Deaths in Mental Health Care

Jim Shannon Excerpts

Monday 30th November 2020 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I thank the Petitions Committee for granting this important debate and my hon. Friend the Member for Hartlepool (Mike Hill) for opening it, and I congratulate Melanie Leahy on the strength of her campaigning to get us to this debate.

As we have heard, Matthew’s case is a tragic one, with a catalogue of failures that culminated in his death. I know that nobody here can fail to be moved by what Matthew and his family went through—the hon. Member for South Suffolk (James Cartlidge), who has just spoken, certainly was. Melanie has been fighting for answers and justice for her son for eight years now; I pay tribute to the work she has done, but I also say it should not have been necessary.

Matthew was in the Linden Centre for only a few days. In that time, he reported a sexual assault to the police, but they took no follow-up action on his report. Staff claimed that he lacked mental capacity, despite no assessment being carried out. He was heavily medicated with anti-psychotics and tranquillisers, despite him telling staff that he would attempt to kill himself if he was given injections. As we have heard, only a week after being admitted, he was found hanging in his room and he died.

That catalogue of failures would be shocking in itself, but it ended with a young man dying. In cases such as Matthew’s, we have a duty to learn the lessons and ensure that others in mental health care do not end up dying preventable deaths.

[Jim Shannon (Strangford) (DUP)]

I sympathise greatly with the hon. Lady and the story that she is telling and that other hon. Members have told. Does she agree that when it comes to helping people who have mental and psychiatric issues, who need help more than anyone, it is important that facilities are modern? They need in-patient care and they need the staff to be trained and able to respond. If those things were improved, does she think that would be a step in the right direction to try to help people and prevent such tragedies from happening?

[Barbara Keeley]

There is much that needs to change, but the hon. Member is right that that is one aspect of it. The mental health estate is known for being run down and out of date.

The learning of lessons has not happened in the Linden Centre or in mental health services in Essex. The charity INQUEST has worked on more than 28 cases involving deaths in mental health settings in Essex since 2013, yet despite the many investigations, reports and inquests that have highlighted failures, preventable deaths have continued. At the Linden Centre, INQUEST is aware of six in-patients found hanging between 2004 and 2019. Despite repeated inspections and visits by the Care Quality Commission, people have continued to die in those services.

The ombudsman’s report found clear signs of a cover-up at the Linden Centre. As Melanie told me:

“Matthew had no key worker. Records of observation levels and when he had been observed were changed. His care plan was falsified after he died. His claims of rape were ignored. Lots of documents were missing and a whole catalogue of policy failings were uncovered.”

That speaks of a culture that is less interested in learning from failings than in avoiding the blame for Matthew’s death.

The only way to restore trust in our mental health services is to publicly demonstrate that all those issues, including the one that the hon. Member for Strangford (Jim Shannon) mentioned, are considered and addressed. Melanie Leahy has suggested that the only way to do that is through a full public inquiry. At the inquest into Matthew’s death, the coroner asked the NHS trust to consider commissioning an independent inquiry.

The ombudsman, in his recommendation, said that the review due to be held by NHS Improvement,

“should consider whether the broader evidence it sees suggests that a public inquiry is necessary.”

In an interview on ITV, the ombudsman went further on the failings, including about Matthew’s care plan being altered after he died and his claim of rape not being investigated. He described them as

“a catalogue of failings which are entirely unacceptable.”

He also said that he would fully support a public inquiry if one was recommended, and that he would like to have investigated further if he had had the powers.

Both public officials who have investigated Matthew’s death, the coroner and the ombudsman, have said that they would support a public inquiry. I ask the Minister, on behalf of Melanie Leahy, to set up a public inquiry. Only a public inquiry will have the transparency and broad participation needed to rebuild trust in the services. The Minister will know that that is the only way that witnesses can be compelled to give evidence without seeking to apportion blame, and evidence must be given on oath.

As Melanie has said,

“Since Matthew’s death I have been on a mission to get to the truth of what happened to Matthew and to get justice for him. On my journey I have not only found that many other families are in the same position as me, but also individuals who have the survived the quotes ‘care’ that they received.”

In this most tragic case, inadequate and neglectful care led to the death of a young man like Matthew. His mother has had to take on a fight over many years to get to the truth. I thank all the families and parents such as Melanie Leahy who have put so much of themselves into their campaign. I return to what she said to me:

“To say the current situation is not good enough is a massive understatement. We know what has to change and we have known for decades. What will make the Government take real action? How many times do we need to hear the same information and recommendations? How many more Matthews have to die?”

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank all those who set the scene and the Petitions Committee for what it did.

Our hearts go out to our constituents. Hon. Members have spoken on behalf of them, and I thank them for that. I admire the determination that each and every one of them has shown. A breakdown in care took place, and we must not see another family in that situation.

I want to take a slightly different approach to the issue of mental health and talk about how we can help within the system. Ultimately, that is what the Minister will set out in her response. I have seen too many of my constituents broken, in need of support and let down by the system. I remember one young man, Michael, who came to my office when he was on the edge. He was a young fellow and was homeless and distraught, and the girls in my office were able to reach out and tell him in a helpful, compassionate way, “Your life is important and we will help you.” He broke down in tears.

We were able to help that young fellow get accommodation through the Northern Ireland Housing Executive. We also got him some help from the local food bank, which is always there to help, and were able to sort out his benefits. What happened was that that young fellow had just disappeared off the grid. He clearly had mental health issues and was not able to cope. He got the psychological help that he needed and he got his benefits renewed, so the pressure on him became less of a difficulty because of those who helped—the Northern Ireland Housing Executive, the local benefits office, the food bank, the local churches. All those people came together.

It is my sincere belief—I believe this in my heart—that if Michael had not come to my office, he may not have survived. We all believe that, including the girls in the office and those we spoke to. Every Government body was exceptionally helpful, and we thank them for that.

That is the foundation for mental health. Ours is not to question how or why people have got to the stage that they find themselves it; we must only see how we can help them where they are. The overhaul of the facilities that I spoke about when I intervened on the hon. Member for Worsley and Eccles South (Barbara Keeley) is about updating them, so that the in-patient help gives people hope to reach out. We are desperate to see an upgrade of facilities that are sometimes not fit for purpose.

Sometimes there is no privacy. Sometimes people need a wee bit of privacy where they are, but they also need to be able to reach out and have someone help them at the times when they need that. Some of the wards that I am aware of are mixed-gender wards, where a lack of privacy is obviously even more of a problem. When it comes to people being allowed to visit, they get one hour each, once a week. I do not feel that that is enough; more time should be allocated for visitors.

I am always very aware of the great work that occupational therapists do. They have a brilliant team, with fantastic ideas. They have allocated some rooms for activities. I think that it is important to have some sort of organised activities, so that those who are under pressure psychologically, mentally and socially have somewhere where they can look outwards. The OTs in the area that I represent have come up with a therapy garden. These things can be done in-house and in a way that can really help. There are gardening classes. Again, it is a question of designating an area for people and ensuring that they have it.

To conclude, it is little wonder that patients and those who are in homes remain uninspired and unhopeful if that is how they view a place designed to provide the help and support that they are crying out for. It is clear that we must make massive changes, and if the first step to doing that is an inquiry, that is where we must begin. My heart goes out to all the families who grieve and feel let down. I believe that we can do better, but not only that—we should do better and must do better.

Independent Reconfiguration Panel

Jim Shannon Excerpts

Thursday 19th November 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I have lost count of the number of times that I have spoken in this House about the future of St Helier Hospital. Time and again, the hospital has been hurled head first into turbulence, with countless consultations coated in fancy branding repeatedly asking my constituents whether they want their hospital to keep its A&E, critical care and maternity services. The latest plan—almost laughably named “Improving Healthcare Together” proposes to downgrade both Epsom Hospital and St Helier Hospital, moving all acute services south to leafy, wealthy Belmont. The purpose of this debate is to look at whether the Independent Reconfiguration Panel was actually independent when it came to a decision not to look into these proposals.

The panel is a little known but hugely important body that provides checks and balances to the plans of one of the most powerful institutions in our country: the NHS. The NHS employs as many people as the red army, and some would argue that it is built around the same command and control principles—that is, decisions are made and everyone is expected to row in behind them. Communities are hugely affected by proposed NHS changes. As such, their representatives in local government have the power to consider whether they agree with a hospital reorganisation. If they do not, they can refer it to the Secretary of State, who has the power to refer it to an independent panel of experts.

In the case of the “Improving Healthcare Together” programme, my argument is not that the chair of the panel, Professor Sir Norman Williams, is not a man with a hugely important and successful medical career who has brought benefits to thousands, or that he has not made a huge contribution to the NHS. My argument is simply that he could not be regarded as independent, and that through his involvement as a member of the board of St George’s Hospital—which will be profoundly affected by these changes—he should have recused himself. We know that in public life not only do we have to do the right thing; we have to be seen to do the right thing. I will argue that Sir Norman could not be regarded as independent because his connection is far from “tangential”.

Let me turn first to the plans themselves. The programme proposes to turn St Helier Hospital into a glorified walk-in centre, removing its A&E, maternity services, children’s beds and critical care. Some 62% of beds would be lost from the area where health is poorest and life expectancy shortest. The programme’s own analysis unsurprisingly reveals the indisputable link between deprivation and the need for acute services, but ignores the fact that 42 of the 51 deprived areas in the catchment are nearest to St Helier. It is a slap in the face for expectant mums in my community.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that although moving beds to a nearby hospital may make sense on paper, to ask expectant mothers to add a lump of time to their journey makes no sense, and that community-led care is essential and should be kept in the community?

[Siobhain McDonagh]

I agree with the hon. Member.

In the plan, it is assumed that mothers in my area want home births. That is a discriminatory assumption that is completely against their right to choose. It takes maternity services away from the mothers who are most likely to deliver a low-weight baby and mothers who are less likely to want a home birth. It also breaks up the continuity of care, with pre and post-natal services being delivered at one hospital and the birth at another.

The programme ignores the intrinsic link between old age and life expectancy in pointing to the higher number of elderly people in Belmont when deciding where need is greatest. The sobering reality is that Mitcham has a far lower life expectancy than Belmont—nine years lower, in fact. There are more elderly residents in Belmont because, quite simply, its residents live longer. To experts, it is yet another example of the Tudor Hart law, or the inverse care law as it is also known: the understanding in health academia that the areas in greatest health receive the most health investment. Or as my mum, herself a nurse, would say, “Much gets more.”

The reality is that the Minister and his Department are being asked to commit £500 million of scarce NHS resources to move acute services to one of the richest and healthiest areas in London, at the expense of one of the most deprived. Surely the Minister can see that that is wrong, if not from a health perspective, then from a financial one. The plans require 22% more capital than the option of rebuilding where health needs are greatest. Improving St Helier would have a higher return on investment, posing far less risk with a significantly lower capital requirement. Our economy is being decimated by the virus. Can the Minister not see that this proposal goes completely against Treasury guidance and value for money?

This was a devastating decision before the pandemic, but have we learned nothing from coronavirus? How can it possibly make sense for south-west London to come out with fewer acute beds and fewer intensive care units than before? Surely the decision to place the only intensive care unit on the same site as a cancer hub now has to be questioned. I do not dispute the extraordinary work of the Royal Marsden or challenge whether it requires an intensive care unit, but these plans were formed long before the pandemic was known about and have to be reassessed in the light of it.

The programme’s own impact assessment in January warned that any unplanned event such as a pandemic could challenge the resilience of the proposed reconfiguration. It described this situation as “unlikely” and yet, astonishingly, just five pages of analysis have been produced on the pandemic’s impact on the plans. It is the wild west, where everything proceeds full steam ahead, no matter the evidence presented—evidence that cannot be dismissed.

We now know that people from black and ethnic groups are most likely to be diagnosed with coronavirus, more likely to require admission to an intensive care unit once in hospital, and up to twice as likely to die than those from white British backgrounds. We know that black women are five times more likely to die in childbirth than white women, and more likely to require neonatal or specialist care baby units. We also know that 64 of the 66 areas with the highest proportion of BAME residents are nearest to St Helier, and that half of those are in the bottom two quintiles of deprivation, increasing their likely reliance on acute services.

It is indisputable: these proposals would negatively and disproportionately impact BAME residents, deprived communities and expectant mums in my constituency. It is no wonder that when they were put out to public consultation, tens of thousands of residents voiced their disapproval, with overwhelming opposition to the downgrading of St Helier. It was also clear from the public response that if these plans went ahead, many residents would not travel to inaccessible Belmont, but would head instead to St George’s—a hospital that is already under immense pressure, with an A&E in the bottom quartile for safe standards.

Why does Sir Norman have a conflict of interest? Because this is a reorganisation of a neighbouring trust that will have a profound impact on St George’s. That is a case that the board of St George’s has rightly and successfully fought, very publicly, so much so that in a letter in March this year, the chief executive of St George’s made it clear that support for the plans was contingent on her hospital receiving capital investment for a new emergency floor to take account of the increased number of emergency care patients that it would receive. That is the kind of change that requires the full consideration, scrutiny and involvement of the board and the most senior staff. I can think of a number of words to describe that relationship: conditional, connected and dependent, but certainly not “tangential”.

In July this year, Merton Council saw these plans for what they are and used its power to call them in for review by the Department of Health and Social Care Independent Reconfiguration Panel. By its name and nature, it is an independent panel of health experts who can cast a fresh, impartial eye for the Secretary of State. The chair of the panel is Professor Sir Norman Williams, who until 30 September 2019 was a long-standing board member at St George’s Hospital. Naturally, I presumed that that conflict of interest would be recognised and he would step aside from judging this proposal. Unfortunately, he did not, with his connection to the plans described as “tangential” and

“not relevant to his role in independently formulating a response”.

This evening, I ask the Minister to consider just how tangential that connection is. In April 2016, Sir Norman became a board member at St George’s, and board meeting minutes and papers reveal that the reorganisation was debated time and time again. The papers from one of his first board meetings in June highlighted the requirement for service change and reconfiguration in south-west London. In March 2017, the chair discussed the upcoming board-to-board meeting with Epsom and St Helier, which would provide an opportunity to discuss the development of joint renal services. Fast forward to October, and the board’s attention was on a joint letter signed by the CEO of St George’s about the importance of considering the future of their hospitals with any reconfiguration at St Helier.

The issue came to the board again in December, following Epsom and St Helier’s indication that it needed to change its clinical model. By the following November, the impact of the proposals on St George’s was so clear that the chair of the board, Gillian Norton, wrote to the programme directly on behalf of her board, including Sir Norman:

“Senior staff within St George’s have spent significant amounts of time over the last 3 months engaging with both the programme team and colleagues in other providers to work through the impact on providers of the shortlisted options…The board agreed that I need to write to you now, formally, to set out these concerns…I understand that a key principle of how programme process has been agreed is that there is no formal requirement to take account of the impact on other providers. I find this difficult to understand in any event given we are a health system but particularly so in the context of the SWL Health and Care Partnership and the expectation that we will work collaboratively.”

I found this letter so extraordinary, after fighting this reorganisation for 23 years, that I wrote back to the board and the chair. Naturally, this issue rightly remained high on the board’s agenda. The papers for the board meeting of December 2018 show concerns from St George’s finance and investment committee about the lack of options explored by Epsom and St Helier, and agreement that the trust should feed this back to the programme. By January 2019, the chief executive spelled out to Sir Norman and the board:

“Any changes to the current configuration of services at Epsom and St Helier are likely to impact St George’s, and it is important these are factored into any future proposals.”

She again used her notes at the February board meeting to state:

“While the location of the new facility is yet to be decided, it’s clear that there are significant estate issues at both Trusts that need to be addressed through capital investment.”

Time and again, the programme was brought to Sir Norman and the board’s attention—in April, in May and in June. This would be a landmark decision for St George’s Hospital. It is completely understandable that it had their full attention.

In July 2019, the programme released the impact assessment on St George’s. It is utterly inconceivable that someone as diligent and respected as Sir Norman would not have been aware of this, particularly as senior staff at his trust had helped produce it—a document released just months before he became chair of the Independent Reconfiguration Panel. That Sir Norman was so heavily involved in these proposals is no criticism. He was rightly fulfilling his responsibility as board member of a hospital that would be heavily impacted by these proposals. He declared his role to the other Independent Reconfiguration Panel members, explaining that he had even had recent discussions with senior consultants at Epsom and St Helier through his role as chair of the national clinical improvement programme. All public office holders are subject to the seven principles of public life, one of which is objectivity. But how could Sir Norman be objective? How could he even appear to be so? In public life, it is important not only to be objective, but to be seen to be objective.

My community has fought tirelessly for St Helier, and the least we expect is transparency, honesty and objectivity from the top. Astonishingly, the panel instead considered that there was nothing more than tangential connections, irrelevant to Sir Norman’s role in independently formulating a response for the Secretary of State. Tangential! If there is any doubt over how interconnected the hospitals are, then be aware that the chair of St George’s also became chair of Epsom and St Helier in 2019. Conveniently, it was on the very same day that Sir Norman became chair of the Independent Reconfiguration Panel. Surely the Minister can see that there is nothing tangential in the evidence that I have laid out today. Not only did Sir Norman already know about the proposals before he was asked independently to judge them, he must have known them inside out, having faced them repeatedly at board level and in conjunction with a whole host of the key personnel involved. It was tangential to the tune of millions of pounds of investment on which his former hospital’s support is contingent.

We must not underestimate the importance of a fresh eye. One of the leaders of these plans, Daniel Elkeles, formerly led the infamous “Shaping a Healthier Future” plan, which proposed similar hospital downgrades in north-west London, wasting £76 million over eight years before the Treasury finally put a stop to it.

I draw to a close now. I must say that I respect the Minister. He found time to meet me in the summer when his time must have been so scarce. I explained my reasoning for calling this debate to his office last week so that he could come prepared. I am not trying to catch him off guard. I am asking that he steps away from party politics and recognises that this connection is indisputable rather than tangential. If an independent panel was asked to review the plans, the panel must be independent. I am asking that he consults his Treasury colleagues on why the most expensive option is being chosen at a time of such economic turmoil. I am asking that he reflects on the powerful shoes he is in and the unique opportunity he has to help to close health inequalities in an area where they are so stark. Surely that would make any Health Minister proud of his work, and maybe then we really could improve health together.

DHSC Answers to Written Questions

Jim Shannon Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

My hon. Friend highlights that the workload from constituents has increased for all Members. I recognise that. It is important that we do our bit in trying to answer questions in as timely a fashion as possible, to assist colleagues in the House with responses to constituents. In response to his second point, he is absolutely right. As I alluded to, it is not only through attending the House and through its mechanisms that Ministers have been accountable; as a Department, we have sought to use multiple channels—briefings to colleagues, WhatsApp and a whole range of newsletters and other mechanisms—to get messages out and to communicate with colleagues and answer their questions.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his departmental response to covid-19 and many issues. As one of the Department’s most prolific questioners, I am aware of the pressure on the Minister’s Department to respond to a vast array of complex medical and social issues. Perhaps to assist the Minister, his team could work closely with the health trusts to provide up-to-date data in a timely manner.

[Edward Argar]

The hon. Gentleman is indeed a prolific questioner, but his questions are always welcome and to the point. He highlights an important aspect that affects the response of the Department, which is that a significant number of questions, and the information required to answer them, is not held within the Department but by various health trusts, NHS England or other external bodies, which can occasionally introduce additional slight delays in the system. We are working closely with them to minimise that and get answers as quickly as we can to hon. Members.

Dementia: Covid-19

Jim Shannon Excerpts

Thursday 12th November 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Sir Graham. I am very pleased to have sponsored this debate alongside the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). Everyone here has a purpose and something to say about this issue.

We know from the Northern Ireland Statistics and Research Agency that of the 475 deaths in March and April—just two months—in Northern Ireland, a third were attributed to dementia on the death certificate. The impact on those who have dementia is clearly greater than elsewhere. In addition to thousands of tragic deaths in care homes, the effects of social isolation are a big issue: 70% of care home residents have some form of dementia, and the prevention of visits to care homes is having a hugely detrimental impact on their lives.

Contact with family and friends is vital to the wellbeing of people with dementia. Some 82% of participants in an Alzheimer’s Society survey reported a deterioration in the symptoms of people with dementia. People with dementia deserve better. The contribution of loved ones to their care and wellbeing should be acknowledged by the Government and reflected in the guidance to care homes on safe visiting.

I will mention one family, whose story is very real. They wrote to me:

“Our mum sadly passed away in September. We were not with her when she died. We had not been inside her home for over six months. In all that time, we saw her through a window. She didn’t understand why we were stood outside and kept telling us to come in. We were unable to hold her hand and unable to kiss goodbye.”

I understand that advice given to the Government by the Scientific Advisory Group for Emergencies in September stated that the transmission risk from visitors was low. That SAGE advice, which says that people could visit homes and there was less chance of infection from visitors, must be implemented and released by the Government. Why not give the family and the person in the home a wee bit of compassion in their time of need? The Government do not allow for loved ones to provide the personal care that the residents so desperately need.

I urge the Minister to implement the Alzheimer’s Society’s recommendations for ensuring that care homes are safe and adequate for the needs of people with dementia. The Alzheimer’s Society study on this put forward recommendations. We should follow its knowledge and the science. There have been some innovations, for example the initiative led by HammondCare. During its pilot service, funded by Innovate UK, HammondCare recorded highly positive outcomes for people living with dementia and care teams, such as reducing certain behaviours and carer stress, building capacity in the sector and reducing the use of statutory services. Plans are being explored to offer a subscription service across the UK to support care teams. The Minister may wish to explore that. The innovation in that pilot scheme has shown a way of doing this.

I ask the Minister to outline the scope of the key worker pilot in England. How will it be rolled out, and when and how will it be evaluated? Given the updated implementation of the care partner model that we have in Northern Ireland—it is always good to learn from each other—will the Minister ensure that the emotional and physical care needs of people with dementia living in care homes will be met, and confirm that it will not be another eight months before people with dementia and their loved ones are reunited?

Dementia is a subject close to my heart. I hope the Minister will listen to the experts and the families, and do all she can better to connect people affected by dementia.

[Sir Graham Brady (in the Chair)]

Before we move on to the wind-ups, I remind hon. Members that the debate will end at 4.33 pm and we hope to give the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) a couple of minutes at the end to wind up.

Smokefree England: Covid-19 and PHE Abolition

Jim Shannon Excerpts

Thursday 12th November 2020 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

For the second time today, it is a pleasure to follow the hon. Member for Winchester (Steve Brine), given the knowledge he has of all the subjects we have covered in this debate and the last one. I thank him for his contribution when he was Minister, too. It is always good to see him in his place.

I congratulate the hon. Member for City of Durham (Mary Kelly Foy) on what I think may be the first debate she has led in the Chamber. If it is, I say to her, “Well done and congratulations.” We look forward to many more contributions from her in this place. I was glad to add my name to the request to the Backbench Business Committee for this debate, and to work alongside the hon. Lady to highlight some of these issues.

I believe that freeing smokers from the tyranny caused by their addiction, and the damage it causes to their health and wellbeing, is an issue not just of health but of human rights. I am my party’s spokesperson for health and human rights, and this debate covers both those issues.

This issue is close to my heart, as I know it is for speakers on both sides of the House. Public health policies, which are the responsibility of the devolved nations, have a key role to play in tackling smoking, but so do the Government in Westminster and this debate. I am pleased to see the Minister in his place. He and I have been good friends for a long time, and I look forward to his response because I know it will be positive.

I want to refer quickly, if I may, to the Northern Ireland Department of Health tobacco control strategy, which was implemented in 2012. It was clear that the Northern Ireland Assembly was trying to direct its action at children and young people, disadvantaged people, and pregnant women and their partners who smoked. A review of that strategy undertaken earlier this year found that Northern Ireland has met its target of ensuring that a minimum of 5% of the smoking population accesses smoking cessation services annually, but there is still a group of people who continue to smoke. I am conscious that people have freedom of choice, but we hope that they take note when we present them with the health issues.

That target was achieved, but we are not hitting our targets at population level. There was a target to reduce the smoking rate among manual groups from 31% to 20% by 2020. That rate still lingers around 27%, so that target has not been met. There was also a target to reduce smoking during pregnancy from 15% in 2010 to 9% by 2020. To date, however, that rate has barely declined, so we have hit problems in Northern Ireland. At the time of speaking, the rate is 14%, so we have reduced it by only one percentage point. Let us be very clear: smoking when pregnant puts babies at risk of avoidable harm, including stillbirth, premature birth and birth defects.

We seem to have done better on the target for 11 to 16-year-olds. I am really quite encouraged by that. There has been a reduction from 8% in 2010 to 4%. The target was 3%, so we are one percentage point shy of it, but what we have done there has been quite dramatic. Children who live with smokers are almost three times more likely to take up smoking than children from non-smoking households, which creates a generational cycle of inequality, with smoking locked into disadvantaged communities.

Will the Minister make contact—he probably has—with the Northern Ireland Assembly, and particularly the Health Minister, Robin Swann, to see what has happened there? I feel that we can feed off each other regionally in Administrations, to our advantage. If something is being done right in England, we want to know about it in Northern Ireland, and the same applies in Scotland and Wales.

The disadvantaged communities worst affected by smoking have also been hit hardest by the coronavirus pandemic. Smoking is a leading risk factor for all sorts of things, such as cardiovascular disease and chronic obstructive pulmonary disease, which have been identified by Public Health England as being associated with worse outcomes from coronavirus. When households stop spending money on tobacco, it can lift them out of poverty, and it increases the disposable income available to spend in local communities rather than lining the pockets of the transnational tobacco firms.

Those inequalities are a problem not just for Northern Ireland but in every part of the United Kingdom. The answer is more action at population level through Government interventions that support people, particularly in disadvantaged communities. I believe that the time is right for the Department of Health and Social Care to publish a new tobacco control plan that addresses UK-wide issues as well as those relating just to England—I believe that we should be doing this across the four regions—and provides solutions to the threats posed by Brexit as well as delivering on the opportunities.

Smoking on screen is an issue close to my heart; we have to find some way of addressing it. Smoking is rarely portrayed in an unattractive manner, or associated with negative consequences. Guidelines on smoking have been established by the communications regulator, Ofcom, but they are often not rigorously applied. The UK Government and Ofcom have committed to working with the British Board of Film Classification to ensure a consistent approach across the piece. On the tobacco control plan, I said in 2018:

“A clear causal link has been established between smoking initiation among young people and smoking on screen in the entertainment media. The impact is down to the amount of smoking that young people see, not whether it is glamorised or not.”

Young people may feel, sometimes unconsciously, that smoking is normal, and that we should all be doing it. However, its depiction is linked to greater risk of smoking uptake. In that earlier debate, I asked:

“Will the Minister ask his colleagues who are responsible for the regulation of film and TV in the Department for Digital, Culture, Media and Sport to work with the Department of Health and Social Care, and press Ofcom and the British Board of Film Classification to ensure that their codes effectively tackle the portrayal of smoking in films and television programmes that are likely to be seen by children?”—[Official Report, 19 July 2018; Vol. 645, c. 685.]

At the time, the Minister briefed that Ofcom and the BBFC were dealing with the issue; quite clearly, Minister, that has not happened to the extent that we would like.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Gentleman promised me that he would no longer address the Minister, but would take to addressing the Chair, in the way one is supposed to in this place. He speaks in this Chamber more than any other Member, and he knows that he must not address the Minister. I cannot understand why he persists in doing it.

[Jim Shannon]

Thank you, Madam Deputy Speaker. I will certainly endeavour to get that right.

In 2018, there was an explosion of new video on demand services, such as Netflix and Amazon Prime, which are particularly popular among young people. Ofcom’s on demand programme service rules, governing video on demand services such as Netflix, have no rules at all on smoking. The use of video on demand continues to grow, so this problem will only get worse. Is the Minister prepared to look at that issue and address it?

The licensing of tobacco retailers is another issue that I spoke about in 2018 that bears raising again. In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the tobacco register of Northern Ireland; the deadline for doing so was 1 July 2016. It built on similar schemes in Scotland and Wales. In 2018, we implemented a track-and-trace scheme that required every retailer to have an economic operator identifier code. That system was required by the EU tobacco products directive, but the Government have confirmed that it will continue after we leave the EU. Can the Minister confirm that all nations in the UK will continue to implement a retail register scheme? Will he ensure that officials at Her Majesty’s Revenue and Customs talk to their opposite numbers in Northern Ireland, Scotland and Wales about their experience of the retail register scheme, and the lessons to be learned about it from the devolved Administrations?

Are the tobacco control regulations on e-cigarettes delivering on the twin goals of helping smokers to quit and protecting children from taking up smoking—objectives supported by all parties and all nations of the United Kingdom of Great Britain and Northern Ireland?

There is a concerning loophole in our regulations: while it is illegal for e-cigarettes to be sold to children under 18, according to advice from trading standards, it is not illegal to give them out as free samples to anyone of any age. Could the Minister give us direction on that? How can we ensure that things are done correctly? I hope the Minister is aware of the article in The Observer in October that highlighted that a supplier working on behalf of British American Tobacco was caught handing out samples from BAT’s popular e-cigarette brand to a 17-year-old without carrying out any kind of age check. That contravenes the spirit, if not the letter, of the regulations. Given the importance of balancing the needs of smokers against any impact on young people, it is vital that a review of these regulations is undertaken. Will the Minister set a timeline for just that?

Breast Cancer Diagnosis and Services: Covid-19

Jim Shannon Excerpts

Thursday 12th November 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I welcome you to your new role in Westminster Hall, Ms McVey. It is a pleasure to follow the hon. Member for Winchester (Steve Brine). He and I have sparred many times—never sparred; we have worked together, which is a better way of putting it—in many debates in Westminster Hall and the Chamber. I very much value those times, and I thank him. It is also nice to see the Minister and shadow Ministers in their places.

Every person in this place, including myself, is probably intimately acquainted with someone who has suffered from breast cancer. The statistics stick in your mind. I will focus on my own area; I know it is not the Minister’s responsibility, but I will give a few stats from Northern Ireland and my own constituency.

Some 129.4 people per 10,000 develop breast cancer in Strangford, compared with 165.2 right across Northern Ireland—a significantly better incidence rate in Strangford. But when we compare the stats with England, we are worse off. The incidence rates for Northern Ireland and Strangford are 62 per year, and 38 people per 10,000 die from breast cancer in Strangford, compared with a rate of 36.1 across England. We in Northern Ireland, and in my constituency in particular, have some rates that are very scary. People are also dying from secondary breast cancer. Northern Ireland has the highest mortality rate from breast cancer in the UK, compared with 33.97 in England, 34.2 in Scotland and 33.9 in Wales.

A freedom of information request by Breast Cancer Now found that 40% of hospital trusts and health boards across the UK were unable to tell how many secondary breast cancer patients were under their care, including my local South Eastern Health and Social Care Trust.

As the hon. Member for North Warwickshire (Craig Tracey) did, I want to focus on secondary breast cancer. I congratulate him on bringing the issue forward for debate. He set the scene well. Clinical trials provide a vital opportunity for patients to access potential new treatments at an early stage of their development. That is particularly important for women with secondary breast cancer, who often have limited treatment options available to them and for whom clinical trials provide precious hope to have more time with loved ones. Recruitment to the many clinical trials was paused during the pandemic. While there was relatively little disruption for breast cancer patients already on clinical trials, the pause in recruitment to many trials will have made it difficult for other patients to access them.

In March, the National Institute of Health Research suggested that many NIHR-funded or supported studies might have to be paused as healthcare professionals were asked to prioritise frontline care and make research facilities available if asked to do so by their employer. Of 92 breast cancer trials that the NIHR clinical research network was supporting in March 2020, 50% were paused for recruitment, 45% continue and 5% were closed.

Research clinical trials are so important. Of the 118 respondents to the Breast Cancer Now survey who were receiving or expecting to receive treatment as part of a clinical trial during this time, just under a quarter said they had experienced disruption. The pause in recruitment will have made it more difficult to access trials, and 59% of all respondents were concerned about it.

I know that the Minister always answers with knowledge and understanding. I ask her what lessons can be learned from the speed with which trials for coronavirus have been set up. How can we apply that to setting up clinical trials for other health conditions such as secondary breast cancer? Perhaps coronavirus gives us an opportunity to look at trials—breast cancer trials in particular—in a different way. What good can we take from all of this?

Members of the Association for Medical Research Charities account for 66% of research on cancer. Shop closures and the suspension of many fundraising activities because of covid-19 have had an immediate and severe effect on those charities’ incomes, and their investment in research will drop by £310 million. Breast Cancer Now will see a 34% drop in its income as a result of the pandemic. I support the AMRC’s call for a life sciences charity partnership fund to mitigate the impact of the pandemic and ensure the continuity of charity-funded research.

I welcome the Government’s commitment to the £750 million charity support package, but the medical research charities have not had any help. I thank the hon. Member for North Warwickshire for leading the debate and all those who contributed. I spoke at about 100 mph there.

Exiting the European Union (Agriculture)

Jim Shannon Excerpts

Tuesday 10th November 2020 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his explanation of where we are. Food and feed safety is vital to Northern Ireland’s important agri-sector, and for my constituency in particular the transition in leaving the EU has to enable Northern Ireland to continue to trade without obstruction. He has confirmed that the full consultation has taken place with the Northern Ireland Executive, and I thank him for that confirmation that ministerial contact in Northern Ireland and here at Westminster has been constructive.

I have one question that I wish to ask the Minister. It relates to a technical point, but I just want this on the record, if he does not mind. I understand the technical aspect of this measure and the need to react and secure, but I must express concern that it highlights Northern Ireland as being outside the UK by using the prefix “United Kingdom (Northern Ireland)”. I need to stress that Northern Ireland lies firmly within the United Kingdom of Great Britain and Northern Ireland, and that cannot be forgotten. Perhaps the Minister could confirm that.

[Edward Argar]

I am grateful to hon. Members for a typically informed and focused debate. It is a pleasure, as always, appearing opposite the hon. Member for Ellesmere Port and Neston (Justin Madders), a different shadow Minister from my normal double act in recent weeks. He raised a number of technical points about the consultation and other aspects. I will endeavour to answer them briefly, but where I do not do so I will, of course, write to him.

I am confident that the consultation undertaken in August and September was sufficient. The hon. Gentleman highlights the smaller number of responses it received. I suggest that is due to the significant consultation undertaken two years before and the fact that in this context little in our approach has changed. Many will therefore have felt that they had had their say back then and that was reflected in the approach taken. He mentioned local councils’ capacity to deal with these regulations. Like many Members of this House, I was a councillor in a past life and I pay tribute to the work that our councils and local authorities do up and down this country. I am confident that they will be able to implement these regulations effectively. On the FSA and FSS, I am also confident that they are ready and prepared for what is coming in these regulations, which are relatively minor and technical in what they are seeking to update. I will of course go through the transcript in Hansard and write to him on anything I have missed out.

On the point made by the hon. Member for Strangford (Jim Shannon), I can reassure him that, while the wording of this statutory instrument reflects the technical legal wording to reflect the Northern Ireland protocol and the withdrawal agreement and the measures in that to help protect and secure the safety of the peace process, I am happy to be very clear with him on the record in this Chamber that, of course, Northern Ireland remains a hugely important and integral part of our United Kingdom and one that I hope to be able to visit when travel is a bit more normal. I may even visit his constituency of Strangford.

[Jim Shannon]

I would welcome the Minister to my constituency. One of his former members of staff came from my constituency as well. It will be a double opportunity for him to visit the town of Comber and also my constituency. I would welcome seeing him there.

[Edward Argar]

I will take that as a clear invitation. Sam Beggs who was a fantastic member of staff to both the hon. Gentleman and I always sang the praises of Strangford. I need no more than the hon. Gentleman’s kind invitation to take him up on it when travel is more normal.

Question put and agreed to.

Covid-19 Vaccine

Jim Shannon Excerpts

Tuesday 10th November 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for North Herefordshire (Bill Wiggin) on setting the scene so well. I am very supportive of his comments and recognise the need to get a covid vaccine in place.

The Health Secretary announced on TV this morning that, as was rumoured last night, a vaccine has been found, but at the same time he was cautious in his assessment, stating that we should welcome what is happening but remain ever mindful of the need for medical trials, which the hon. Gentleman also referred to. We watched that unfold and then later in the day we had an opportunity in the main Chamber to ask the Health Secretary questions—I think 60 right hon. and hon. Members did just that.

I welcome the fact that there might be 10 million doses of the vaccine available by the end of this year. I am particularly happy because it is a bit of good news at long last. I am always a “glass half full” person, but in the last six months it has been very difficult to try to be positive about where we are going, because the uncertainty was unreal. So today we have some good news. I know that we are not there yet, but we are moving in the right direction.

I am very pleased that Pfizer has achieved this breakthrough. However, I have some concerns at this stage that the vaccine will only be for adults—I will comment on children in a few minutes. The fact that AstraZeneca is also involved, as are many other companies around the world, shows the need to work together. I think that the Health Secretary said, in reply to one of the questions put to him today, that we need to work on an international basis, and he is right. The hon. Member for North Herefordshire also referred to that. It is really important that we realise that we are all in this together, the world over, so it is important that we get ourselves organised.

I am a diabetic—a type 2 diabetic. It is one of those chronic diseases that means I have to get the flu vaccine every year. I was fortunate enough to get the flu vaccine way back in September, I think, when I had occasion to be in the doctor’s surgery. I am not there very often, but I was down getting a check-up and they said, “Take your flu vaccine now.” I am glad that I did, because the fact of the matter is that they have run short of flu vaccines in my constituency, and in many other parts of the United Kingdom.

My question to the Health Secretary this afternoon was about the shortage of flu vaccines, and the importance of ensuring that the covid-19 vaccine, once trials are completed, is available to those who need it, so that we do not find ourselves in the same situation as many of my constituents—of a certain age, vulnerable, and who have come to me for assistance because they cannot get the vaccine. We also want to ensure that the flu vaccine that many are waiting for is available.

School teachers and care professionals—nurses, doctors and frontline workers—must be considered priorities for the vaccine once we know it is safe. If the vaccine is offered, I intend to take it, but some of my constituents have contacted me to say that they do not wish to do so. The Minister has previously said that there will be no compulsion, but my health is not just about me: it is about you, Mr Dowd, about the shadow Minister, about hon. Members and about every one of my constituents. My duty is to everyone else.

I am conscious of the time and I will not take much longer, but I want to make a plea for something that will be possible only with the support of the pharmaceutical companies and those who understand the science. I, like you, Mr Dowd, and other Members, regularly see children at my constituency surgeries with chronic asthma and other respiratory complaints. Their parents send them to school daily in fear. The young girl who drafts my speeches and does my research has a four-year-old with chronic asthma. She had to self-isolate at home from March until the beginning of August. Members might ask whether that is possible, but it is what the doctor told her to do with her child. I hope that the trials will come up with a covid-19 vaccine that children can access to.

I support the Education Minister and my own Education Minister back home in saying that children need to be at school, but they need to be safe at school. Only yesterday my grandchild was sent home because some of the pupils and teachers in the form above her showed covid-19 symptoms. They are all self-isolating for two weeks, but the fact is that we just do not know where we are with the virus. Ever mindful of the shortage with the flu vaccine, I hope we will ensure that the covid vaccine is available.

In this morning’s debate, which was also attended by the Minister, there was mention of the black, Asian and minority ethnic community and people with obesity, who are more liable, according to the stats, to have a covid-19 diagnosis. Again, when it comes to prioritising, I hope that we may include that issue.

I want to make a plea for ethnic groups across the world, as I did in the Chamber last Thursday in a debate about vaccines across the world opened by the hon. Member for North East Fife (Wendy Chamberlain). I have a personal interest in religious minorities and different ethnic groups, and I want them to have the opportunity to have the vaccine. The hon. Member for North Herefordshire mentioned that issue, and he was right. When it comes to handing out vaccines or covid-19 help and assistance, the people at the end of the queue every time are the Christians and small minority groups in countries across the world. The Health Secretary also mentioned that in passing today in the Chamber—I am referring to him quite often, and that is because I am taking note of the points that he made in the Chamber. I want to make sure that the vaccine is available not only for us, here, but for every person in the world. That comes back to the point about needing to deal with the matter internationally, and I hope that that is where we will be going.

[John Howell (Henley) (Con)]

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

Yesterday the news was announced that Pfizer had a potential vaccine that was quite advanced. I do not know how it affected other hon. Members in the Chamber, but my heart skipped a beat. It was brilliant news, and it is not surprising that the attitude in the rest of the country has been exactly the same. It is also not surprising that the stock exchange has effectively gone wild in some areas. People are utterly depressed by the lockdown they are living in, and the news gave them hope that there is a real light at the end of the tunnel, towards which they could drive. Unlike the lights in most tunnels, it is not an oncoming train, but a real opportunity to get out of the situation we are in.

However, it was quite right of the Prime Minister to pull back a bit on that in his broadcast last night. A number of things need to be looked at and studied before we can really rejoice in what Pfizer has done. Most scientists, for example, anticipate that a vaccine will not be 100% effective. As my hon. Friend the Member for North Herefordshire (Bill Wiggin) said, it is only—I use the term lightly—90% effective. However, no vaccine will be 100% effective. We need to ensure that any approved vaccines are as effective as possible, so that they can have the greatest impact on the pandemic.

We have also heard that there is a robust pipeline of potential vaccines in development and that some have already advanced to phase 3. However, we cannot be certain when a vaccine will become available. That is why we cannot rely on a future vaccine to fight the pandemic. We must use all the tools we already have at our disposal, such as testing, contact tracing, physical distancing and masks. I also recommend co-trimoxazole, a drug that is being trialled in Bangladesh and India and that has also been trialled to a certain extent in the UK, which stops the inflammation of the lungs that comes with this terrible virus.

It is too early to know whether covid-19 vaccines will provide long-term protection. Additional research is needed to answer that question. However, the thing that encourages me from the data on people who recover from covid-19—I believe my hon. Friend has recovered from it—is that they develop an immune response that provides at least some protection against reinfection, although we do not know how strong that protection is and how long it lasts. However, that data gives me encouragement that a vaccine can duplicate and pick up on that—if it was not there, I would be very worried that a vaccine was not going to work.

A number of people have mentioned the need to do things on an international basis, and that is a great concern of mine. I happened to meet and have discussions with Dr David Nabarro, who is the special envoy on covid for the World Health Organisation. The Council of Europe—this is one of the great things that comes out of the Council of Europe made a discussion available to members of the social affairs committee. We had a virtual session with Dr Nabarro, who is an engaging, absolutely brilliant man who answers questions forthrightly—he will never make a good politician, but what I got out of the session was absolutely brilliant. To think that, in 2017, we put him forward to be the director general of the World Health Organisation, a proposal that was lost in the politics of the WHO. What a shame. What a difference that man would have made to the World Health Organisation.

The World Health Organisation has a number of programmes. It has a value framework for the allocation and prioritisation of covid-19 vaccinations. It has a road map for prioritising population groups for vaccines foe covid-19. The fair allocation framework aims to ensure that successful vaccines and treatments are shared equitably across all countries. The framework advises that once a covid-19 vaccine is shown to be safe and effective and is authorised for use—there is an argument, which I fully accept, that we could do more to make sure that different regulatory authorities are brought into line on this—all countries should receive doses in proportion to their population size to immunise the highest priority groups. That is just the first phase, after which the vaccine will roll out. If the World Health Organisation can continue in its role—I hope the United States backs off from deserting it and allows it to continue—it will be one of the things that helps to get the vaccine to all countries.

[Jim Shannon]

I am sorry for intervening, but I am concerned that those who are in good health but who happen to have a fairly deep pocket financially may think they can access this vaccine. It is really important that the people who access the vaccine for covid-19 are those who need it right now and who perhaps do not have the finance to buy it, as others might. Does the hon. Gentleman agree?

[John Howell]

The hon. Gentleman makes a good point. The World Health Organisation’s group of experts has already provided recommendations to countries about which populations should be prioritised. They include frontline health and care workers at high risk of infection, older adults and those at high risk throughout the population—people who are suffering from conditions such as heart disease and diabetes. As the second phase rolls forward and more doses are produced, the vaccine should go to groups at less risk of being infected or suffering badly.

I will finish there. This is an exciting opportunity, which we should not let go of. We should keep on top of this. Let us all hope that maybe in a few months’ time we can all be here celebrating the distribution of at least one—and perhaps more than one—vaccine that will help us out of this situation.

Obesity: Covid-19

Jim Shannon Excerpts

Tuesday 10th November 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered obesity and the covid-19 outbreak.

This issue has come to my attention so many times over the past few months—I am highly aware of it. I applied for this debate in March, but because of the covid-19 restrictions I was able only to introduce a petition. I am glad to have reached this pinnacle of opportunity to speak on the matter.

I thank colleagues who supported my application for the debate and the Backbench Business Committee, which kindly found time for us to discuss this important issue. I also thank Members for attending the debate and for emailing me to register their interest in speaking in it. I look forward to hearing from the shadow spokespersons of the SNP and Labour party, and especially from our Minister, who is always courteous to everyone, with the answers we hope to hear from her on this topic of great importance.

For the first time in many a month this nation can smile, following the news this morning that it is hoped a vaccine will be available. I do not want to pre-empt the final trials, but for once the nation smiles with hope that better days lie ahead, which must good news for us all.

Obesity is one of the country’s greatest health challenges. The UK has, unfortunately, the highest obesity rates in western Europe, and they are rising faster than those of any other developed nation. We cannot ignore that, which is why we are debating it today and why the Minister is here to respond. We are a majority-overweight nation, with more than six in 10 UK adults being overweight or living with obesity. That has a significant effect on the nation’s health, on the NHS and on the quality of life of each and every one of us living with the condition.

Obesity increases the risk of developing conditions such as type 2 diabetes, and I declare an interest as a type 2 diabetic. I was once a 17 stone, overweight person.

[Andrew Selous (South West Bedfordshire) (Con)]

Unbelievable.

[Jim Shannon]

I was having Chinese takeaway five nights a week with two bottles of Coke. It was not the way to live life, but I had a very sweet tooth.

Until about a year before I realised I was a diabetic I did not know the symptoms. My vision was a wee bit blurred and I was drinking lots of liquids—two signs that should tell you right away that something is not right. I took a drastic decision to reduce weight and lost some 4 stone, which I have managed to keep off.

We need to look at our diet and our lifestyle. We all live under stress, and we all need a bit of stress because it keeps us sharp, but there is a point where we draw the line. I recall the day I went to the doctor and he told me, “We are going to put you on a wee blood pressure tablet.” I said: “If that is what you think, doctor, I will do what you say.” He added: “When you start it, you have to keep at it. You cannot take a blood pressure tablet today and then not take it next week, because your system will go askew.”

Obesity leads to high blood pressure and some types of cancer and is strongly associated with mental health and wellbeing, which is so important in the current crisis. There are strong links between the prevalence of obesity and social and economic deprivation. People living with obesity face extraordinary levels of stigma and abuse. We need to be careful and to be cognisant of other people’s circumstances, because they might have a genetic imbalance, which I will speak about later.

The outbreak of covid-19 makes the obesity epidemic more urgent. It is deeply concerning that obesity is a risk factor for hospitalisation, admission to intensive care and death from covid-19. The facts are real. People with a body mass index of 35 to 40 are 40% more likely to die from covid-19 than those of a healthy weight. In people with a BMI of 40-plus, it rises to 90%. That places the UK population in a very vulnerable position.

In the latest report from the Intensive Care National Audit and Research Centre, which audits intensive care units in England, Wales and Northern Ireland, almost half—47%—of patients in critical care with covid-19 since 1 September had a BMI of 30 or more. In other words, they were classified as obese. Those figures show that almost half the people in critical care had a lifestyle that they needed to address. That figure compares with the 29% of the adult population in England who have a BMI of 30 or more. People with obesity are much more likely to be admitted to critical care with coronavirus.

We also know that covid-19 has a greater impact among black, Asian and minority ethnic communities. Currently, 74% of black adults are either overweight or living with obesity. That is the highest percentage of all ethnic groups. That is a fact—an observation—not a statement against any group, but we have to look to where the problems are and see how we can reach out to help, because we need to reach those groups.

It is encouraging to see the Government setting out the steps that they will take to support people to live healthier lives and reduce obesity. Those steps will make a positive contribution to the environment we live in and will encourage people to make healthier choices, helping to prevent obesity. I will also speak about other groups, because it is sometimes those in a certain financial group who do not have the ability to buy the correct foods and are driven by the moneys that they have available.

The Government now have to implement their proposals and fund them adequately. Then they need to measure their success and to review what more can be done. Three childhood obesity strategies have been published since 2016, and the proposals have not yet been fully implemented. One reason we are here today is to see how those proposals can be implemented, and we need a timescale. I know we are on the cusp of finding a vaccine, but we also need to address the issue of obesity in the nation as a whole. Perhaps covid-19 is an opportunity to address it. We cannot afford a delay. It has to be an urgent priority for the Government and the Minister if we are to protect people from severe illness from covid-19.

Furthermore, we need to address the structural drivers of obesity. Inequality is a key element, as I mentioned a little earlier. Obesity prevalence in children is strongly linked to socioeconomic deprivation. Families with lower incomes are more likely to buy cheaper and unhealthier food because what drives them—let us be honest—is what is on offer this week and what budget is available to buy the food that is on the shelf. We do not always check the labels. Is it high in calories, sugar and salt? Those are things that we probably should check, but we do not, because the driver is money.

A report by the Food Foundation in 2018 found that the poorest 10% of households need to spend 74% of their income on food to meet its Eatwell guide costs. That is impossible for people on low incomes. When the Minister sums up, perhaps she will give us her thoughts on how we can address that issue directly.

I welcome the Prime Minister’s commitment to the support for schoolchildren and school meals. It is good news; it is good to know that the four nations in this great United Kingdom of Great Britain and Northern Ireland are united in taking action on that issue. Scotland is doing it, Northern Ireland is doing it, Wales is doing it and now England is doing it. That is good news, because by reaching out and offering those school meals we will help to address some of the issues of deprivation and how the mums and dads spend the money for food in the shop. This is a way of doing that. We all know that school meals have a balance as well, so it is really important over the coming school breaks and other times that children have the opportunity to have them. In Northern Ireland, the Education Minister set aside £1.3 million to help to provide school meals over the coming period.

The Government need to work more closely with the food and drink industry as well, to make the healthy option the easiest option. However, while we need to support healthier choices and behaviours, there is no point in seeking to make individuals’ behaviours healthier if the environment in which they live is not suited to healthy behaviour. It is okay to say these things, but how do we make them happen? We need to look further at the social factors that lead to obesity, and we need to address them to make them more conducive to healthy living. To give just two examples, eating more fruit and vegetables and walking, which gives the opportunity to be out and about, are among the things that we need to look at.

There is a long-term process, which involves planning, housing, the workplace, the food supply, communities and even the culture of life in the places that we live in. It is about the groups of people we live with and the people we have everyday contact with. Earlier, I mentioned genetics, which is also an important factor in causing obesity. Again, it is a fact of life that there are people who may carry extra weight because of their genetics. Indeed, it is suggested that between 40% and 70% of variance in body weight is due to genetic factors, with many different genes contributing to obesity. Again, I am sure the Government have done some research on that issue, working with the bodies that would have an interest and even an involvement in it. It might be helpful to hear how those people who have a genetic imbalance, for want of a better description, can address it.

Without going into the motivations and challenges faced by people living with obesity, and particularly those living with severe obesity, it is clear that it is not always easy for them to lose weight. Let us be honest: it is not easy to lose weight. Some people say, “Well, what do you do? Do you stop eating? Do you cut back on your eating?” But if someone enjoys their food—I enjoy my food, although in smaller quantities, I have to say—and overeats, we have to address that issue as well.

We want to encourage people to improve their wellbeing and mental health and to have the willpower. There are a lot of factors that need to be part of that process. I was therefore pleased that the Government strategy sets out plans to work with the NHS to expand weight management services. Again, perhaps the Minister will give us some idea of what those services will be.

Support for people to manage their weight can range from diet and exercise advice to specialist multidisciplinary support, including on psychological and mental health aspects, and bariatric surgery. We have the National Institute for Health and Care Excellence guidance on these treatment options, which sets out who should be eligible for them, yet they are not universally commissioned, which means that many patients cannot access support even if they want to. Given the urgent need for people to reduce weight to protect themselves against covid-19, we need to make these services more accessible by increasing their availability and the information provided about them to patients and the public.

Over the years, I have had occasion to help constituents who probably had a genetic imbalance and were severely overweight. The only way forward for those people—men and women—was to have bariatric surgery. On every occasion that I am aware of involving one of my constituents, bariatric surgery was successful. It helped them to achieve the weight loss that they needed and it reduced their appetite. That made sure that their future was going to be a healthy one.

We have strict acceptance criteria in the NHS for obesity treatment that are not found with other conditions. If a person has a BMI of 50, they must follow diet and exercise advice and receive a multidisciplinary specialist report. These services are otherwise known as tier 2 and tier 3 services. We are almost sick of hearing of tiers 1, 2 and 3, but they are a fact of life for obese people before they are even eligible for surgery.

If a patient does not complete those courses, they must start again, which can make some people lose motivation. The lower levels of support are absolutely necessary and effective for the appropriate patients, but it would be better to remove the loopholes and duplications. That would allow more people to achieve the appropriate support, even before additional resource is provided.

Currently, the United Kingdom performs 5,000 bariatric surgeries every year, which represents just 0.2% of eligible patients. If more people had the opportunity to have that bariatric surgery, they would probably take it. Can the Minister indicate what intention there is to increase the opportunities for surgery? We lag behind our European counterparts when it comes to surgery for obesity, despite it showing benefits in terms of cost, safety and the ability to reverse type 2 diabetes.

Many reports in the papers in the last few months have indicated how people can reverse their type 2 diabetes and the implications of that. Talking as a type 2 diabetic, I am ever mindful that if people do those things and reduce their weight, it helps, but it may not always be the method whereby type 2 diabetes can be reversed. When I lost that weight, I found that my sugar level was starting to rise again after four years, and I moved on to tablets and medication, which controls it now. Ultimately, the control will be insulin, if the level continues to go the wrong way.

The British Obesity and Metabolic Surgery Society has recommended that the number of surgeries should increase incrementally to 20,000 a year—a massive increase from 5,000, but we believe it will heal some of the physical issues for the nation. This is a small proportion of the total number of people with obesity, but they would also benefit the most. This debate is not about highlighting the issues, but about solutions. I always believe that we should look at solutions and try to be the “glass half-full” person rather than the “glass half-empty” person, because we have to be positive in our approach.

For people who require nutritional, exercise or psychological advice, face-to-face services were closed during the first wave of the pandemic. I understand the reasons for that. While digital and remote services can provide help to vulnerable people during lockdown, these new ways of working cannot reach everyone. How do we reach out to all the people who need help? That is vital as the country moves through future stages of the pandemic. We hope we have turned the corner, but time will tell in relation to the trialling for the new vaccine. Obesity continues to be a priority, and services should remain available.

Lastly, in future, obesity services should not be cut as part of difficult funding decisions. I understand very well the conditions in the country and the responsibility that falls on the shoulders of the Health Ministers not just here in Westminster, but in Scotland, Wales and Northern Ireland. It is vital that the inequity in access to these services is corrected to ensure that people can access support, no matter where they are in the country. What discussions has the Minister had with the regional Administrations—with the Northern Ireland Assembly and particularly with the Minister, Robin Swann, and with our colleagues in Scotland and Wales? If we have a joint strategy, it will be an advantage for everyone. I would like to see the person in Belfast having the same opportunities as the person in Cardiff, Edinburgh, London and across the whole of this great nation.

I have three asks of the Minister, along with all the other questions I have asked throughout my speech—I apologise for that. Can she reassure us of the continued political prioritisation of the prevention and treatment of obesity? I call on the Government to implement, evaluate and build on strategies to reduce obesity. Can the Minister tell us how have discussions on that been undertaken with the regional Administrations across the UK? I also call on the Government to work with local NHS organisations and local authorities to ensure that services are available to our constituents who wish to manage their weight.

In summary, given the range of secondary conditions caused by obesity—this also applies to covid-19—would it not be more prudent to address their underlying cause before they occur? I always think that prevention, early diagnosis and early steps to engage are without doubt the best way forward, and it would be helpful for the nation as a whole if those things were in place. I believe that would help to reduce the impact of conditions such as type 2 diabetes, heart disease, kidney disease, high blood pressure, stroke, sleep apnoea, many types of cancer and more. The problem with covid-19 is that although our focus should rightly be on covid-19, we must not forget about all the other, normal—if that is the right word—health problems that people have, because dealing with those is very important for our nation to move forward.

The NHS currently faces huge demands, but reducing obesity now would significantly reduce demand on wider NHS services. It is a question of spending now to save later, if we are looking at the financial end of it. It is not always fair to look at the financial end, but we cannot ignore it, because there is not an infinite budget available to do the things we want to do; we have to work within what our pocket indicates. And we have to do that while also protecting people who are vulnerable to coronavirus.

I commend the Minister and our Government for their focus on obesity. I very much wish their new obesity strategy success. How it will work across the four nations is important, but we need to do more, in both the short and long term, to prevent and treat obesity, and we must do so with adequate funding, which is crucial to enable the operations, strategies, early detection and early diagnosis to be in place.

I hope that our future strategies to reduce obesity will continue to focus on how people can also be supported to live healthily. When it comes to these things, we have to be aware that it is not just one person who is living with the obesity; the family also live with it. Sometimes we forget about the impact on children, partners, wives, husbands and so on. Whenever someone sits down for a meal, is their meal the same as what the rest of the family are having? It would be better if they were all eating the same food, in terms of diet and content. I believe that if we can achieve that, we will find a way forward.

May I thank in advance all right hon. and hon. Members for taking the time to come to this Chamber and participate in the debate? Like me, they are deeply concerned about how covid-19 is affecting those with obesity issues. Today is an opportunity to address this issue, and I very much look forward to hearing other contributions; I am leaving plenty of time for everybody to speak.

[Philip Davies (in the Chair)]

It might be helpful if I say that I intend to get to the Front Benchers no later than 10.30 am. There are currently five Members on the Back Benches who want to speak, so if people could take seven minutes or so each, that would be helpful to give everyone a fair crack of the whip.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their contribution. I thank the shadow spokesperson and I thank the Minister in particular. I love the statement of a combined national effort; I think we have all captured that as the message we want to send out. I very much support what the Minister has said in relation to advertising and further reductions, the consultation programme that is going on, preparing and cooking meals and child weight loss programmes. All those things are important, so I thank the Minister and I thank hon. Members.

Motion lapsed (Standing Order No. 10(6)).

Covid-19 Update

Jim Shannon Excerpts

Tuesday 10th November 2020 Commons Chamber

[Matt Hancock]

Of course it is important that we continue to build and strengthen the contact tracing system, as we are doing. My hon. Friend mentions the uncertainties, and the issue of the virus that has spread back from mink to humans is one example of that. Of course managing a pandemic is beset by uncertainty. We still have uncertainty, for instance, over whether even the Pfizer vaccine will pass the safety hurdles that we very much hope it will in the coming weeks, but managing through that uncertainty is a critical part of getting this right.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. Is it not good to see the nation regain at least a smile in relation to the potential for a vaccine? That has to be good news for us all. Will he outline how he intends to ensure that, unlike with the flu vaccine, where there is a shortage in the nation and in my constituency, each region will receive the necessary amount of this vaccine and that rather than using estimations, the health service will allocate on the basis of priority need and not postcode?

[Matt Hancock]

Yes, absolutely; this is a UK programme and I have been working closely with my Northern Ireland counterpart, Robin Swann, who is doing a brilliant job in Northern Ireland, to make sure that we get this roll-out as effective as possible right across the whole United Kingdom.