for women.

Nevertheless, there have been repeated calls to lower the age of screening, not only in this petition, but in others, including one we received previously. In response, the Government would rightly say that the UK National Screening Committee has looked at the evidence and decided that there is no real evidence to support reducing the age of screening. Their reasoning, which is valid, is that one in three tests below that age will produce a false positive; and that, when people are given unnecessary treatment, there is a risk to future pregnancies. I hope the Government will publish the evidence on the risks of getting cervical cancer at that age and the risks from screening so that women can make an informed decision. They should publish that in a way that can be understood by people who, like me, are not doctors or scientists. The evidence is often couched in scientific jargon, which conveys very little to most of us. That is the first important thing that we want to do.

Even with that evidence published, there will always be some cases, and cases in young women can be very tragic. They can lead to the loss of a young life, and often leave children without their mother. Because the disease can be so devastating, in 2008 the then Labour Government introduced a programme of vaccination against the most virulent forms of HPV for all girls from the age of 12. In fact, for that first cohort, we vaccinated up to the age of 18 to catch up. Those who were 18 at the time will now be undergoing their first screening. If as expected the rate of cervical cancer in that age group drops, it will have been well worth while.

When the programme was introduced, I well remember MPs getting a lot of letters from parents saying they did not want their daughters vaccinated—it still happens—because they somehow saw it as encouraging promiscuity. That is not what vaccination is about. It is about vaccinating girls before they become sexually active. I hope parents will think about the risk they are putting their daughters through if they do not have the vaccinations.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for presenting the case in the petition. While the vaccine has been shown to lower incidence of cervical cancer, does she agree that cervical screening should take place as a matter of urgency, initially for those who are sexually active? The average age when sexual activity begins is 15.6 years across the United Kingdom of Great Britain and Northern Ireland. Does she agree that people cannot be allowed to wait 10 years for a first cervical smear? It must be addressed immediately.

[Helen Jones]

I will answer that point in a moment, because it is important that we look at the evidence. There will always be some cases, even among women under 25. We can never eliminate the risk completely. When that happens, it is important they get the right treatment. That is why in 2010 guidelines were published for GPs to ensure that young women who presented with abnormal symptoms were offered screening and referred on to a consultant if necessary. That does not always happen—I will come on to that in a moment.

--- Later in debate ---

[Helen Jones]

Yes, and I hope those tests will be rolled out across the rest of Britain.

On the problem of women getting access to screening services, time and again they report that they ring their GP for an appointment that is then weeks ahead. Someone I met recently told me that, in her case, it is months ahead. It can be as much as 10 weeks. All are offered appointments at times they cannot attend, perhaps because they work shifts—that applies particularly to younger women who are more likely to be in insecure employment and therefore not eager to ask for time off.

I do not know why we persist in this, but very often the comments on screening give the impression that someone is saying, “These stupid women are not going for their screening.” Actually, there is a problem of access. I remember when we had mobile breast cancer screening units that came to a place of work. I got my blood pressure tested in the middle of Warrington shopping centre because the hospital had a programme to encourage people to go for testing in case they were at risk of vascular disease. Why can we not do more to take cervical screening to places where women are? Why can they not be screened in the workplace, for example, where groups of women are much more likely to say, “Come on! We will all go together”? It is not beyond the wit of man to arrange that.

[Jim Shannon]

Will the hon. Lady give way?

[Helen Jones]

I will give way one more time and then I must make some progress.

[Jim Shannon]

Constituents have expressed concerns to me on two issues: first, that it is very painful; and secondly that it is embarrassing. When it comes to giving peace of mind to ladies going for cervical cancer screening at whatever age, it is very important that the doctors and GPs are involved at an early stage to put their minds at rest. The importance of cervical cancer screening cannot be underlined enough, but the ladies need to be assured of not having the pain and embarrassment, which is a big task for the NHS.

[Helen Jones]

The hon. Gentleman is right. Women need to be assured that they will be treated sympathetically, whatever their age. All of us who have been to screening know that sometimes it is fine, but sometimes someone is a bit ham-fisted and it is not fine. It is better than getting cancer.

Another issue needs tackling: when women under 25 present with abnormal symptoms such as abnormal vaginal bleeding, they are not always treated according to the guidelines. In fact, they are frequently not treated according to guidelines. There are plenty of examples of younger women going to their GP with symptoms and being told they are too young for cervical screening, and plenty of examples of women going time and again and, as one lady told me earlier, being fobbed off. The problem is that GPs do not see a lot of cases and cervical cancer is therefore not the first thing they think of. The Government must do more to alert GPs to the possibility of cancer to get early diagnosis and ensure that people are referred to consultants where necessary.

Appropriate ME Treatment

Jim Shannon Excerpts

Thursday 24th January 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing this debate. She has been a champion for those who suffer from ME. We thank her for all her efforts, and are here to support her.

I have had the pleasure of meeting a lady in my constituency who is attempting to cope with her illness. She is also a champion for raising awareness and changing how those who suffer from ME are dealt with—I say “suffer”, because the lady I met certainly suffers. It is estimated that ME affects some 25,000 children in the UK, and it is said to be the leading cause of long-term school sickness absence in the UK. Given the stigma that people with ME face, families will continue to meet accusations of misconduct and withholding support. What is being done to help those 25,000 children?

We urgently need to update the training of GPs and medical professionals, so that they are equipped with clear guidance for a diagnosis of ME, and can give advice and guidance on appropriate management to reflect international consensus on best practice. In addition, all commissioning bodies must ensure that medical, welfare and care services are accessible to people with ME, including home visits for those severely affected.

As the hon. Member for Glasgow North West said, not much has changed. I still have constituents with ME who are turned down for the personal independence payment, even though they are unable to leave the house for 29 days in a month. People are removed from employment and support allowance and told to go to job interviews, even if they cannot manage to stand in the shower, let alone leave the house or get a job. It is time to move past the idea that if something cannot be tested it cannot be helped.

This debilitating illness takes its toll on men, women and children throughout the United Kingdom of Great Britain and Northern Ireland, and we simply must do better by them. I would appreciate a response from the Minister on whether there are any plans to do better. If such plans are not in place, when will they be introduced? The 400 sufferers of ME in my constituency request such plans—indeed, they demand them.

Mental Health First Aid in the Workplace

Jim Shannon Excerpts

Thursday 17th January 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on securing this debate, and I thank her for setting the scene so well. I thank right hon. and hon. Members from all parts of the Chamber for their valuable contributions. I echo the comments of others in the Chamber about what a joy it is to have a debate on a subject on which we can all agree. We agree on the strategy and the way forward. I am reminded of the programme I watch on a Sunday night—“Call the Midwife”. Perhaps others watch it, too. There is always a real tragedy at the beginning of the programme, but at the end, things always turn out well. I hope that Brexit turns out the same. We will see how it goes.

Most of us in the Chamber have a good understanding of the impact that mental health issues have on people’s emotional and physical state. In the short term, mental health problems alter personality traits and the behaviour of individuals. In the long term, they can lead to suicidal thoughts. In the worst-case scenario, they can eventually drive a person to commit suicide. There were 318 suicides registered in Northern Ireland in 2015, which was the highest since records began in 1970. People often have trouble coping with mental health issues, which of course will translate into their work life. Mental health cannot be compartmentalised. That is not the key to working and living with mental health problems.

[Mr Kevan Jones]

It is too tempting not to intervene on the hon. Gentleman. Is he aware—I am sure he is—that Northern Ireland has a particular issue? When I was a Minister in the Ministry of Defence, I was shocked to see that even though the violence of the troubles was 20 or 30 years ago, there is still a legacy of mental illness from those times.

[Jim Shannon]

The right hon. Gentleman has obviously had sight of my notes, because I was going to refer to that point later. He is absolutely right. The 30-year terrorist campaign has a legacy, and it affects us. I will mention that in my comments.

When I was first elected in 2010, I took in a new part of my constituency, Ballynahinch, which I very quickly found out had some serious problems in relation to suicides. They were mostly among young people, and unfortunately they seemed to be cluster suicides, if I can use that terminology. A number of young people took their lives, but the community very quickly reacted in Killyleagh and Ballynahinch. Church groups, community groups and interested individuals came together and addressed those issues. With Government Departments, they helped to reduce the level of suicides. It was particularly stressful to be confronted with that as an MP so early in his parliamentary term.

One in six workers suffer from anxiety, depression and unmanageable stress each year, causing 74% of people with a mental health problem to take more than a year out of work. In 2015, 18 million days were lost to sickness absence caused by mental health conditions. Mental health issues affect both the work and the lifestyle of countless people. Urgent action must be taken to educate employers about the difficulties that result from mental illnesses, mainly to help those who are struggling in the workplace but also to benefit those employers, for whom that may mean cost outlays. It follows that not only is a happier worker a more productive worker, but there should be a natural decrease in sickness periods. Other Members have mentioned that.

If employers are to take steps to promote and improve people’s wellbeing in their workplaces, they need to be able to identify an instance in which someone may be struggling with mental health problems, but it is not always easy to do so. I understand that, because I have talked to many people who seem to be smiley, jokey and happy, and may be the life and soul of the party, but when they go home they are very different. Sometimes we do not really know what is happening. In the workplace, there needs to be someone who can see through the façade to the real person underneath.

Some 49% of workers said that they would not be comfortable disclosing a mental health issue at work. Others in the workplace should be educated to ensure that they can recognise individuals who are dealing with such problems. They should be trained in mental health issues—and that should include mental health first aid—so that the workplace can become a positive environment.

Given that two in five employers admit that they have seen a rise in mental health problems, it is important for workplaces to foster a culture of support and openness for those needing help, making them feel reassured about seeking assistance from fellow employees. The Scottish Association for Mental Health, backed by the Scottish Government, has adopted a programme on physical activity. I can say with all honesty and sincerity that the Scottish Government, and their Health Department in particular, lead on health issues in general, including mental health issues. I know that the hon. Member for Glasgow South West (Chris Stephens) will probably mention this, but I think it important for us to recognise good practice wherever it may be, and I hope that we can replicate it in other parts of the United Kingdom of Great Britain and Northern Ireland. Better together, that is what I always say.

I believe that the Department for Work and Pensions must take the lead, and that all workplaces should be supplied with a mental health toolkit as standard practice. It should be issued not just to those who request it, but to all who are paying tax for a business. That could be modelled on the content of the current publications by Public Health England, Business in the Community and the Samaritans—what a good job they do to address these issues. Every one of us will know what really tremendous work they do in our constituencies, and I cannot praise the volunteers highly enough. To engage employers to participate in initiatives such as “Time to Change” and be educated further on the subject of mental health, there must be a move from the Department, and help must be garnered from it.

It has been suggested that as well as becoming involved with mental health organisations, companies should review their absence policies and make keeping-in-touch arrangements, as evidence suggests that 12.7% of all sickness absence days in the UK can be attributed to mental health conditions. There must be tools to enable employers to create an employee assistance programme. I have read research indicating that in the few businesses that use such a programme, 25% of employees say that their organisation encourages staff to talk openly about their mental health issues. Research shows that the more people do that, the easier it becomes to deal with their problems. We are always hearing that “it’s good to talk”, and that is so true, but many of the people we meet may not have anyone to talk to.

Such programmes not only help the individuals who are suffering with mental health problems, but benefit companies. Better mental health support in the workplace can save UK businesses up to £8 billion per year. If we do the job right we can save money, and so can the businesses, because they will have a happier and more productive workforce.

Three quarters of all mental health problems are established by the age of 24, when people are entering long-term careers. That is another factor that we should recognise at that early stage. As many as 300,000 people a year lose their jobs because companies are not sure how to provide the help and support that they need. In the past year, 74% of people have felt stressed as they have been overwhelmed or unable to cope owing to the demands of their career. Managers should be able to spot the signs of common mental health conditions, but that happens only when they receive dedicated training. Others have referred to the need for such knowledge of what is happening. Many managers are blind to, or uneducated about, the symptoms of mental illnesses, and it is all too easy in the busy working world to be consumed by a goal and not to see the elements that are in play around us. We would never send an engineer into a dangerous environment without the necessary training, so why should we assume that companies can automatically notice when an employee’s health is plummeting?

I am sure that you, Mr Deputy Speaker, are like the rest of us in this regard: we often eat at our desks. However, that does not mean that everyone else has to do it. We have to recognise that sometimes it is good to get away from our desks and go for a walk, and have our minds on other things for a time. The benefits of regular breaks and eating lunch away from desks, and creating a positive workplace state of mind, should be promoted to those who have a busy life and seek to cram things into every second at the risk of their mental health.

As we heard a moment ago from the right hon. Member for North Durham (Mr Jones), Northern Ireland in particular is struggling with the issue of mental health owing to a lack of resources. When compared with 17 other countries, Northern Ireland was shown to have the second highest rates of mental health illness, 25% higher than those in England. That is certainly largely due to 30 years of the troubles and the legacy of the terrorist campaign, but it is more than that. We must address those issues and do better in enabling people to lead high-quality lives with the tools to handle stress and daily life. A massive step in that regard would be creating mental first aid as standard in workplaces.

Workplace mental ill health costs employers about £26 billion a year, and many places are struggling to find the large amount of money that is needed to improve their awareness of mental health. A report for the NHS found that mental illness accounts for nearly half of all ill health in people younger than 65, and that only a quarter of people in need of treatment currently get it.

This is a health issue, but it is important for four Departments to come together with a strategy, because it is not just about health. It should also involve the DWP, the Department for Education and the Department for Business, Energy and Industrial Strategy. Companies need to be given more support and funds, as does the NHS to help those who are suffering in the long term, as it is currently unable to provide the materials needed. Action needs to be taken, because the number of sick days due to mental health issues is increasing rapidly owing to negative work environments: 89% of employees with mental health problems say that it affects their work lives hugely. That needs to change, for the betterment not only of business and the economy but of those who are struggling with mental health issues.

I look forward to the comments of both the Minister and the shadow Minister. I am convinced—as, I think, is everyone in the Chamber—that we shall hear a positive and helpful response from the Minister.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 15th January 2019 Commons Chamber

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

[Jim Shannon (Strangford) (DUP)]

With recent Northern Ireland figures showing that at least 25% of young people and 40% of teens are classed as overweight or obese, will the Minister outline what cross-departmental discussions have taken place on the strategies to improve the health of young people through co-ordination and interaction with parents and the provision of healthy eating schemes?

[Steve Brine]

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

Cancer Workforce and Early Diagnosis

Jim Shannon Excerpts

Tuesday 8th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate, and for giving us the opportunity to discuss this important issue. I am the Democratic Unionist party spokesperson on health, so such matters are at the top of the tree for me. I am pleased that the Minister and shadow Minister are here to respond to our concerns, and we appreciate the Backbench Business Committee kindly granting us this debate.

Cancer is a word I hate; it is a disease I hate. A respecter of no person, it indiscriminately attacks and takes from us those who we love and rely on. I truly believe that a cure must be found and found soon for this dreaded disease, but while that work is taking place, we must focus on the best use of the limited resources available. I congratulate the Government on their NHS 10-year plan and their commitment to a cancer strategy within it.

As hon. Members have said, we all have family members and friends who have been stricken by cancer. I have a good friend who will have breast cancer surgery on Friday, and my father survived cancer on three occasions due to the expertise of the surgeon, the nurse’s care and, critically, the prayer of God’s people. My hon. Friend the Member for Upper Bann (David Simpson) referred to the bowel cancer testing kit in Northern Ireland, and probably because of my father’s history, I carry out screening with that kit every year, and therefore I would know early on whether any cancer has been detected. That is what we are doing in Northern Ireland, and hopefully it is something that other parts of the United Kingdom can take on board.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that, given the almost universal acceptance of the importance of early detection, the long-term plan, like any other plan, will be judged against an increase in early detection? That is the key.

[Jim Shannon]

I agree wholeheartedly with my hon. Friend and colleague, and although many people are dying from cancer, a larger number are surviving that diagnosis.

I wish to thank the tremendous staff who work well above their paygrade and the hours they are paid to make a difference to the quality of care and support for cancer sufferers. I also thank the wonderful charities that aim to step into the breach where at all possible. We all know of such charities, and if I do not mention some of them that does not make them any less important. Many charities, including Marie Curie, do tremendous work.

Macmillan Cancer Support is an amazing charity. In 2017, it had more than 5,700 nurses supporting 658,000 people, with a further 2,000 healthcare professionals throughout the United Kingdom. In 2017, 1.6 million people received personal, high-impact support from one or more Macmillan professionals or services. While broadly welcoming the Government scheme, Macmillan has expressed serious concerns that the plan does not adequately address the immediate and longer-term pressures facing the NHS cancer workforce. Those concerns are put forward in a constructive fashion, as they should be:

“The NHS long-term plan makes clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the HEE budget has yet to be set by the Government. This is a key priority and must be urgently addressed. The plan states that there will be a separate Workforce Implementation Plan in 2019, but more detail is needed about the timeframes, and how the implementation plan relates to the long-promised phase 2 HEE plan on the cancer workforce. It is essential that we build on the ambitious foundations of the NHS long-term plan and put in place a fully-funded strategy for the workforce that will deliver truly world-class cancer care.”

That is what Macmillan Cancer Support expressed before this debate. Perhaps the Minister will respond to those points.

I agree with the sentiments expressed by Macmillan, and more detail is needed to deal with funding gaps to address the issue of speed of diagnosis in quick-moving cancers such as pancreatic cancer. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Bristol West (Thangam Debbonaire) spoke about early diagnosis, and nearly every Member who has spoken in the debate has said it is critical—and so it is. Pancreatic cancer is the quickest-killing cancer, with one in four people dying within a month, so we need a faster pathway to diagnose and treat it, as the hon. Member for Scunthorpe (Nic Dakin), who is particularly interested in it, will know. Early diagnosis is essential in the case of pancreatic cancer, as it offers the only chance for potentially curative surgery. However, fewer than 20% of people with pancreatic cancer are diagnosed at an early stage, and fewer than 10% will receive surgery. The capacity does not currently exist, and there must be an increase in the cancer workforce to ensure timely diagnosis and treatment. Every Member who has spoken in the debate has supported the point of view expressed by Macmillan, and it is critically important.

Prostate cancer has been mentioned. When men are ill we are, by our nature, the illest people in the world, but sometimes we just do not know when we are ill. I make that point in relation to prostate cancer because we do not do the checks, although we know what has to be done. Needing the toilet more frequently, a burning sensation and passing blood are some of the symptoms, and men perhaps need to look out more for them. We need to raise awareness of prostate cancer. To be fair, I think that the Government do that, but perhaps there is a need to do more.

I hope I will be forgiven for repeating some comments that have been made, but these issues are important. The hon. Member for Bristol West referred to CLIC Sargent, and I want to make some comments on children’s cancers. CLIC Sargent is a wonderful charity and has asked me to use this opportunity to stress something that shocked me when I first read it, and which underlines the point about the workforce. Children make up the highest proportion of cancer patients diagnosed through emergency admissions, and many young people and parents have a poor experience of diagnosis. The 2016 “Best Chance from the Start” research report on experiences of diagnosis found that more than half of young people and almost half of parents had visited their GP at least three times before the cancer diagnosis.

As the hon. Member for Bristol West said, there is a particular need for early diagnosis for children. Nearly half of young people felt their GP did not take their concerns seriously. I do not think that is a criticism; it is how they felt. A third of parents felt that their GP did not take into account their knowledge of their child. We should not ignore what parents know and say about their child. It is important to do something to raise GPs’ awareness in relation to children. Just over a third of young people and a quarter of parents felt that their GP did not have enough time to listen to them talk about their symptoms. I want to ask the Minister what has been done about that. I am mindful of the pressure on GPs, who have a lot of work to do. However, something needs to happen for children diagnosed with cancer and their parents. Like the hon. Member for Bristol West, I am requesting that something be done. The urgent change that is needed can be achieved only through funding to take the pressure off diagnostics, allowing GPs to refer before the third repeat visit. They must be allowed to go with their gut and send anything suspicious to be tested further, rather than playing a numbers and probability game. Cancer does not respect the numbers game—it strikes where it might be least expected.

This is my last paragraph, Mr Howarth. Time has beaten me. I heartily welcome the strategy, but we need more detail and more action, and soon, to make a difference, and so that we can make a worthwhile attack on the plague of cancer, which affects families throughout the United Kingdom. That is why the debate is so important.