Medical Cannabis under Prescription

Jim Shannon Excerpts

Monday 20th May 2019 Commons Chamber

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

We have heard some really rather touching and heartfelt speeches, and I suspect that I cannot justice to some of what we have heard. Although of course I condemn the current policy of criminalisation, I am incredibly sceptical about the use of cannabis in a recreational sense, but I am very much in favour of us moving towards a proper, normalised relationship with cannabis and cannabinoids in our health system.

The cruelty of what happened last year was that we dangled hope in front of lots of people’s faces—not only the children and their families who led the campaign, but many adults who suffer with long-term pain conditions and other conditions that would be helped by medical cannabis—and said that medical cannabis would be available for them. Through administrative burden—deliberately or because of a cock-up, I cannot quite tell—we have created a system in which the barriers are so high that the drugs are not being prescribed. Part of the problem is to do with the rescheduling, which has not been sufficient. The rescheduling has not normalised cannabis and cannabinoids even to the level of opiates. Extra conditions have been laid down through which clinicians have to jump; they have to know that no other drug could work.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way. I am very conscious of my constituents Darren and Dannielle Gibson and their young daughter Sophia. I see that the Minister, the right hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), is in his place. We are greatly indebted to him for his co-operation and help. [Interruption.] The Minister is in the House, but not in his place. Let me get it right. There were very memorable moments in the fight for Sophia’s medication, including coming to terms with the differences in policy between Northern Ireland and the mainland, jumping through the hoops in Northern Ireland, liaising with the Minister to find a way for my constituent to get what she needed in time and my constituent being rushed into intensive care. But here is the story. That young girl today is in receipt of medicinal cannabis. Her epileptic fits have been reduced to one a month. She can attend school again and do all the recreational things with her young friends at school and in the playground that she never could do before. It happens. It can be done. It changes lives.

[Lloyd Russell-Moyle]

It can be done if it is given to patients at the right time and in the right manner. Part of the reason why clinicians are possibly nervous about prescribing these drugs is that additional thresholds have been added to doing so. There is an extra nervousness, particularly with new drugs, as we require their use to be based on already pre-existing proven evidence.

Earlier, I mentioned what had happened with other life-threatening diseases, such as HIV, and what had happened at other times. We have now changed, relaxed and modified the rules around testing, but that was not done immediately. Those who remember will know that there was a vociferous campaign from people, particularly in America but also here in Britain, about the folly of this requirement for pre-existing medical knowledge. The shift was to look at harm: what is the harm done to not trial and not implement anything versus what is the harm done of any potential risks. In this case, we need to employ that kind of sense. Back then, it was not the clinicians or the Government who shifted the issue; the shift was achieved through the fantastic work of campaigners.

We are again seeing that fantastic work of campaigners. They may need the drug themselves, or one of their family may need the drug, and so they are having to push this debate. It is frustrating to some extent that we have not learned the lessons of previous eras when this issue was argued out. In fact, time and again, the issue has been won on the side of prescribing. Why this time are we coming down on the wrong side of the argument? What is it about cannabis that suddenly sets off some kind of alarm bell in the heads of Ministers or civil servants so that we create a system that is not particularly conducive to prescribing?

I am bemused by the current situation in which, for some reason, private prescriptions are acceptable—others have talked about this—and seem to be getting through if people can raise the right amount of money, but our NHS is not able to reflect that. I do not know whether that is a consequence of cuts or of an NHS that is at breaking point. It could be a consequence of commissioners not wanting to prescribe these drugs, which seems strange to me because, when I look at the figures, the cost does not seem too high. It is cheaper than prescribing some other traditional medicines. It seems to me therefore that this is not an austerity issue, which we know is a bigger problem in the NHS, but some other hidden force, which means that parents need to raise thousands and thousands of pounds to try to get private prescriptions and self-prescribe.

I would like to slightly widen the debate from children, on whom we have quite rightly focused, to some of my constituents who are adults in chronic pain. Although it is right that, through the story of a child, we can push this issue forward, the fact is that this drug could help millions who, as we have heard earlier, may already be self-prescribing with cannabis. Self-prescribing is not good for a person’s long-term health or for the state of healthcare. Doctors who are trying to provide them with holistic and rounded care cannot fully do so if people are having to go off and self-prescribe elsewhere.

United Patients Alliance is very active across the UK, but particularly in my constituency. One of my constituents, a 42-year-old man, was diagnosed with complex regional pain syndrome in October 2006. If he took conventional medication, he would be expected to take 10 ml of oral morphine a day, which is a huge amount. It means that his actual life quality is completely reduced. He is as not as cognisant as he should be or as able to interact and hold down a job. With the head of the pain clinic at St Thomas’s Hospital, he has discussed moving on to medical cannabis. They have even said that it would be a real possibility, but they believe that the hurdles are too high for them to be able to prescribe it now. He has now resorted to getting medical cannabis from other sources—to some extent involving his doctor or his clinician and creating a network of people having almost to lie and deceive the state. It is a bizarre situation. We end up making people do things in hushed conversations, rather than being able to record things properly in medical records.

This absurdity must end. We thought that it had ended. My view is that the schedulisation of drugs should not fall under the remit of the Home Office; it should be in the Department of Health and Social Care. It makes no sense for scheduling to be anywhere near the Home Office, because it should be based on medical evidence—the Home Office should, of course, decide on classification. The Department of Health and Social Care needs to make some real moves very quickly to demonstrate that this has not all been hot words and big let downs.

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[Julie Cooper (Burnley) (Lab)]

This has been a very powerful and emotional debate that has moved Members on both sides of the House. It has also been characterised by anger and exasperation on both sides. I thank the Backbench Business Committee for selecting this subject for debate.

I pay tribute to my former, much-respected colleague, Paul Flynn, for his excellent campaigns on this subject. Somewhere, he will be cheering us on and I hope that he will have more to cheer about by the end of this debate, when we hear the Minister’s comments. I pay particular tribute to the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi); their unflinching commitment to this cause does them credit. Thanks is also due in no small part to the all-party parliamentary group, whose dedicated purpose is to

“help secure…access to natural cannabis for medical purposes in the UK under prescription from a medical professional.”

The group has worked tirelessly to that end, highlighting the barriers that exist and posing constructive suggestions to remove them.

As the hon. Member for Reigate (Crispin Blunt) rightly said, we are not concerned today with criminals and illegal drug supplies. We are not concerned with the use of recreational drugs. We are considering a most important health issue. I welcome the fact that at long last the Government accept that the therapeutic use of cannabis is a public health issue and not the business of the Home Office. I trust, therefore, that we will never again see parents in possession of medicinal cannabis products accosted and treated like criminals. I refer of course to the disgraceful treatment meted out to Teagan Appleby’s family.

Cannabis has long been known to contain active ingredients that could have therapeutic use in the treatment of many conditions, including muscular dystrophy, Parkinson’s disease, Crohn’s disease, cancer, AIDS, sickle cell disease and many more. International research and real-life experience in the UK have shown that the active ingredients CBD and THC, in combination, can provide relief for these conditions. There are also strong indications that these medicinal cannabis products can have a transformational effect in paediatric epilepsy cases. In the UK, though, we have been very slow to accept this and even slower to act to help those who could be helped.

Other powerful drugs with significant street values, such as heroin and diazepam, have long been available on the NHS under the supervision and control of qualified clinicians. Such drugs are extremely harmful in the wrong hands, but, subject to the existing controlled drugs regulations, these products can be used beneficially. In recent years, we have made some progress and have begun to accept that cannabis could and should be available in the same way. This changing attitude has most definitely been driven by increased public awareness of the suffering of individuals, many of them children.

[Jim Shannon]

Just to reiterate what the hon. Lady is saying, my young constituent Sophia has not been hospitalised with an active seizure in 10 months. I quote her mum:

“Our little lady just amazes us every day and we are very blessed to be in this position but we can’t help but think of the thousands of other children and adults that could need this right now!!!!!”

Does the hon. Lady agree that we must ensure that we are making progress? This debate is about progress and moving forward, so it is important for the Minister to do just that.

[Julie Cooper]

I am grateful to the hon. Gentleman for his intervention, and I absolutely agree. There is the potential to help thousands. We must move forward at the earliest opportunity.

Members have raised some powerful cases on behalf of their constituents—adults and children who could benefit. I want to mention the experiences of the Griffiths family. Mrs Griffiths asked me to help her nine-year-old son, Ben. Ben suffers with severe intractable epilepsy. This means that he has up to 300 seizures a day and has come close to death on more than one occasion. At the new year, Ben was admitted to Alder Hey Children’s Hospital, where, during an 18-hour period, he was observed to have 200 seizures. Ben’s parents asked whether he could have access to CBD and THC, but they were informed that Alder Hey has a blanket ban on medicinal cannabis products containing THC. Ben was discharged and his discharge letter stated that his parents had asked for an illegal drug.

In desperation, the family have turned to a private neurologist and, thanks to him, since January this year, Ben has been taking medicinal cannabis CBD and THC. His condition is much improved and yesterday he had only four seizures. His family tell me that Great Ormond Hospital and Professor Finbar O’Callaghan, the head of the British Paediatric Neurology Association, have acknowledged Ben’s improved condition, but the family are still unable to get an NHS prescription to supply the medicinal cannabis that he needs. The private prescriptions for his treatment are costing the family £2,500 a month. The family cannot continue to fund what is for Ben life-saving medication and they fear they will lose their son. Mrs Griffiths asked me: “How sick does our child have to get before the NHS will help him?” I know that question will go to the heart of everyone in the Chamber today. In relation to the high costs of private prescriptions for this medication, we are seeing the development of an unjust two-tier system where those who can pay get access to vital medication and those who cannot pay go without. That goes totally against the very principles of the NHS of which we are so proud.

In July 2018, the chief medical officer published a report declaring that there was conclusive evidence of the therapeutic benefit of cannabis medicinal products and she recommended that the whole class of cannabis medicinal products be rescheduled under the misuse of drugs regulations. The Home Secretary listened and, on 1 November 2018, the Government took action to reschedule cannabis for medical purposes. This was a very welcome step, making it legal for doctors on the specialised register to prescribe unlicensed whole-plant cannabis products for medicinal use in the UK. On that day, hundreds of families across the country celebrated, believing that this meant that they would have access via the NHS to medicinal cannabis. Sadly, that has not been the reality. Not one single NHS prescription has since been written for whole-plant medical cannabis and the hopes of many have been cruelly dashed.

Ironically, changing the legal status of medicinal cannabis has actually made the situation worse. Prior to that change in legislation, the Home Secretary had the power to grant special licences to make medicinal cannabis available. The Home Secretary no longer has that power. Now supplies are conditional on both clinical sign-off and a funding agreement, and that is not happening. I know that the Minister and the Secretary of State want to resolve the problem. I also know that the Secretary of State has met some of the affected families and has promised to help them. But the clock is ticking. The End Our Pain campaigners are absolutely clear that this is a matter of life and death. It is now two months since the Secretary of State met the families and, in that time, not one single NHS prescription has been written for medicinal cannabis that contains both CBD and, crucially, THC. There are many good intentions, but the Department’s implementation procedures following the rescheduling of medicinal cannabis are not fit for purpose.

The Secretary of State has said repeatedly that he cannot overrule the judgment of clinicians, and of course we do not expect him to do so. We do, though, expect that he recognises that these are exceptional circumstances of great urgency and urgent special action is required. It is clear that the procedures are not working and we cannot rely on a “business as usual” approach. As my hon. Friend the Member for Manchester, Withington (Jeff Smith) said, we need a bespoke solution. We need an acknowledgement that cannabis is a special case. We need a broader analysis of the evidence for the efficacy of medicinal cannabis that brings together worldwide research with the experience of patients and families in the UK who have benefited from using medicinal cannabis. While NHS England investigates the causes of the blockages in the implementation process, the NHS needs to step in to meet the costs of private prescriptions.

We need improved education and support for medical practitioners with regard to medicinal cannabis. The current guidance for prescribing medicinal cannabis needs to be changed to support and protect prescribing clinicians who prescribe, following best practice, in the best interests of their patients. We need the Department of Health and Social Care and the NHS to stress that medicinal cannabis is legal and that there is an expectation that it will be prescribed in the same way as any other unlicensed medicine when appropriate. We need a guarantee on funding. We need to know that everyone right across these islands, wherever they live and whichever CCG governs the healthcare in their community, has access to funded products where appropriate. Good intentions on their own are not good enough: we need urgent action.

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[Seema Kennedy]

I will come on to timelines later in my remarks. NHS England is currently obtaining patient consent and scheduling the necessary interviews with clinicians, decision makers and their patients. The first interviews were held today.

I want to touch briefly on devolved matters. Health is a devolved matter, but officials across the UK have been working closely on the development of this policy. The law is exactly the same in all four countries of the UK and only funding is devolved. Members have said that clinicians might be nervous about prescription and that we need to improve training. I will talk about this later, but the training package that has been commissioned from Health Education England will be made available across the UK.

[Jim Shannon]

The Minister has heard my comments on behalf of my young constituent, Sophia Gibson, who is getting medicinal cannabis through the trust area. May I suggest that, if that is how it is done for my constituent in Northern Ireland, it could be done for people across the rest of the United Kingdom through their trust area or non-governmental organisations—wherever the responsibility lies?

National Marriage and Mental Health Awareness Weeks

Jim Shannon Excerpts

Thursday 16th May 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

First, I will say a big thank you to the hon. Member for Congleton (Fiona Bruce) for having set the scene. She is always a strong supporter of marriage, and I wholeheartedly support the issues that she brings before this House, whether here in the Westminster Hall Chamber or in the main Chamber. Furthermore, without speaking for the hon. Lady, whenever I bring issues to either Chamber, she is always there to add her support. I thank her for that. She has been very much at the forefront of ensuring that National Marriage Week and the issues of family life and family values are heard about in this House whenever the occasion arises. It is a real pleasure to speak in this debate.

Marriage is a wonderful thing but, like all things of worth, it is not easy. In all honesty—I speak as someone who, on 6 June, will have been married for 32 years—I have a very long-suffering wife. The truth of the matter is that she has suffered long and hard, but she is still there, and that is one of the good things about married life. If my dad had lived another two weeks—he has been dead for four years—he and my mum would have been married for 61 years. They were a long time together, and that is not counting the time they were going together way back in the early ’50s. I have no idea how and why my wife Sandra has stuck me for so long, but I thank God every day that she has.

A strong marriage requires two people who choose to love each other even when there are times they do not particularly like each other. That is the fact of it. If Sandra was here, she would say, “Amen to that.” She would wholeheartedly know what I mean when I say that, because we have some exchanges of opinion now and again. I think it is good to have those release valves. It does not mean we have fallen out; it means we can have differences of opinion. My wife is not politically motivated at all; she only became interested in politics when she married me. The fact of the matter is that whenever I bring up issues to do with politics, truthfully she is perhaps not that interested, but she supports me well and she has an opinion on political matters. She is quick to tell me about those things.

Marriage is tough, and my heart goes out to those who are unable to make things work despite the hard work put in. The reality is that relationships break down. That is a fact, even with the best relationships. No one gets married to get divorced; people get married to spend the rest of their lives together. That is how it happens, but sometimes things happen along the way. As elected representatives—we are all here speaking in this debate as elected representatives—we are probably confronted every day in our advice centres with people who have had marital breakdowns. If they are churchgoers, I genuinely usually say, “Have you spoken to your minister?” If not, I say, “Have you had a chance to talk things through with someone in Relate to see whether it is possible to pull things together?” Sometimes that works. I am not a Relate councillor with great skills, but I try to point people in the direction where some things can be brought together. That sometimes works, but it does not always work. Sometimes when they come to me as the MP, or when they did in my past life as a Member of the Legislative Assembly, things have broken irretrievably. Those are difficult times.

I read an incredibly interesting report by the Marriage Foundation, which had some noteworthy analysis and statistical presentations. Analysis carried out on the millennium cohort study data on 10,929 mothers with 14-year-old children reveals that mental health problems are especially prevalent among children whose parents split up. We have just finished the main inquiry on education in the Northern Ireland Affairs Committee. Some of the figures on education in Northern Ireland are truly scary and worrying. We have the highest levels of anxiety and depression among children of primary school and secondary school age for the whole United Kingdom. That is very worrying. This debate is so important—the hon. Member for Congleton has referred to it—because it shows the importance of having a normal home life. I say that honestly, because having that does in some way help things.

It is incredibly difficult for a child to watch a break-up, and all too often they are in the middle. It happens so often. I thank every parent who makes the determination that, regardless of the relationship status, they will not allow their child to be a pawn or used as a weapon. A story came to my memory when I was sitting here. There was a sad, sad story last weekend in one of the papers. A mother and father were breaking up and they had two children from that relationship. The really sad thing was that neither the mother nor the father wanted custody of the children. I said to myself, “How sad is that?” Neither the mother nor the father felt that the children could be with them and they wanted the other one to have them. I do not know what the outcome of that will be. Sir David, you and I have talks about many things. You are chairing this sitting, so you are independent, but I know that you and I very much agree on the importance of married life and what it does for a relationship and the children that come out of it.

I have three sons from my relationship with Sandra. Two of them are married. The big fella, Jamie, has been married 11 years, and the second married just last year, and out of that comes the grandchildren. We could never get a wee girl—it was always wee boys—but Sandra always wanted a wee girl. She now has two wee granddaughters, Katie and Mia, and just before Christmas a third grandchild was born to my second son, who was married just last year—the product of that is a wee boy called Austin. How much do we as grandparents enjoy the grandchildren, ever mindful that at 7 o’clock at night we can give them back? That is a big, big thing. We get all the enjoyment, smiles and laughter, but when they get tantrum-y and want to go or argue, we can phone up to say, “They’re ready for going home.” That is always something to remember, but I say it because of the enjoyment they give to us as parents.

The findings show that the influence of family behaviour on teenage mental health extends far beyond parental conflict. Family breakdown is the single biggest factor for girls and equal top influence for boys, along with parental relationship happiness. Whether parents are married and happy, and stay together and remain close to their child, all make a unique contribution. I believe that parents have a strong responsibility; they need to be reminded that children watch and note their every word, action and deed. Therefore, the role of the parent is critical in setting an example for children in how the family gets on together.

The positive effect of marriage on mental health is clear and there for all to see. It is particularly interesting that the Marriage Foundation study showed that the effect of marriage extends well beyond stability and selection effects. For boys, whether their parents were married when they were born remains one of the two biggest influences on their subsequent overall mental health, even after taking into account their mother’s age, education, ethnicity and relationship happiness when the child was born, and whether the parents stay together. We cannot ignore—and nor can parents—the influence that parents have on their children.

The 2016 report by the Marriage Foundation found evidence that marriage boosts self-esteem for boys and girls. It is good that that happens. The report relied on the data of 3,822 children from the British household panel survey. It revealed that teenage boys living with continuously married parents have the highest self-esteem, while teenage girls living with continuously cohabiting parents have the lowest. The data outlines that the mother’s education has a smaller effect on self-esteem, while the child’s age and the mother’s income have no effect at all. Some of those stats are particularly illuminating because they give an idea of how what happens in the family home can affect children. Although those differences are all relatively small, they are highly significant and provide robust evidence that the wellbeing of teenagers and their future life chances are influenced by whether or not their parents are married. I am not making it up—the stats come from organisations, and they cannot be ignored.

Teens of either sex who live with continuously married parents have higher self-esteem and acceptance than those who live with continuously cohabiting parents or other family types. In outlining all this, I must be very clear: I do not believe that if a family is not united by marriage, a bad outcome is predetermined—it is not; far from it—but I am referring to the findings and how the information was collated. Data shows that children from married families show a higher level of wellbeing and mental health. That should be noted and highlighted.

The institution of marriage, to which I happily subscribe, has stood the test of time, and its benefits to society are clear. I believe that the House must acknowledge that, which is why I am so happy to support my friend, the hon. Member for Congleton, and I thank her for allowing us to highlight that wonderful institution once more. I am someone who is convinced of the benefits of marriage, and in June, my 32 years of marriage will be an example of just that.

Alexandra Hospital, Redditch

Jim Shannon Excerpts

Wednesday 15th May 2019 Commons Chamber

[Rachel Maclean (Redditch) (Con)]

I am glad to be able to raise in the Chamber the issue of services at the Alexandra Hospital in Redditch. I hear concerns time and again in public meetings, and I thank the local groups, such as Save the Alex, that are campaigning on this matter.

In short, services at the Alex are inadequate. That is not my word, but the one used by the independent Care Quality Commission. It inspected Worcestershire Acute Hospitals NHS Trust, which includes the Alex Hospital in Redditch, in June last year and again found it to be inadequate. That represents no change since the last inspection. Indeed, in 16 areas that the CQC inspects, only one was rated good, none was outstanding, and half were rated inadequate, with the remaining requiring improvement. That is not good enough.

On being elected in 2017, I inherited a situation where the trust had already approved a new clinical model for future acute services to which centralisation was key. As a result, regrettably, a number of services, including maternity and paediatric care, were removed from the Alex and relocated to Worcestershire Royal Hospital. Our maternity unit closed in November 2015, and paediatrics was “temporarily” transferred in September 2016. The new plan, which was rubber-stamped in 2017, is intended to relieve pressure on both hospitals, improve patient safety and address staff shortages, but almost two years on from the removal of services and the approval of the new plan, it is clear to me that it has not had the intended outcome. The hospital is still inadequate, and the trust remains in special measures. Some services have got worse. Patients cannot access services when they need them, waiting times are poor and promised investments are not coming to fruition quickly enough. Pressure has not been relieved. Patient safety is being called into question, and staff shortages persist at both sites.

Since my election, I have given NHS bosses and management time to demonstrate to me and my constituents that the new clinical model is beneficial. I have done my best to explain to constituents why services were transferred, and I have visited the hospital time and again—along with my fellow Worcestershire MPs, who are here tonight—to keep a close eye on developments.

We have thousands of dedicated and fantastic staff in our hospital. I have spoken to many of them, and my constituents report time and again that the care they receive is fantastic. I thank every single member of staff at the hospital for their work. However, I do not believe I can continue in good faith to defend the new clinical model. It is not delivering for the people of Redditch. I secured this debate to press my constituents’ concerns on the Minister and call for a fresh approach. All options must remain on the table.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way; I spoke to her beforehand and explained the situation of some of my hospitals back home. I commend her efforts to retain services at the Alexandra Hospital. The recommendations of Redditch Borough Council health commission, which came out firmly against the clinical commissioning group proposals, must be given weight. The proposals must not progress to any lessening of services in the Alexandra. My own Ulster hospital is seeing proposals to redirect stroke services to a hospital that is over an hour away in traffic, which will certainly mean that damage cannot be fixed within the window of opportunity for recovery. Does she agree that money saving cannot trump life saving in any trust area?

[Rachel Maclean]

I thank the hon. Gentleman for his intervention. It sounds as though his experiences are very similar to ours in Worcestershire. I am sure he will continue to stand up for his constituents.

I have campaigned for improvements to local health services, and I welcome the investments coming on stream as a result. Upgrades in endoscopy, a new urgent care centre at the Alex and better infrastructure have all come on stream. A frailty unit has been transferred from Worcester, and a new ward has opened to improve the flow of patients in and out of A&E. Those are all making a difference.

British Sign Language Users: Access to NHS Services

Jim Shannon Excerpts

Wednesday 15th May 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), and I give special thanks to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for her passionate contribution on behalf of those who use British Sign Language. I commend her for the steps she has taken in her constituency.

I must be honest and say that I do not know much about British Sign Language. The staff in my office are aware of it and we try to have someone available for people to communicate with in BSL, should they wish to; it is important that we as elected representatives provide that opportunity. While I do not have the ability, some of my staff have made it their business to be able to communicate with those who use BSL.

I am happy that my two granddaughters have both learned sign language—in a rudimentary way; not in totality—at school. They can sign their names, which is a small way of moving forward, among other things we can do. I will ask the Minister a question along those lines, but first let me say that I am pleased to see her in her place. She seems to be enjoying her new role, and we are pleased to see her there. The difference between my grandchildren and me highlights the need for young people to have basic skills to enable them to communicate with people who may need their help. It is important that our children have an opportunity to do that at an early stage.

Although we must take steps to address the interpreter system within the NHS, as mentioned by the hon. Members for Poplar and Limehouse and for Newcastle upon Tyne North, I sincerely believe that we also need to make BSL a staple of education, so that every child has a rudimentary understanding of sign language by the time they leave school. I know the Minister is not responsible for education—her role is big enough as it is—but will she communicate with the Department for Education and find out how that can be achieved? It is so important. Our children are often criticised for anti-social behaviour, but I believe our young people are a marvellous example of what the future can hold. Such small steps enable them to have compassion for other people. My boys were always interested in other people, and I am encouraged to know that my grandchildren are the same. If the new generation has an interest in others, that means a whole lot.

The media in Northern Ireland last year highlighted the case of a deaf lady who was going through treatment for cancer, but who did not have an allocated interpreter for any of her appointments. I was shocked by the lack of signers available to NHS trusts in Northern Ireland. An article in the Belfast Telegraph outlined the issue and quoted Ann Owens from the charity Hands that Talk—a lovely name that sums up sign language. She spoke about the lack of signers available for short-notice requests:

“It can be difficult as you can need about two to three weeks’ notice sometimes, but if it’s an emergency there can be times when someone’s not available due to the shortage, including for A&E admissions.”

That is a critical point at which to have interpreters in place. She went on:

“There’s about 25 to 28 British Sign Language interpreters in Northern Ireland and only three Irish Sign Language interpreters, which would mainly be used in the Enniskillen area.”

That illustrates the issue that we want to highlight, and it shows the dearth of interpreters. We need to address that by recruiting more people who can give up their time, and who are paid to be available at short notice. Each trust must have a list of interpreters who can be available at short notice to step into A&E situations. Other Members have referred to this, but it is important to take steps to address the matter where it is at its most critical, which is usually in A&E or on the ward.

I do not want to be critical of nurses—that is not the purpose of this debate—but we need nurses who can communicate in sign language with those who require it. Last year, I was in hospital on three occasions, and I was asked to sign a document to give consent. Truthfully, I was in so much pain that I would have signed away my land and farm; just imagine what it would have been like if I could not understand what I was being told to do, because I was deaf. How difficult would it be for a deaf patient, lying in absolute agony, to be asked to sign something that they did not understand? That shows me how frightening it is for deaf people, and how important it is to have the right people in the right place at the right time.

When foreign nationals go to A&E, interpreters are sourced and money is paid out—rightly so; I support that 100%—and yet our own British deaf people are left out in the cold because of the lack of interpreters. It is not good enough to say that we do not have the signers. We know there is a problem, so let us train staff within the NHS to do the job. The hon. Members for Newcastle upon Tyne North and for Poplar and Limehouse have referred to that, and I think others who speak will do the same. Let us put funding and courses in place to teach signing, to ensure that there is always someone on site who has at least a basic understanding of BSL. It is important to have someone with even a rudimentary knowledge of sign language to communicate. We know there is a problem, we have acknowledged our responsibility and now we must address it.

Although there are 11 million people with hearing loss in the United Kingdom, new research has revealed that a staggering 94% of Brits—I am one of them—know no more than two words of British Sign Language. That really has to change. We have to be more open and more capable of responding, especially in our Government Departments and most especially within the NHS. It is so important to address the issue in the NHS. I look forward to the plan of action to fund and recruit the necessary staff to do what is right for the deaf in our community. I look forward to the contributions of the shadow Ministers from the Scottish National party and the Labour party, but I especially look forward to the Minister’s response. We are very impressed by her so far, and there is no pressure on her.

Medical Aesthetics Industry: Regulation

Jim Shannon Excerpts

Tuesday 14th May 2019 Westminster Hall

[Alberto Costa (South Leicestershire) (Con)]

I beg to move,

That this House has considered regulation of the aesthetics industry.

It is a pleasure to serve under your chairmanship, Mr Owen. I am again grateful to lead a debate on this issue, which is becoming more pressing and may affect many of our constituents. The previous debate on this topic was successful, and I thank those who took part and contributed. I also mention my constituent, Rachael Knappier, who has been brave enough to tell her story and who initially brought this issue to my attention.

As some Members will remember, Rachael received a lip filler from an unregulated beautician, who accidently injected it into her artery, causing a trauma to her lip. In January, I raised this with the Prime Minister at Prime Minister’s questions. Since then, some progress has been made by the Government and I welcome the announcement made today, but more progress is required. Following my championing of the issue, I am glad that the Government have begun to act. The Department of Health and Social Care is today launching a campaign to encourage consumers to seek professional advice when considering having procedures such as Botox, dermal fillers and cosmetic surgery.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. As he rightly says, there is need for a tightening of the regulations. In the media, there are children as young as 15 with botched lip fillers and injections; we need to do more to protect those children.

Does the hon. Gentleman agree that we must ensure that only medically-trained professionals, with a duty of care provided by their professional boards, carry out these procedures, under very strict regulations?

[Alberto Costa]

The hon. Gentleman is correct. We need to ensure that we have appropriate regulation with these procedures, or similar types of procedure. He is right to raise this issue on behalf of his constituents.

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Lady is right, and I am grateful for the spirit in which she makes her comments. Anyone who establishes themselves in business as a beautician wants to deliver a good service, has pride in what they do and would not want to be accused of doing anything unsafe.

My first focus of activity is those organisations that train people in these procedures, because I can see a situation in which a beautician will have paid thousands of pounds to go on a course and will then think that they are qualified, but they might not be. That is where we need to bring the focus of regulation in the first instance, so that when somebody proudly displays their certificates, consumers can have some guarantee that they are legitimate. I welcome the opportunity to air these issues with the all-party parliamentary group as we move this system of regulation forward.

Sadly, we only have 30 minutes for this debate, so I doubt whether I will be able to get through as much as I would wish, but I will do my best. I am grateful for the interest of all Members here. We will continue this discussion. It is worth saying that Botox treatments and dermal fillers are increasing and, along with laser hair removal, now represent nine out of 10 non-surgical treatments performed in the UK. This is a major area of risk.

Hon. Members have referenced the campaign that we launched today. Clearly, consumers will be the best defenders of their own interest, but we must make sure that they have access to appropriate information with which to do so; we need to do much more to inform people about the risk. Just as in my hon. Friend the Member for South Leicestershire’s example of his constituent, I am quite sure that many people who have had fillers—who have gone to have their lips done, like they do—would have no idea that there is a risk of their artery being injected with poison. We need to make sure that consumers are much more aware of that, which is why we are doing so much more in the next six weeks to try to raise public awareness.

We will focus on targeting our messages to women aged 18 to 34, on whom the majority of the treatments are undertaken. I am pleased that we are working with Bauer Media, which publishes Grazia, Closer and Heat, which I hope will be appropriate vehicles to reach that audience. We will make sure that the NHS information is kept up to date and remains a meaningful resource for consumers.

[Jim Shannon]

Would the Minister consider making it so that under-18s could not have this treatment?

[Albert Owen (in the Chair)]

Minister, you have less than two minutes.

Acquired Brain Injury

Jim Shannon Excerpts

Thursday 9th May 2019 Commons Chamber

[Liz Twist]

I thank the right hon. Gentleman for those comments. I most certainly agree that we need to have very specific proposals on how we can support people and to make sure that the support is actually put into place as well. As we know, there can sometimes be delays in achieving the ECHP, so I hope that more work can be put into that as well.

The Child Brain Injury Trust, which does excellent work in this area, has issued a call for action that includes some quite practical steps. It tells me that professionals across the field of acquired brain injury educational psychology are working hard to achieve the changes needed to support children in education following an acquired brain injury, but this requires all parties to listen and to implement the recommendations of the “Time for Change” report.

An acknowledgement of the support and interventions needed for paediatric acquired brain injury is required to limit the long-term societal costs and impact that this disability can have. Of course, it affects society as a whole, not just the individual. We want to give people the best chance in life, and that is why it is particularly appropriate to look at how we can support children who have an acquired brain injury. There needs to be improved training for newly qualified teachers—currently, acquired brain injury is not covered in that training—and a national campaign of recognition that acquired brain injury affects an additional 40,000 children and young people every year and has a significant impact on society.

The Child Brain Injury Trust says that acquired brain injury continues to be misdiagnosed and misunderstood, and our current system, and lack of knowledge and support, is letting down thousands of families. Funding is required for whole-family support. We need improved training for educators and youth justice teams, because over 60% of young people in custody report prior head injury. As other Members have mentioned, many young people affected by acquired brain injury are excluded from school due to their “inappropriate behaviour” and then go on to commit crime. Therefore, better knowledge of the condition and improved support has the potential to save society huge sums of money otherwise needed for youth justice.

The Child Brain Injury Trust calls for involvement and commitment from the Department for Education to support and fund some of these recommended initiatives. As I said, I hope that the Department for Education will take a more active part in looking after these young people and look again at its response to see how it can be improved.

The other area I want to touch on, which has already been mentioned by a number of Members, is acquired brain injury and carbon monoxide poisoning. This is not something that I had thought of myself. It shows, again, how many areas of our lives and our environment affect people and can cause acquired brain injury. I am a member not only of the APPG on acquired brain injury but the APPG on carbon monoxide, and earlier this year we had a special roundtable meeting chaired by my hon. Friend the Member for Rhondda. One of the difficulties is recognising when people are suffering from carbon monoxide poisoning, especially the impact that that can have on the brain. The shortage of support is particularly difficult for people with an acquired brain injury caused by carbon monoxide poisoning, as they are less likely to receive specialist treatment if they experience low-level carbon monoxide exposure that results in more subtle neurological effects. To address this, the APPG on carbon monoxide recommends that NHS England develop a specialist clinic for people with long-term neurological effects caused by carbon monoxide exposure. This will help to plug the gap in care provision and enable future studies that will innovate treatment methods.

We must also remember that, as the Government said in their November 2018 health and social care policy paper, prevention is better than cure, and preventing carbon monoxide poisoning will also prevent some of these acquired brain injuries. The APPG recommends that the Government introduce preventive measures, including mandating carbon monoxide alarms in all tenures. I know that the Government are already looking at this in certain tenures, but it should be across all tenures. Carbon monoxide monitors should be provided for those in first-time pregnancy. We must tackle substandard housing that increases the risk of carbon monoxide exposure. We also recommend that Public Health England and the Foreign and Commonwealth Office do more to raise public awareness of carbon monoxide, to encourage risk-lowering behaviours at home and abroad. The special roundtable meeting that we had was very productive. We had a high number of medical people there who were recognising this problem that perhaps the rest of us had not recognised until now. We need some practical steps to improve that.

I have mentioned the Child Brain Injury Trust’s recommended actions, particularly on education. There is so much more that I could say, but much of it has already been said, so I will only mention a few things. We are seeing more people survive severe trauma, and we must give more effective support after they recover from their immediate injury, to help them develop their life.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way. I have personal experience of this through my brother, who unfortunately had a very severe accident, which left him brain-damaged. Owing to the determination of my parents and family, who took the time to care for and look after him, we were able to give him some sort of an independent life, which is very important. He is happy and safe with his carers, friends and family. Does the hon. Lady agree that more needs to be done to support the families of those with ABI, to give them hope that there can be more than Sunday visits to a designated place—there can be a home life as well—and there is a chance of a semblance of normal life for people with ABI? Intensive care packages are essential to rehabilitation, and funding must be available for them. It is so important to give people who have acquired brain injury a normal life, if at all possible.

[Liz Twist]

I thank the hon. Gentleman for his comments. I certainly agree that we must give more support to the carers and families of young people or adults with acquired brain injury, while allowing the person who is directly affected to have as full and good a life as they can.

I want to mention the “One Punch” campaign. We are becoming increasingly aware of the impact that one punch on a night out, perhaps after a lively evening, can have. It can be devastating, and I am glad to see campaigns around the country aiming to ensure people are aware of that. We have talked about how sports must keep up the level of support and awareness and, if in doubt, sit people out. That is really important. We have also heard about the huge impact on our prison community. We must develop a response to that, so that we can take account of acquired brain injury and how it affects people’s behaviour and development.

Headway has made some recommendations. It says:

“Brain injury can happen to anyone, at any time. Living with the effects of a brain injury creates challenges in almost every area of life.”

That is so true. Headway is calling on Members of Parliament to recognise and support the needs of service users, families and carers, including greater understanding of the complexity and hidden effects of brain injury; wider recognition of the symptoms of brain injury, to ensure rapid and accurate diagnosis; access to timely, specialist rehabilitation and support services; an end to lengthy waits for social service assessments for support funding; changes to disability benefit assessments, which currently fail a large number of brain injury survivors and their families—Headway has a campaign called “Right First Time”—and more effective data gathering across the NHS, to provide clearer evidence of the needs of survivors, around diagnosis, acute care, longer-term rehabilitation and support to regain independence. Acquired brain injury is life changing, and we must do everything we can to support people across all spheres of life.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

I am pleased the hon. Gentleman has raised this issue, because he is absolutely right that we need to drive up performance nationally on diagnosis for autistic people. It is only with diagnosis that people can get the support and help they need. We are collecting data for the first time. It will be published later this year for the first time. It will mean that each area can be held to account and given the help and support it needs to drive up those figures.

[Jim Shannon (Strangford) (DUP)]

Will the Minister further outline the steps that have been taken to push for a UK-wide, ring-fenced uplift to respite care funding for those who suffer from autism, bearing in mind that there is a two-year waiting list in some healthcare trusts for families to access overnight respite care?

[Caroline Dinenage]

That is a really good point. We all know that access to respite care can be incredibly valuable, both for autistic people and their carers and their loved ones. That is why we are supporting CCGs that want to invest in respite care, and we are looking more carefully at how we can direct funding to these important services.

Healthcare: East Midlands

Jim Shannon Excerpts

Tuesday 30th April 2019 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

Thank you, Mr Hollobone, for allowing me to speak first. I think it is the first time I have heard a Chair say that there is no time constraint, but I will not detain the House for too long. At the risk of being called to order, I had planned to raise the work that you have done for Kettering General Hospital and your impassioned demands for improvements to it over the years, which no doubt the Minister has listened to many times. I was with some friends last week who said, “Ah, Northamptonshire. That’s the Bones—Peter and Philip—isn’t it?” Kettering General Hospital came up. At the risk of being called to order—I do not see you doing that—let me say what a good job you have done for that hospital. As was said in the Chamber this week, your whole identity in the House is linked to the work you have done there.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing not just half an hour but an hour and a half in what used to be called the Grand Committee Room but is now Westminster Hall. She spoke passionately and with detailed knowledge, as a former nurse, about the problems in her area. I listened to her speech, and I have sympathy with what she said about some of the consolidation that has taken place, but inevitably there have to be some changes and rationalisations in the health service.

I will talk mainly about the changes in the great town of Hinckley, in my west Leicestershire constituency of Bosworth, which is some way from Lincoln. We were very fortunate that the Secretary of State himself—ipse—recently came to Hinckley to look at the changes that will be made thanks to the £8 million grant that has been secured for upgrading the facilities in Hinckley. Mayur Lakhani, the chair of the West Leicestershire clinical commissioning group, spoke warmly about the way the Secretary of State had responded to their bid, and the support of Hinckley and Bosworth Borough Council, which happens to be Conservative-controlled, and which I will refer to later.

I was lucky to be elected to this House a long time ago—in fact, so long ago that I sometimes forget the date. I have been a Member for more than 30 years, and the one health issue that has bedevilled my constituency above all others in that period is what to do with the Mount Road hospital—the old hospital in the middle of Hinckley. Because of the £8 million grant that the Secretary of State awarded to the clinical commissioning group, we are now able to make some substantial changes to the health improvements in Hinckley. Given your interest in Kettering General Hospital, Mr Hollobone, you will understand my joy at seeing the improvements that are about to take place—consultations are going on at the moment.

I have a letter from the West Leicestershire clinical commissioning group setting out exactly where we are now. It says that the investment supports plans to provide modern, fit-for-purpose facilities, and more services in the local community and closer to home in Hinckley. I say to the hon. Member for Lincoln that part of that will be about shutting down old facilities. One is a portakabin and another is the old hospital. In exchange, the investment will make better use of all available existing space in Hinckley Health Centre on Hill Street, not far from the old hospital, and Hinckley and Bosworth Community Hospital, which we call Sunnyside because it is on a hill and gets the sun all day long—it is a marvellous place for a hospital.

As part of the £8 million package, the Hinckley Health Centre will be refurbished to accommodate X-ray, ultrasound and physiotherapy, and to increase the number of consulting rooms, which is extremely important. Out-of-hours primary care services will be relocated from Hinckley and Bosworth Community Hospital—Sunnyside—to the newly developed urgent care hub in the Hinckley Health Centre, which will provide out-of-hours urgent care for local patients. A combined day case surgery and endoscopy unit with day case beds will be created. That will provide an increased range of day case procedures and cancer screening services for local patients. We will be removing services from the old Hinckley and District Hospital and the physiotherapy portakabin, which are unfortunately not fit for purpose, and physiotherapy services will be relocated to Hinckley Health Centre.

As I have the luxury of time, I say to people who have campaigned for years to save the old Hinckley and District Hospital that as it is such an old building, upgrading the hospital to the highest standards would require a phenomenal amount of work at a very high cost, with a low return on investment because all the special cables now have to be run with special conduits for oxygen and monitoring. It simply cannot be done efficiently in such an old structure. Although many of my constituents will have an emotional attachment to the old hospital, the decision that has been taken by the clinical commissioning group is right: it needed to close. In exchange, we are now getting an £8 million grant, which will provide much better facilities. As I mentioned earlier, some of the facilities are coming into the town from the outskirts—from Sunnyside to the health centre. It is quite an achievement.

We were lucky to get the grant of £8 million. My father always said to me that you generate your own luck in life, which is true. In this case, one of the drivers that made it possible for the Department and Secretary of State to agree to the clinical commissioning group’s bid was the extraordinary co-operation in west Leicestershire between the different service providers, particularly in Hinckley in my constituency.

At the beginning of the 2005 Parliament, I was lucky enough to get elected to the Health Committee under the new procedures. Subsequently, I chaired it for a short time. When I was elected to the Committee, I asked the then leader of the council, “Would you like me to come and talk about health on a regular basis?” It was agreed that I would, and that developed into a health and wellbeing partnership, which meets quarterly with the clinical commissioning group; the director of public health for Leicestershire County Council, Mike Sands; and senior officers at Hinckley and Bosworth Borough Council, including Bill Cullen, Simon Jones, Councillor Maureen Cook and many other excellent Conservative councillors over time. We also have doctors from the local surgeries attend.

Over a period of some years, we saw the meeting change from participants sitting with their arms folded and leaning back, to sitting up and listening attentively. We have learned to work together, and the partnership has been leakproof—there is nothing to gain from talking outside. We have had an extraordinary degree of co-operation, and I am absolutely convinced that it has improved the health services in my constituency and the county as a whole. It has reduced costs and brought up a whole a range of new ideas, some of which I shall go through today. The work of the secondary provider, Hinckley and Bosworth Borough Council, has been really remarkable and hugely encouraging, and it is something that all local people in my constituency can be proud of. Leicestershire County Council has done a good job, too, but I am particularly proud of what Hinckley and Bosworth has done through its health and wellbeing partnership—its contribution to health delivered through that partnership.

It might be instructive if I run through some of the areas that Hinckley and Bosworth Borough Council has worked on. I am pleased to see the Minister of State in his place rather than a Parliamentary Under-Secretary; he is the deputy of the Secretary of State. It illustrates how seriously the Government take the issue of health funding in the east midlands. I want to share with him what is going on in Hinckley. First, I reiterate that we have a local delivery of preventive services through co-operation. I mentioned the councils, but we also talk to the voluntary and community sector. We have patient participation groups, school participation groups and elderly patient participation groups.

The information pyramid is broad-based, and the lines of communication are fluid. Information can come from the bottom to the top very easily. From those ideas, the Conservative-controlled Hinckley and Bosworth Borough Council has produced a comprehensive prevention strategy, which sets out the work that the authority will undertake with its partners. The first objective is to prevent issues from escalating by taking action as early as possible. The second is to reduce demand for high-cost services and dependency on statutory services, thereby making spending more efficient.

Another objective is to develop self-help approaches to enable communities to take responsibility for their own health and wellbeing, which is something that the Department of Health and Social Care worked on under the Secretary of State’s predecessor, and the Health Committee in the 2005 Parliament looked at personal budgets and how they work. It was about getting people to think about their own health. With an ageing population, that is one of the areas that really must be brought to the fore in the future. However much money we ask for the NHS, we will never have enough supply of resources to meet demand unless we encourage people to take greater care of themselves. In this respect, the initiatives that Hinckley and Bosworth Borough Council has taken are hugely important in encouraging people to do that.

I will come on to what the council has done in a moment, but the overall aim of the strategy is to ensure that, together with its key partners, the council enables communities—especially people who are most at risk—to keep safe, keep well, stay independent and enjoy life. To support those aims and achieve those objectives, the council provides integrated locality teams, which identify and support people in a more co-ordinated way, focusing on two specific areas. The first is:

“Proactive identification via risk stratification of patients (18+, frail, multiple LTCs) at risk of a hospital admission and assessing the ‘whole person’ and their needs to keep them safe and well at home where it is appropriate to do so.”

I quote from this document—“whole person”—because a key thrust of health policy in the future should be holistic healthcare, which has become slightly muddled up and seen as definitely not mainstream. Actually, it should be at the core of the mainstream, treating the patient as a whole. I will come on to long-term care and conditions when I discuss the Health Committee’s report, “Managing the care of people with long-term conditions”, which I signed off as Chairman.

In Hinckley and Bosworth, we have a council that is proactively segmenting the population to treat people who are most in need as priorities, which I absolutely applaud. It also does that through the use of health ambassadors, who are

“uniformed volunteers who support and encourage people to get more active more often. They undertake this by playing to their strengths. Some give presentations, some lead activities, some encourage and support new participants on current schemes. Some are happy to have a coffee after an activity and talk to new participants. The big thing is they are positive role models who are empathetic with people and can support them to change and be more active in a way that is natural and comfortable to them.”

The programme is particularly effective when dealing with older people. In my beautiful constituency, Desford sports centre provides classes for elderly people, to keep them active. They have a chance to talk to experts—not doctors particularly, but sports therapists. They can play table tennis, sit down and do quizzes, play tennis—there is even tennis for people who are disabled. The whole idea is to get people who are a bit tired of life, or a bit sad by themselves, to meet other people and to engage in activities, thereby making them happier and healthier, and reducing the burden on the health service.

We are trying to divert away from A&E—the Leicester Royal Infirmary has one of the highest patient inputs in the country relative to its geographical footprint. I will not talk about the royal infirmary and the wonderful work of its health workers, but when the chair of the clinical commissioning group came to see what we were doing in Desford—on another visit, without the Secretary of State—we saw the Steady Steps programme. It is a 24-week free postural and stability exercise programme for older adults, aimed at those aged 65 and over who are at risk of falling, unsteady on their feet, lacking in confidence or likely to lose their balance.

One therapy that the sports centre is not employing, but to which I should like to draw the House’s attention, is the Alexander technique, which I have used in the past. Alexander was an opera singer, and he found that he could not sing. Part of the problem was that his chest was constricted all the time, so he could not project his voice—something that politicians are also quite keen to do at time when on the soapbox, if they can ever get there. Alexander discovered that breathing was connected to posture, and most people do not stand correctly with their hips as part of their back; they tend to have a break and swivel around the second and third lumbar vertebrae. He managed to get people to stand correctly to get their weight right. With their weight right, their lungs could perform properly. Those techniques, which have been developed by experts over the years, should be looked at carefully by the Department of Health and Social Care, but I will come to ways that we can take pressure off the Department generally.

Through the Steady Steps programme, it is so exciting and empowering to see elderly people who have become immobile actually get back into the community. Some of them have mental health problems, and Hinckley and Bosworth Borough Council has an active mental health support programme with five main objectives. They are to create networks to co-ordinate comprehensive and integrated mental health services in the community; to implement activities and events for promotion and early intervention and prevention in mental health; to improve awareness of mental health issues among children and young people, so that they do not think it strange that an older person is perhaps not as with it as they were in their 20s; to improve mental health and the impacts in the workplace; and to improve the quality of life of people living with dementia, and of their families and carers.

That is not rocket science; it explains to people simple facts of life about health. The programme brings the community together—it is a project that speaks to cohesion—makes it less likely that people will be upset by the behaviour of other people, and enables instructors to identify core problems. In the Hinckley and Bosworth area, we have over 6,500 dementia friends and 40 dementia champions. That is a lot of people in a constituency of 100,000 with 70,000 electors, and a very serious intervention.

Suicide is another issue that we as MPs deal with regularly. Most colleagues will have had cases in their surgeries about which they have had to approach care agencies. Leicestershire and Hinckley and Bosworth Borough Council have taken very decisive steps, with the Start a Conversation suicide prevention campaign for Leicester, Leicestershire and Rutland. The Start a Conversation website was launched on 10 September to coincide with World Suicide Prevention Day, and aims to provide information and signposting to people who are experiencing distress, to those worried about someone else, or those bereaved by suicide. The website is still in development, but will offer support and training to professionals.

[Jim Shannon (Strangford) (DUP)]

Whether we are discussing healthcare in the east midlands or in Northern Ireland, the issue of suicide is prominent in my constituency. When I became its MP in 2010, the level of suicide among young people was at its highest. That was dealt with through the involvement of community groups and of people in the community who had lost loved ones. There was also interaction with church groups and those of faith. By coming together, we reduced the incidence of suicide, and by working alongside healthcare in Northern Ireland, which is a devolved matter, we found that together, we could address the issue. It took both the community and healthcare to make that happen.

[Mr Philip Hollobone (in the Chair)]

Before Mr Tredinnick responds, I remind the Chamber that there is half an hour of Back-Bench time left, with two other Members seeking to contribute.

Mental Health Support: Young People

Jim Shannon Excerpts

Tuesday 9th April 2019 Commons Chamber

[Ruth George]

I absolutely agree with my hon. Friend. There are so many areas of children’s mental health where support is needed, but with ASD a diagnosis is needed as well, which can delay the support they so desperately need.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way. I did seek her permission to do so beforehand. I congratulate her on bringing this issue to the House today for an Adjournment debate. It is a critical issue and we are all very aware of it. Does she agree that the world young people face today, in which they have little privacy and so much exposure, is just so difficult? There is no place to go to get out of the reach of bullies or social media. This pressure sees so many young people struggling with self-esteem and self-worth. There must be more early intervention support for these young people to provide affirmation and tools for parents to help at an early stage and not let self-harming or suicidal thoughts begin.

[Ruth George]

I absolutely agree with the hon. Gentleman. I will come on to some of the additional stresses that young people are facing at the moment.

--- Later in debate ---

[Ruth George]

Absolutely. I pay tribute to my hon. Friend for his work on the matter. I hope that the Government will take up the recommendations in the report that the all-party group on social media and young people’s mental health and wellbeing, which he chairs, has produced.

We are seeing not just online but physical bullying, and rising violent crime, especially among young people. I spoke to teenagers at a college yesterday who told me that they are actually scared of the gangs of 13 and 14-year-olds who roam the streets in my area. Of course, young people are more likely to be victims of violent crime than anyone else.

Even in quiet rural areas such as mine, county lines gangs put pressure on more and more teenagers to become involved in crime. When I visited my local youth centre and talked to teenagers there, they said that, for one night a week, it is the one place they can go to escape the gangs and their peers who put pressure on them to get involved in drugs, aged just 13 and 14.

[Jim Shannon]

Will the hon. Lady give way?

[Ruth George]

I really need to make progress—I am sorry.

At the same time, more parents are working longer hours and spending more time travelling to work. We have the longest commuting times in Europe. Those parents have less time to spend with their children. There are more demands for flexibility from employers, especially at weekends, in the evenings and in school holidays—the times that parents most need to spend with their children.

There are new demands from the state for parents to be in full-time work, whether to access free childcare places from age three or through the demands of universal credit from age 12. At the same time as parents are working harder and longer, there is an increase in child and family poverty. Increasing numbers of parents face money worries and debt and have to visit food banks—strains that their children all too often see.

Alongside all those pressures on families and our young people, the number of professionals who are there to support them is reducing. Class sizes in schools are increasing and there are fewer teaching assistants, so school staff have less time for each child and growing pressures to prove academic achievement. Our schools do a fantastic job and I pay tribute to the staff who go above and beyond to support the young people in their care, but they cannot help with the sustained, one-to-one counselling and professional support that is so often needed. On top of that, child and adolescent mental health services have huge waiting lists and are still underfunded.

Our clinical commissioning groups spend 14% of their budget on mental health, but just 0.9% on children’s mental health. Even when the Government put additional funding into CCGs, it was not ring-fenced and, too often, not spent. Although an extra £250 million a year was allocated to CAMHS, in the first year only 36% of CCGs increased their spending by as much as that allocation. In the following year, 2016-17, only half of them did so, and last year, 2017-18, the spending stayed roughly the same. In 2018-19, it increased by just £50 million. Only a small fraction of the £1.25 billion that the Government had invested in children’s mental health services and CAMHS actually reached the front line.

CCGs are under huge pressures. Derbyshire’s CCGs have had to cut their spending by £51 million this year, and, despite the promised extra £20 billion for the NHS, they face further spending cuts of £270 million over the next four years. Mental health services are on the target list. The number of psychiatrists working in CAMHS at all levels fell by 3.7% between 2011 and 2018, although the number of referrals has almost doubled, as has the number of children admitted to A&E with mental health problems. At the same time, councils are cutting their spending.

School nurses spend a great deal of time supporting families and young people on the CAMHS waiting list who are going through the agonising wait of 12 to 18 months while experiencing suicidal thoughts, but they too are being subjected to cuts because of cuts in public health spending. We are losing half our school nurses in Derbyshire. As for “early help” support for families, 200 staff are being made redundant, and there is nowhere for families to turn for support. At all levels, support services are being underfunded. The Government have made a commitment to providing more counsellors in schools, which is often the right place for them, as children may need access to support. However, the target of extra provision in just a quarter of schools in five years’ time is not good enough. Our children are being failed, and their families are being failed.

Investment in mental health support for young people would actually save the Government money—not just in the health service, which would be able to nip mental health problems in the bud, but in the education, social services and criminal justice sectors. Our young people are crying out for help. The Government have some laudable aims in the 10-year plan, but they have not enough concrete plans to implement those aims, to fund CCGs to deliver them, or to invest in the training of the staff who will be on the front line.

The huge number of people who have contacted Parliament, and me personally, about this debate shows how much concern exists out there about the terrible cases of young people who are driven past the point of despair and the families whose lives are turned upside down. This is a cry for help on behalf of all of them. I ask the Minister please to listen, and to tell us how the Government will act.

--- Later in debate ---

[Jackie Doyle-Price]

My hon. Friend makes a good point. Transition is clearly an area that we need to address, and she is right to highlight the importance of this in universities.

The hon. Member for High Peak made a number of points in her speech. She referred to people with ADHD and ASD, and I could not agree with her more that there is a real issue with the failure to diagnose people with those conditions early enough. We know that those people are more likely to suffer from mental ill health, so early diagnosis is absolutely crucial if we are to equip those young people with the tools to look after themselves. I am pleased that that has been a target in the forward plan that we will roll out. The hon. Lady also rightly highlighted the issues surrounding county lines and knife crime, and there is no doubt that the increased incidence of trauma in communities will bring with it more demand for mental health services. That is something that we are very much tackling as part of the Prime Minister’s summit, which took place just last week.

I have been very pleased to work with the hon. Member for Ogmore (Chris Elmore) on this, and I welcome his all-party parliamentary group’s report on the impact of social media. The impact of social media brings with it a whole new set of pressures on children’s and young people’s mental health. It brings greater intensity to relationships, for example. We think our children are safe in their bedrooms, but they are not necessarily, and we need to be vigilant about how we hold social media and internet providers accountable for the content that they host on their sites.

[Jim Shannon]

The Childline charity has reported a 30% increase in referrals in the past year. That is an indication of the pressure being put on our children. Has the Minister had an opportunity to speak to Childline?

[Jackie Doyle-Price]

I have not had that opportunity yet, but I am sure I will.

I could say an awful lot more, but I do not have much time remaining. It is clear from hon. Members’ contributions to the debate that we all recognise that this is perhaps one of the biggest challenges facing our young people right now. It is heartening to see that so many people are really seizing those challenges, whether by demanding better services or by asking for changes to Government policy to deal with some of the threats. That is all very welcome, and I have no doubt that all Members will continue to challenge me on this important issue.

Question put and agreed to.

Age-related Macular Degeneration: NHS Funding

Jim Shannon Excerpts

Tuesday 9th April 2019 Westminster Hall

[Bambos Charalambous]

My hon. Friend makes an excellent point; I will come to that matter later in my speech.

AMD is an ever increasing public health issue, presenting as one of the number of long-term conditions that can lead to an increased risk of morbidity in patients. AMD costs the economy an estimated £1.6 billion a year and hits the productivity of society. There is a strong correlation between AMD and decreased quality of life outcomes, including an increase in depression, impaired ability to do everyday tasks, feeling more socially isolated and being 1.7 times more likely to suffer falls. Twenty-one per cent. of the annual medical cost of falls, which is £56.5 million, is attributed to those with visual impairments. The loss of independence resulting from sight loss can also be incredibly debilitating because systems are not set up to deal with it.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate, and I offer the Minister all best wishes in her new position. It is well deserved, and we look forward to working with her regularly in Westminster Hall and elsewhere.

My father suffered from AMD, although he did not know he had it until it had reached a late stage. Does the hon. Gentleman agree that early diagnosis is important for all matters of eye care that affect us, as is visiting an optician at least once if not twice a year? That is one positive thing we can do.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. Early diagnosis is so important, especially for wet AMD. The target requires people to be seen within 18 weeks of diagnosis, but that is unacceptable for people with wet AMD who should be seen within two weeks. Otherwise, their vision could suffer serious damage.

One concern is that the NHS has insufficient eye clinic capacity, due to delays and cancelled appointments that the British Ophthalmic Surveillance Unit has identified could lead to up to 22 patients a month losing their vision. The all-party group on eye health and visual impairment—I am pleased to see two members of the group here today—is supported by the Royal National Institute of Blind People, and in its inquiry, “See the Light”, published in June 2018, it identified 16 recommendations on which the Government should take action.

Three recommendations on which the APPG is still waiting to see progress include: the urgent need to increase the number of trainee ophthalmologists to keep pace with increasing demand; the need to ensure that sustainability and transformation partnerships—STPs—address current and future need; and the need to establish a national target to ensure that patients who require follow-up appointments are seen within a clinically appropriate time to prevent delayed and cancelled appointments.

According to statistics from the Industry Vision Group, last year three out of 44 STPs identified ophthalmology as a priority service, and only seven out of 44 met the 18-week referral target every month between January 2017 and January 2018. Early intervention for wet AMD is crucial to avoid blindness, and even the 18-week target that I mentioned to the hon. Member for Strangford (Jim Shannon) is not suitable for people with wet AMD, which requires treatment within two weeks. There is still a need to collect robust data on ophthalmology at clinical commissioning group level in order to assess performance and learn from best practice. Some of the issues relating to delay or the cancellation of appointments may be due to systems and processes, and not necessarily to funding.

Ophthalmology has the second highest outpatient attendance of any speciality, with 7.6 million appointments in England in 2017-18 accounting for 10% of all outpatient appointments. As we are all living longer, that figure is projected to increase by up to 40% over the next 20 years. The Government could do a number of things to help improve the situation for people with AMD and other sight-threatening conditions. First, we need a national eye health strategy—that point was raised by my hon. Friend the Member for Battersea (Marsha De Cordova). Unlike Scotland and Wales, England does not have a national eye health strategy, but one is needed to address workforce capacity issues and health inequalities, and to enable better care and improvements to the quality of life for those with AMD.

[Bambos Charalambous]

I am pleased to hear of the excellent work taking place in the hon. Gentleman’s constituency.

Contained within the strategy should be a minimum commitment to research similar to that given in the Government’s dementia 2020 challenge, which committed £60 million a year to dementia research, resulting in significant advances for those suffering with dementia. It is unclear how much funding has been set aside for ophthalmology from the £20 billion announced in the Government’s NHS long-term plan. I would be curious to hear from the Minister whether it is part of the plan or not.

There is also a need for the establishment of a national ophthalmology database to collect and analyse data for the purpose of improving outcomes, better decision making, and allocating resources. At present, there is fragmented data collection, such as that by the health quality improvement partnership, administered by the Royal College of Ophthalmologists, which covers only cataract surgery. A database that routinely collects information on AMD would greatly assist research and the planning of clinical care for those with AMD.

All STPs and integrated care schemes should be held accountable for developing and implanting integrated ophthalmology plans. Three years ago, the Department of Health commissioned a number of “Getting It Right First Time” reports into a series of areas, including ophthalmology. Unfortunately, that report is yet to be published, but hopefully when that happens it could inform the integrated ophthalmology plan, along with other sources such as the Royal College of Ophthalmologists’ “Way Forward” reports.

[Jim Shannon]

The hon. Gentleman is very gracious. As I should have said earlier, I declare an interest as the chair of the APPG for eye health and visual impairment. He is right that it is important to visit an optician to have a test for AMD, but such a visit can have other benefits. Through a person’s eyes, an optician can get an idea of what that person’s body is like, and can diagnose other things that are wrong. There are other benefits to visiting an optician for an early AMD test, in terms of everything that goes with it.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. We should all visit opticians on a regular basis, because they can detect a whole series of other eye conditions.

My second ask is for the publication of a workforce development plan for ophthalmology. That should also be a priority. There is already a shortage of eye care specialists who can diagnose and treat AMD. The number of ophthalmologists in the UK is the second lowest in Europe. The numbers are expected to reduce further, while the patient population is likely to increase significantly. The Department of Health and Social Care should commit to producing a workforce development plan that addresses the current situation and assesses future demand and provision need.

NHS RightCare should also develop guidance and a workstream for AMD, and data packs that can be shared as a resource and inform improvement in treatment for AMD. An IT platform that allows better integration of services is needed—for example, from primary care to hospital-based ophthalmology—so that a more joined-up approach can lead to better outcomes for patients with AMD.

Finally, it should be remembered that there is a link between sight loss and mental health, depression and frailty. The secondary effects of sight loss should also be considered when making both national and local policies on commissioning services.

--- Later in debate ---

[Seema Kennedy]

I will respond to the question that the hon. Lady raised in her intervention later on in my remarks. We know that regular sight testing can lead to early detection of these conditions. In his capacity as chair of the all-party group, the hon. Member for Strangford (Jim Shannon) referred to the importance of regular eye tests, given that, combined with early treatment, they can prevent people from losing their sight. That is why we continue to fund free sight tests for people over 60 and, alongside NHS England, are fully supporting the aims of the UK Vision Strategy to improve the eye health of people in the UK. A mark of the priority that the Department places on eye health is the inclusion in the Public Health Outcomes Framework of an indicator of the rate of avoidable blindness, both as a headline measure and by main cause, to highlight and track the direction of travel at national and local level.

The hon. Member for Enfield, Southgate has raised a number of wider important issues for the eye care sector. Many of those were highlighted in the report from the all-party parliamentary group on eye health, “See the Light”, which was published last summer. The Department welcomes this report and, along with NHS England, is carefully considering the key recommendations.

The hon. Gentleman said that eye clinic capacity was insufficient. I of course share any concerns about delays to treatment. National guidance is clear that all follow-up appointments should take place when clinically appropriate, and patients should not experience undue delay at any stage of their referral, diagnosis or treatment. To help address that issue, two key initiatives—“Getting it Right First Time”, led by NHS Improvement, and the elective care transformation programme, led by NHS England—have been set up to consider what can be done to ensure that patients do not suffer unnecessary delays in follow-up care. My Department is following that work closely.

The hon. Gentleman also asks that we establish a national target to ensure that patients requiring follow-up appointments are seen within a clinically appropriate time. As I am sure he will appreciate, the intervals for follow-up appointments will vary between different services or specialties, and between individual patients, depending on the severity of their condition. That is why all follow-up appointments should take place when clinically appropriate. For patients who require further planned stages of treatment after their “referral to treatment” waiting time clock has stopped, treatment should be undertaken without undue delay and in line with when it is clinically appropriate and convenient to the patient to do so.

The hon. Gentleman and the hon. Member for Battersea both raised the matter of a national eye health strategy. The Department takes sight loss very seriously. We are working with NHS England to ensure that the commissioning and development of eye services are of high quality and sustainable. I look forward to meeting the hon. Lady to discuss all matters relating to vision and sight loss.

CCGs are responsible for commissioning all secondary care ophthalmology services, and are also available to commission primary care services such as minor eye services and monitoring, in the community, to meet identified need. It is therefore right that the planning and commissioning of high-quality eye care services that meet the needs of the local population should happen locally, not at a national level.

The hon. Member for Enfield, Southgate, also referred to the national ophthalmology database, and asked that it be expanded to collect data on AMD. Data is currently collected on cataracts as part of a five-year programme funded by NHS England. I understand that at an earlier stage the programme funding panel considered expanding the focus, but decided that the focus should remain on cataracts in that time-limited audit.

I recognise the hon. Gentleman’s concerns and thank him for raising the matter. We are working incredibly hard, alongside NHS England, Public Health England and other partners, to ensure that eye care policy is focused both on preventing disease and, where disease develops, on ensuring that there are high-quality, sustainable eye care services for people across the country. I hope that the significant focus on effective treatment, prevention and AMD research that I have outlined means that he can reassure his constituents that we take AMD incredibly seriously. Maintaining good vision throughout life is of the utmost importance, especially as we grow older.

[Jim Shannon]

It might be helpful to give the Minister the report of the inquiry by the all-party parliamentary group on eye health and visual impairment. Perhaps she would agree to meet the officers of the all-party group, so that they can advance that case.

[Seema Kennedy]

I very much look forward to reading the report of the APPG that the hon. Gentleman chairs, and to sitting down with him in due course.

My Department remains committed to preventing sight loss and to ensuring that anyone and everyone living with AMD has access to the very best treatment and support.

Question put and agreed to.