Cancer Workforce and Early Diagnosis

Jim Shannon Excerpts

Tuesday 8th January 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

[Jim Shannon]

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

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

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

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

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

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

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

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

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

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

NHS Long-term Plan

Jim Shannon Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Yes, it was a joy to make that visit. We found ourselves in a new medical school in a room where the students were enjoying a dissection—my goodness, after a night without sleep it was quite a thing. It was a joy to go there with my hon. Friend and I agree with both the points she made.

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the Secretary of State on the NHS 10-year long-term plan. There are between 6,000 and 8,000 rare diseases. One in 17 people, or 6% of the population, will be affected by a rare disease in their lifetime—that is 3.5 million people in the United Kingdom. Will he confirm a commitment to assisting those with rare diseases, and can the NICE process for new life-saving drugs be urgently speeded up so that more lives can be lightened and saved?

[Matt Hancock]

I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.

Leaving the EU: Tobacco Products and Public Health

Jim Shannon Excerpts

Monday 7th January 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Happy new year, Mr Deputy Speaker.

I beg to move,

That the draft Tobacco Products and Nicotine Inhaling Products (Amendment etc.) (EU Exit) Regulations 2018, which were laid before this House on 1 November, be approved.

Smoking causes 78,000 deaths a year in England, accounting for 16% of all deaths annually. The United Kingdom is a global leader in tobacco control and the Government are committed to ensuring that we remain so after we leave the European Union. As hon. Members know, the Government have negotiated a deal with the EU and are in the process of taking it through Parliament. As has been much discussed, the deal is designed to secure a smooth and orderly exit from the EU. At the same time, it is of course the job of a responsible Government—I am pleased to say that the shadow Leader of the House is listening intently—to prepare for all possible scenarios. We are committed to ensuring that our legislation and policy function effectively in the event of no deal. It is for this scenario that these regulations have been laid. If the UK reaches a deal with the EU, the Department will revoke or amend this instrument to reflect that agreement.

This instrument will ensure that the UK domestic legislation that implements the two main pieces of EU tobacco legislation—the tobacco products directive and the tobacco advertising directive—continue to function effectively after exit day at the end of March. The instrument also amends and revokes some EU tertiary legislation that will no longer apply to the UK after our withdrawal. The amendments and revocations are being made under the European Union (Withdrawal) Act 2018 and are necessary in order to correct deficiencies in the UK and EU legislation in the event of no deal. The primary purpose of this instrument is to ensure that tobacco control legislation continues to function effectively after exit day. These proposed amendments are critical to ensure that there is minimal disruption to tobacco control if we do not reach a deal with the European Union.

This instrument introduces three main changes. First, in the event of no deal, the UK will need to develop its own domestic notification systems for companies that wish to sell tobacco products and e-cigarettes on the UK market. The notification process is essential for ensuring that companies are complying with legislation on product standards. Public Health England and the Medicines and Healthcare Products Regulatory Agency have already commenced work to ensure that domestic notification systems are in place and functional by exit day.

Secondly, in the event of no deal, the UK will not hold copyright to the EU library of picture warnings for tobacco products. Requiring the industry to continue to use these pictures would breach copyright law. Picture warnings are a key part of tobacco control, and it is therefore extremely important that we continue to require the inclusion of graphic picture warnings on tobacco products. The UK has therefore recently signed an agreement with the Australian Government to obtain their picture warnings free of cost—who knew, Madam Deputy Speaker? This agreement covers all copyright issues. I am very grateful to the Australian Government for their assistance in this matter. Action on Smoking and Health supports the proposals on notification systems and on the picture warnings as

“pragmatic and practical, minimising the amount of additional work involved if there were to be a no deal Brexit.”

Thirdly, this instrument proposes a transfer of powers. Currently, the Commission holds a range of powers under the tobacco products directive that enable it to respond to emerging threats, changing safety and quality standards, and technological advances. This instrument transfers these powers from the Commission to the Secretary of State. It should be noted that all powers in this category relate to technical, scientific and administrative adjustments that may be necessary to respond to changing circumstances in this space.

This instrument will have some impact on the tobacco and e-cigarette industry—there is no getting away from that. My Department ran a short technical consultation in October to seek feedback on the practical issues that will affect the industry in a no-deal situation. It focused on picture warnings and the notification process that I have outlined. We received 32 responses and have welcomed practical feedback on the issues highlighted in the consultation. Tobacco control stakeholders expressed support for the continued use of picture warnings as an effective way of stopping people smoking. They also showed support for the proposals to amend the notification system for e-cigarette and tobacco products as a means of harm reduction. The tobacco industry raised concerns around the timing of implementation and cost, primarily in relation to the changes to picture warnings. The Department has consulted with external experts who confirmed that the timescale for industry to implement these changes would be difficult but certainly manageable. To support industry with these changes, the Department intends to publish detailed guidance later this month.

Let me say a word on the devolved Administrations. It is important to note that the DAs have provided their consent for the elements of the instrument that are considered to be devolved. Furthermore, we have engaged positively with them throughout the development of this instrument. This ongoing engagement has been warmly welcomed. I want to place that on the record for our friends in the devolved Administrations.

In conclusion—

[Jim Shannon (Strangford) (DUP)]

Will the Minister give way?

[Steve Brine]

In conclusion, Madam Deputy Speaker, taking my lead from your look—Members will have a chance to contribute—this instrument constitutes a necessary measure to ensure that our tobacco control regulations continue to work effectively after exit day. I should, however, emphasise that, due to the instrument being made under the withdrawal Act, the scope of the amendments in the instrument is limited to achieving that objective. Therefore, at an appropriate point in the future, the Department will review where the UK’s exit from the EU offers us opportunities to reappraise current regulation to ensure that we continue to protect the nation’s health. That is timely on this day of all days, when we have published our long-term plan.

I urge Members to support the instrument, to ensure the continuation of effective tobacco control and harm reduction. I commend the regulations to the House.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I will be succinct, Madam Deputy Speaker. I just have a couple of quick questions for the Minister, but first let me say that I welcome the regulations.

Before recess, I asked the Minister a number of questions that came from the tobacco sector itself. Has he had any contact with the sector to seek its opinion on proposed legislation to ensure that what is put forward reflects its point of view?

The Minister referred to the devolved Administrations. I am ever mindful of the current situation in Northern Ireland, which I hope will change. We have a non-functioning Assembly, which means that the responsibility for the administration of legislation falls on the permanent secretary and civil servants. Will that be done through a statutory instrument, so that the permanent secretary can make a decision? Legislation passed in this place last year on the Northern Ireland Assembly gives the permanent secretary the authority to make a legislative change. I just want to be sure about how that will work in Northern Ireland.

Madam Deputy Speaker, those are my succinct comments.

Mental Capacity (Amendment) Bill [Lords]

Jim Shannon Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to follow the right hon. Member for North Norfolk (Norman Lamb), who has such expertise in this area and brought such valuable content to this debate as well as a valuable tone, which was very good to hear. I want to say a few things, first, in support of the Bill. As the right hon. Gentleman said, it is very important that we take a moment to reflect on the significance of getting this right.

Depriving someone of their liberty is a very significant act. Liberty is a fundamental right and freedom. We must take it seriously, and we must get this right. It is clear that the current system is not working. The fact that between 100,000 and 200,000 people are waiting because of an applications backlog is clearly unacceptable and cannot continue, given the consequences for individuals who have been deprived of the safeguards to which they are entitled, and the impact on their families and on care homes in which they may be residing.

[Jim Shannon (Strangford) (DUP)]

Earlier today I had a chance to speak about this matter to the Minister and some of her officials. Is it the hon. Lady’s understanding that the issue of human rights has been included in legislation that has been endorsed by Age UK, the Law Commission and Simon Wessely? If that is the case, the action that the Minister and the Government are taking this year is right, because it brings everyone together and ensures that there is legislation that everyone in the House can support.

[Helen Whately]

The hon. Gentleman has made a good point about the support for the Bill. Some Opposition Members have suggested that there is not much support for it, but it is, in fact, widely supported. Yes, there are concerns, with which I shall deal shortly, but, as the hon. Gentleman has said, there is widespread support for improvements in the current system. Those improvements include simplification—less bureaucracy and fewer administrative burdens—and the critically important representation of individuals through the independent mental capacity advocates, which will give them a voice. The frequency of assessments will become more appropriate; as my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) said earlier, timings can be inappropriate and excessively burdensome. There is a better choice of language: the Bill removes the term “unsound mind”, which is very stigmatising and completely unnecessary. I am also pleased that the Government have listened to the concerns expressed by some of my constituents about, for instance, potential conflicts of interests for care home owners when a financial interest may be involved.

However, I have three outstanding concerns. First, there is the question of how the amended Act will work for people with severe mental illnesses. The Bill clearly focuses on those who lack capacity because of, for instance, dementia, learning difficulties, autism or brain injuries, but, if I understand it correctly, it could be applied to people with severe mental illnesses. Figures suggest that the current Act is applied to a significant number of people in such circumstances. We know that such illnesses—bipolar disorders, for example—are likely to fluctuate, and that as a result people’s capacity may also fluctuate. That could cause them to be detained and deprived of their liberty when, in fact, they have regained capacity. The Minister in the Lords, Lord O’ Shaughnessy, gave a commitment that that would be addressed in the code of practice, but may I press this Minister to ensure that there are sufficient safeguards in the Bill?

Diabetes: Artificial Pancreas

Jim Shannon Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. I am aware of the #WeAreNotWaiting group and as recently as earlier today I had an email from one of them. I will not name them, because I do not have permission to do so.

[Jim Shannon (Strangford) (DUP)]

Will the right hon. Gentleman give way?

[Mr Howarth]

I will give way in a moment. I just want to finish answering the point made by my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe).

The email reads:

“As someone who has built an artificial pancreas using the open artificial pancreas system and is reaping the rewards from this technology, I just wanted to wish you good luck with this evening’s Adjournment debate. Having been a type 1 for 38 years, I can confirm that this is truly life-changing.”

Before I give way to the hon. Member for Strangford (Jim Shannon), I want to say a word about those who are manufacturing their own artificial pancreases. In some respects, we should celebrate that there are so many young people out there who have the ability to build what is in effect an artificial pancreas, while, at the same time, writing their own algorithms to link them together. That is truly amazing.

I have a background—this is a long time ago—in engineering and I cannot even conceive of doing that, so it is very encouraging that people are doing it. On the other hand, I worry. I have spoken to clinicians and one said to me, “I’ve looked at some of them and they are viable devices, but I worry about people building something that is not reliable and then relying upon it. There could be serious consequences down the line.” But this does show what is possible when people—in their bedrooms or in their mum and dad’s garage—are effectively able to control their own diabetes.

[Jim Shannon]

I congratulate the right hon. Gentleman on securing this debate on using modern technology to deal with diabetes. I declare an interest as a type 2 diabetic. I know other Members in the Chamber have similar ailments.

Northern Ireland has some of the highest levels of diabetes in the whole of the United Kingdom. We have the highest level of type 1 diabetics among children in the whole of the United Kingdom per head of population. That gives an idea of the importance of this debate.

I am very interested in the success of the artificial pancreas given to a teenager in Leeds. Does the right hon. Gentleman agree that this revolutionises both treatment and quality of life, but that it must be available throughout the whole of the United Kingdom of Great Britain and Northern Ireland? It must not be a postcode lottery. This must be available as a matter of course for those who fit the protocol. Will the Minister tell us how we can do that across the whole of the United Kingdom of Great Britain—Scotland, Wales, England—and Northern Ireland?

[Mr Howarth]

I am grateful to the hon. Gentleman, who must be psychic, because that is the very next point I was going to make.

There have been, as the hon. Gentleman says, postcode lottery-style problems with accessing the technology. For example, with FreeStyle Libre, a flash glucose monitoring device, patients in Liverpool are able to get it on prescription if they meet the criteria. That is very welcome, but many patients from outside the area cannot get one, as up to 30% of CCGs do not fund them. There needs to be more work done on that and I know the Government have made an announcement, which I will refer to in a moment.

Thanks to Diabetes UK’s campaign on 14 November, World Diabetes Day, NHS England announced that from April 2019 the FreeStyle Libre will be made available to all who meet the clinical criteria regardless of where they live. That is a very welcome development. I do not think it will apply to Northern Ireland, but I hope a similar policy is adopted in Northern Ireland. Innovation in diabetes technology is evolving rapidly in exciting ways.

--- Later in debate ---

[Mr Howarth]

The right hon. Gentleman is right, and it was an omission on my part not to have acknowledged that. Any parent of a diabetic child has to experience the disease—at second hand, but in very important ways. The younger the child, the more responsibility parents have to take, so that is important. By the way, training and other support for parents needs to be built into the system.

[Jim Shannon]

I just want to reinforce what we do for diabetics in Northern Ireland. The surgery that I belong to, in Cuan in Kircubbin, holds diabetic classes twice a year. The staff there do tests on all the diabetics—type 1 and type 2—including for their blood pressure, feet, eyes and all the other things they need to test in the clinics. The surgery then reports back on those tests. For instance, patients will get an eyesight test a month after they have been to the clinic. That shows that there are ways of dealing with this. I am not sure whether surgeries on the United Kingdom mainland do something just as good, but perhaps they should.

[Mr Howarth]

There are centres where people can access a lot of services in one place in a similar way to what the hon. Gentleman describes as happening in Northern Ireland.

I attended an interesting conference in Vancouver three or four years ago. I found out—the Minister or one of her colleagues might want to investigate this a bit further—that some of the smaller island states tend to provide all the services in one place because they do not have the capacity or resources to do anything else. It is an accident of geography that they are forced to do that, but it seems to work very well, particularly in some of the Pacific island areas, where there is a massive problem with type 2 diabetes.

NHS Reorganisation

Jim Shannon Excerpts

Wednesday 12th December 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Warrington South (Faisal Rashid) for bringing the debate. It is a pleasure to follow the hon. Member for Mitcham and Morden (Siobhain McDonagh). The Minister will not be able to answer all my questions because, as everyone knows, health is devolved to Northern Ireland. However, I will illustrate the issues with NHS reorganisation with some stories from the Province. The Minister has a close parliamentary aide from Northern Ireland, so he knows a wee bit about Northern Ireland.

I thank the House of Commons Library for the help it always gives us. Sometimes its information is enormously helpful, and today is one of those days. I have listened with great interest to the contributions so far; it is clear that, no matter the make-up of the constituency—whether Strangford in Northern Ireland, Mitcham and Morden, Warrington South or constituencies in Glasgow, Cardiff or wherever—there are issues. The NHS is struggling UK-wide, and either the pressure goes or its ability to treat will go. We are caught betwixt those two.

I welcome the Government’s commitment to spending £20 billion extra on the NHS, which is a credit to them. My constituency is on the seaside, and lots of people head that way to retire; I suspect things are the same in many constituencies. Our elderly population is growing, and the future demand on healthcare will be enormous. That is why the £20 billion that the Government have set aside is so helpful—because it gives a golden opportunity to plan ahead. The hon. Member for Warrington South was clear about where that should go.

The Library briefing—I am sure that the Minister has had chance to read it; I know that other Members have—contains six simple lessons from the Nuffield Trust, which are very helpful.

“Lesson 1: Avoid the temptations of a grand plan”.

This refers to the complex and heterogeneous nature of healthcare. We all know that it is complex; that is the very nature of healthcare. There are no one-size-fits-all policies that can address the issues. There has to be more than that.

“Lesson 2: Listen to the public—and don’t pretend you will if you won’t”.

As elected representatives, we know how these things work. When constituents come to us and tell us a problem, we listen intently and respond accordingly. This debate will hopefully be an occasion when we can do just that.

“Lesson 3: Don’t treat the workforce as an afterthought”.

It is very important that the workforce are part of a focused reorganisation plan. With the input of the workforce, there is a way forward.

“Lesson 4: Make sure the funding follows the plan”.

If funding commitments are made, they should be in there.

“Lesson 5: Don’t overrate structural reorganisation”.

In other words, it will not be sufficient to add more to the system that is operating on its own without building that structure up.

“Lesson 6: You need a plan your staff can follow”.

Create a policy and strategy that staff can get behind and support. The best way of doing that is to make sure that staff are involved in the creation of the plan, with staff values reflected in targets. All those things are vastly important, and I know that the Minister, who is a compassionate man and understands the issues well, will be able to respond even to the very generic terms that I put that in.

For Hansard and for the record, I will highlight an issue that I know is important across the whole of the United Kingdom of Great Britain and Northern Ireland: GP out-of-hours services. I emphasise the importance of that service, but we have particular problems with it in my constituency of Strangford. Part of any strategy or plan for NHS reorganisation should look at that.

My local health board is the South Eastern Health and Social Care Trust—clearly, not the responsibility of the Minister—which covers my entire constituency. On selected days just last month, the GP out-of-hours service in the main town in my constituency, Newtownards, had to close because it was understaffed, and there are particular reasons for that. People could either follow the advice and go to the nearest South Eastern Trust facility in Downpatrick, some 40 minutes away from Ards—for those who dare to live in Portavogie in the Ards peninsula, not that far from me, it is an hour and 20 minutes—or they could go to the A&E department, which was standing room only. The choice puts massive undue burden on an already drowning service.

I suggest to the Minister—as I have suggested at home; I think it would be helpful—that, whenever GPs commit themselves to operating an out-of-hours service, there may need to be another method of addressing the issues of those who use the service. For instance, why not have a staff nurse to treat minor ailments, taking pressure off the GPs? There are ways of doing things. There does not always have to be a GP there. GPs are predominantly overburdened; they certainly are in my constituency, and I suspect they are everywhere else as well.

I will give the example of my parliamentary aide from just last week, which I believe, unfortunately, is the tip of the iceberg. Her daughter, who has just turned three, is treated in an asthma clinic. She had an extremely high temperature that would not come down to the normal range and which had been going on for nearly two weeks. Her little body fought so hard to control the infection that it was going through that her breathing rate was double what it should have been. The out-of-hours service was rung, and four hours later the call was returned—a long time when the mother and family are getting panicky. The child was lifted out of sleep and brought to a waiting room full of other children who were equally unwell.

Had the service not been able to sound out her lungs, she would have had to travel to the Ulster Hospital, which she ultimately had to do the following week, as her ear infection burst an ear drum. Unfortunately, she is one of many. My aide met doctors who were harassed—not because they were nasty people, but because of their workload—but doing the best they could. When she asked whether there is insufficient funding to pay for out-of-hours care she was told that there is insufficient desire. How do we inspire doctors to be part of the out-of-hours service, which can only function with GPs who want to be part of it?

The new remuneration system came into operation in Northern Ireland in 2003. Although the system was designed to give GP practices much more flexibility on how they deliver services, allowing them to choose how to organise patient care and rewarding them for the quality of that care, the introduction of the new general medical services contract also allowed GPs to opt out of providing out-of-hours services, leaving the system essentially on its knees.

The fact is that the A&E in the Ulster Hospital in Dundonald simply cannot cope without the service. The fact is that nursing homes that rely on GPs coming out to drivers into patients who are in agony and pain, or to call time of death, need the service, as do parents who need someone to sound out the chest of their asthmatic child without being subjected to a four-hour wait in a room with ill, injured and drunk people in the middle of a cold winter’s night.

The service is vital. I read a report in July this year that referred to Wales as having similar circumstances and similar difficulties with their GP service. I am interested to know whether the shadow Minister or the Minister are aware of similar circumstances across the UK mainland. I suspect any MP in touch with their constituents, as we all are, will be able to replicate the stories that I am telling.

I very much respect GPs and the hard work that they do and their right to a social life. No longer do we expect the village doctor to be on call every day and night, but we need them to be available. There are no longer enforceable contracts, and I believe that, in any new NHS reorganisation or strategy, we must find another way of operating the out-of-hours service that gives the care that our constituents want at the times that they need it, which is usually out-of-hours or whenever they are under pressure.

I spoke very recently to a recently retired GP. He had been doing the night shift four nights a week, but realised that that was too much and pulled out. Perhaps if he had been asked to do only one or two nights, he would have stayed. Too much has been asked of too few people. We need to ensure that funding and people are available.

I know he will be mortified, but I am going to name one local GP, because he is a very popular and well liked GP in my constituency. Dr Doyle has his own practice and can be found a lot more than is right, and than is probably his duty, in the out-of-hours surgery. He makes time to help his patients by writing support letters for personal independence payment and employment and support allowance applications and he genuinely cares. I am not saying that others do not care; I am picking out this man as a representative of what happens. I look at Dr Doyle and wonder how much longer he and others like him can possibly continue. We need to spread the burden through the area.

I would urge the Health and Social Care Committee here to look at what is happening with the out-of-hours service, see the good that it does and perhaps look at a different way in which the out-of-hours provision could work. The Select Committee on Northern Ireland Affairs, on which I serve as one of the members from my party, is doing inquiries into many things, and one of them is health. People from Northern Ireland with a knowledge of and interest in health are coming here to make presentations to the Committee. And one thing that crops up is the out-of-hours service.

The question is how we adjust to the demands on the health service for the future. I started my comments by saying how much I genuinely welcome the £20 billion that the Government have set aside. We will get some of that through the Barnett consequential, so we are very pleased, but I see the needs in my constituency among the elderly population. I am also very keen that there should be early diagnosis and that preventive steps should be taken in delivering a health service for the future. If we do that, we will be doing the right thing. We must not just react all the time. Let us have a strategy that looks forward and aims to prevent things happening.

I am a type 2 diabetic, and many in the House are, as it turns out. Our Prime Minister is a type 1 diabetic. We all live with our particular ailments. But how much better would it have been if I had known about my condition earlier. I suspect that I was a diabetic for perhaps a year before I was diagnosed as one. I did not know at the time what the issue was. It was only when I went for a check-up with a doctor that I suddenly realised when he told me what was wrong. That makes me wonder whether there are steps that we can take for education, awareness and prevention. That is what we should be doing.

The Northern Ireland Affairs Committee will come to a conclusion in our inquiry on the health service in Northern Ireland, but I will conclude my speech today with this point for the Minister. The problems that I have referred to are specific in some cases to Northern Ireland and to my constituency in particular, but I believe that problems exist UK-wide and therefore that the response must be UK-wide as well.

[Mike Gapes (in the Chair)]

Order. I think that there will be a vote imminently. If so, we will break for 15 minutes and get back as quickly as possible.

NHS: Hysteroscopies

Jim Shannon Excerpts

Tuesday 11th December 2018 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I beg to move,

That this House has considered NHS treatment of patients requiring hysteroscopies.

It is an absolute pleasure to serve under your chairmanship, Mr Howarth. We know that hysteroscopies save lives, but all too often they cause excruciating pain and humiliation because some of the women who need them are not treated with the dignity, respect or even humanity that they deserve.

As hon. Members will know, a hysteroscopy involves the insertion of a camera into the womb, past the cervix, to look for abnormalities and potentially enable a surgeon to remove them. It can be used to rule out a diagnosis of cancer when women are experiencing heavy periods, unexplained bleeding, repeated miscarriages or difficulties in becoming pregnant, and it is a core part of the treatment for debilitating conditions such as fibroids and health risks such as polyps in the womb. However, for some women patients it causes severe pain, a sense of violation and lasting trauma.

The NHS website states:

“A hysteroscopy is not usually carried out under anaesthetic… Taking painkillers such as ibuprofen or paracetamol…can help reduce discomfort after the procedure.”

Unfortunately, many women experience severe pain during hysteroscopy. It is usually done with little or no anaesthetic, and many women are told nothing to prepare them for the agony that awaits. I have passed the Minister many dozens of anonymous cases from women who have experienced terrible pain at the hands of NHS surgeons and were ill-informed or misinformed about the pain risks and offered little or no pain relief. I am glad to say that she has always received those stories with sympathy, empathy and understanding, but I am receiving more and more of them all the time.

This is not an issue that gets huge acclaim or interest in the press. People are finding our campaign and Facebook page simply because they need to. I will put just two experiences on the record today.

[Jim Shannon (Strangford) (DUP)]

As my party’s health spokesperson, I am interested in all health issues, but particularly in this one, so I commend the hon. Lady for securing the debate. The National Institute for Health and Care Excellence guidelines published in March recommend that women should be offered an out-patient hysteroscopy if they have symptoms or risk factors associated with gynaecological conditions. Does she agree that that recommendation has not been translated into GP referrals? More must be done to ensure that those in need of the procedure, for the purpose of early diagnosis or the removal of issues, are referred and treated in an effective manner. It has to be done early, and that is where we fall down.

[Lyn Brown]

I entirely agree, but the importance of early action is sometimes used to encourage or even force women to stay with a procedure that is causing them great pain because of the fear of what might happen afterwards. If the hon. Gentleman gives me a moment, I will illustrate that point.

In October, I heard from Jenny, who has undergone two hysteroscopies, both of which were traumatic. She told me:

“My first experience was shocking. I wasn’t prepared for it. The doctor didn’t warn me at all, and during the procedure I experienced the most unbearable pain ever and I almost fainted. I rose up from the bed that I was on and I shouted out. It felt like my insides were being ripped out. I wasn’t given the option to stop nor was I given any support.

The nurse was behind the doctor throughout the procedure and just watched as I suffered. After the procedure my legs were like jelly. I felt faint and in pain but I wasn’t even helped off the bed, I wasn’t even given a sanitary towel to help with the bleeding. I left the room and drove myself home in that state, I’m lucky I didn’t have an accident. I felt traumatised, in a state of disbelief and shock.”

What is even more shocking is that Jenny’s second hysteroscopy was also traumatising, even though she now knew the risks and had taken steps to ensure that the same thing would not happen again. She explained to her doctor what had happened and requested a female doctor the next time. Her doctor said that she would write that on the referral, and at her pre-hysteroscopy appointment Jenny was told that she could have an injection to numb the area. She was reassured and trusted the female doctor to be more careful, but the procedure was—again—horribly traumatising. Jenny said:

“My god it was shocking, I once again shouted out and raised from the chair this time. The nurse was trying to calm me down…while the doctor said she would stop at any time but she needed to go in again and take a biopsy. I was told that if she didn’t...the procedure would be incomplete and I would be left worrying that it could be cancerous. So I endured more excruciating pain.

I wasn’t given the option to come back and have the procedure done under general anaesthetic, which I have now found out could have been an option. I felt tricked into having the procedure.

I suffered with terrible pain for a week after. Mentally I was left traumatised and still am to this day.”

Understandably, Jenny is now scared about any gynaecological procedure—including smear tests, which she knows are essential for her health.

This autumn, Annie got in touch. Annie had had ultrasounds and smear tests before; like many others, she was given literature about her hysteroscopy that made her think that it would be no different. She was advised just to take paracetamol and ibuprofen before the appointment, and she felt confident. She told me:

“As the procedure began, I felt instant pain, so unexpected and intense that I began to cry and panic within seconds. I was asking the nurse if this was normal as I was so scared there was something wrong, and she nodded to reassure me. I couldn’t get my words out, I was panicking, going into shock. She offered me her hand to squeeze through the pain. I tried to be strong, but I couldn’t, I was yelling out in pain, shaking and crying.

The nurses were telling me to relax my legs but it was impossible. When the Dr began the biopsy it was by far the worst pain I have ever suffered. I was hyperventilating and the nurse was telling me to breathe, but I couldn’t. I endured pain for 15-20 minutes.

I was asked to wait before I stood up, and I was so traumatised and sobbing, I just couldn’t move.

After a couple of minutes I got up and had to put on a sanitary towel and get dressed. It was hard—I was disoriented and shaking.

I sat with the Doctor who told me that due to it being too painful I have to have polyps removed under general anaesthetic. I could barely talk to him due to shock and tears. I wasn’t even offered water, and nobody asked me how I was getting home.

I cried from leaving the hospital at 2 until my wife arrived home at 6, at which point I broke down uncontrollably in her arms. I felt violated and abused, and the procedure felt very very wrong.”

As we know, women are still having these terrible experiences. I received another story in the past two weeks, but I do not have time to share them all. Women are still leaving NHS care feeling violated, and it ain’t going to stop unless we choose to stop it. I am very grateful to the Campaign Against Painful Hysteroscopy for providing support to those women and making sure that they are heard. The campaign group’s petition has received more than 47,000 signatures, which demonstrates that this is not an unusual, occasional thing.

We have four asks. First, if we are to stop patients from being violated or misled, all NHS trusts need to provide accurate information that enables women to give genuinely informed consent. I was pleased to hear from the Minister that her Department is developing tools to improve hysteroscopy care; I look forward to hearing her elaborate on those tools, but involving patients will be essential to making them work. The campaign wants to see a new patient information leaflet made available across the NHS. Campaigners have been working with the Royal College of Obstetricians and Gynaecologists and with specialists to create an appropriate leaflet that patients who have had negative experiences of hysteroscopy have helped to write, but it still needs to be rolled out.

The leaflet needs to be honest with patients. It needs to warn that there is a real risk of severe pain during out-patient hysteroscopy, and explain the risk factors that make pain more likely. They should tell patients that they have the right to ask for the procedure to be stopped at any time and for it to be rescheduled with a full anaesthetic. Hospitals should no longer have any excuse to hand out literature stating there will only be

“mild discomfort, just like a smear”.

After they have read through the leaflet, patients should be given an opportunity to discuss with a trained doctor what is going to happen during the procedure—whether a sample is going to be cut out for a biopsy, the risks involved, and the anaesthetic choices available. The campaign suggests that both patient and doctor should then sign a consent form to confirm the discussion has taken place and the choices the patient has made.

Our second ask is for improved training to enable better and more consistent care. We know that hysteroscopy can be a painless experience for women—some women will experience little pain from hysteroscopy even with minimal anaesthetic—but as we have heard, for others it will be like torture. There are some risk factors—older women and women who have never had children are far more likely to experience severe pain during hysteroscopy—but we cannot tell in advance what someone will experience, and that means we have to improve the guidelines and raise standards through training. The current national guidelines, produced by RCOG and the British Society for Gynaecological Endoscopy, do not recommend several forms of anaesthetic that I am told could be helpful. That has to be looked at, because, for some patients, stronger forms of anaesthetic might be the only way to have a hysteroscopy without experiencing severe pain.

Once we have changed the guidelines, investment in training will be needed to embed new best practice across the NHS. Hysteroscopy nurses should be routinely asking for patients’ pain scores during the procedure, so that informed decisions can be made about whether to continue or to stop. We need to audit pain scores and keep records of how comfortable the surgeon was with continuing, so that we can monitor whether more training is necessary. It should be a basic element of training that hysteroscopy teams should simply stop the procedure if a patient is suffering severe pain—not just hold them down—and reassure the patient that the procedure will be promptly rescheduled with more effective anaesthesia, rather than using the threat of possible undetected cancer to encourage her to continue.

Our third ask is for enough resources to enable all NHS bodies, everywhere in the country, to give women the choice between different anaesthetics when they need a hysteroscopy. The problem is not just flawed guidelines and inadequate training. Trusts may be loth to enable anaesthesia beyond over-the-counter painkillers or local anaesthetic simply because other methods are more expensive. Some are in-patient procedures, and some require clinicians to have specific training, and we all know that that comes with extra costs.

Our fourth, and possibly most important, ask is for a change to NHS incentives for hospitals. According to the information we have, the Department of Health’s quality, innovation, productivity and prevention tariff encourages trusts to promote hysteroscopy without anaesthetic, rather than offering an open choice to women. Annex F to the 2017 to 2019 national tariff payment system is explicit:

“For...diagnostic hysteroscopy...the aim is to shift activity into the outpatient setting.”

The best practice tariff

“is made up of a pair of prices...one applied to outpatient settings, the other to...elective admissions. By paying a higher price for procedures in the outpatient setting, the BPT creates a financial incentive for providers to treat patients there.”

The national target is for the risky out-patient hysteroscopies to increase to 70% of the total, up from 59%. The Department for Health is not working to reduce pain and trauma for women—it is incentivising hysteroscopies without effective pain relief and is taking our choices away. It has to stop, and I hope the Minister will look at how she is going to stop it.

Those are our four asks of the Government, and I think the Minister will agree with me that they are entirely reasonable. I do not believe they would be massively expensive to implement, and we should also consider that current NHS practices may not be cost-effective. Women who have undergone a painful hysteroscopy may not return for other gynaecological tests and procedures. If they do not have those early preventive interventions, more costly interventions will be needed later.

Some action has already been taken. The issue has been raised with the national medical director of NHS England. I thank the Minister for that, and for launching her women’s health taskforce, which I would be interested to hear more about today.

I would like to say something about the history of the hysteroscopy campaign and the amazing women who have led it—I am delighted to see some of them in the Gallery today. With their support, I have regularly been raising this issue in the House for four years now. I cannot say progress has been easy or swift. At times I—we—have been ignored by the Government, despite strong cross-party support every time I have raised the issue. I have been left concerned that officials at the Department of Health, and some senior NHS managers, have not been willing to engage with the problem of women’s pain when the NHS is under financial stress.

However, this last year has been more hopeful. The Minister met me and a core group of campaigners last year, and listened with compassion to their stories. I believe she has taken this cause as her own. I am waiting with bated breath to hear what she is going to say today, and to hear about the rapid and dramatic progress we are going to be able to make on this issue over the coming year.

NHS: Staffing Levels

Jim Shannon Excerpts

Tuesday 11th December 2018 Westminster Hall

[Tracy Brabin]

I absolutely agree that training for this most lauded position should not be done at the cost of nurses themselves.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Lady agree that we must have fewer medical quangos and more medical professionals in their white doctors’ coats seeing patients; less cleaning up of paper trails and more cleaning up in wards and A&Es; and funding that is targeted at frontline staffing and reasonable rates of pay?

[Tracy Brabin]

Certainly, funding and support should be given to frontline staffing. I will go on to talk about how I see that playing out.

The Mid Yorkshire trust is a major employer of about 8,000 members of staff who operate across three hospital sites: Pinderfields Hospital, Pontefract Hospital and Dewsbury and District Hospital, which is in my constituency. Like many trusts across the country, the trust is feeling the pressure on recruitment. In the most up-to-date figures, which were given to me directly by the trust this week, there is a 10% vacancy rate. That includes 95 full-time-equivalent posts for medical staff, 209 vacancies for full-time registered nurses, and vacancies for all other posts covered by the trust. The trust tells me that its key workforce challenge remains recruiting registered nurses and junior doctors in training. Those staff shortages lead to expensive cover being required— a bill that is ultimately paid by the taxpayer.

I am pleased that the trust has taken steps to mitigate against staffing shortages, including an extensive recruitment programme where vacancies across the trust are advertised and marketed widely. It has introduced a new associate nurse role in partnership with a local university, and expanded and increased the number of apprenticeship opportunities to offer different routes into careers in the NHS. It has held open theatre days to promote particularly difficult roles to recruit for, such as operating department practitioners. Finally, it has increased the number of nurses and doctors on the local temporary staff bank, which reduces its reliance on, and the cost of, commercial agency staff. I am sure that all hon. Members agree that that is all great.

Despite that work, problems remain. I must put on record my concern that staffing shortages can lead to problems for patients. The ambulatory emergency care unit at Dewsbury and District Hospital opened in 2015 to care for patients who needed a quick diagnosis and treatment, and who could be treated without the need for admission to a hospital bed. Since July, it has been closed because of staff shortages and it will remain closed for the foreseeable future. It had also been closed from the end of December last year to early March. Patients now face the lengthy and expensive trip to Pinderfields Hospital.

In the most recent inspection at Mid Yorks, the results of which were announced last week, the safety of services was deemed to require improvement, which will cause deep concern to my constituents. We are now told that the harsh funding climate for our NHS, which has existed since 2010, is coming to an end—austerity is over.

HIV and World AIDS Day

Jim Shannon Excerpts

Thursday 29th November 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

First, may I thank the hon. Gentleman for bringing his personal story to the House today? I mean that very much. I also wish him continued good health and that he continues to prosper, as he quite clearly is doing.

I mentioned to him before the debate that I wanted to intervene, and I wish to bring to his attention the Elim church in my constituency. The church has an HIV programme in Swaziland, which has the highest levels of HIV in the world. Every year, the children from a choir group come over. Every one of them is HIV-positive, but every one of them is surviving today because of the medication that is available. If the medication is there, we can do lots of things, save lives and give opportunity. Among many churches and individuals around the world, there is a lot of good will to help.

[Lloyd Russell-Moyle]

That is quite right.

We are making progress on treatment, but when it comes to stigma we still have so much further to go. Last week, I was in Kenya with the International Development Committee and met a HIV-positive mother of eight children from the Democratic Republic of the Congo. Although she was on medication, she had suffered such abuse that she was forced to flee the DRC and now lives in a refugee camp. Because of the prejudice and violence that she faced as a result of her status, she was forced to leave without her children, and she knows not of their future.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.

[Jim Shannon (Strangford) (DUP)]

4. What steps he is taking to support people to lead healthier lives.

[Robert Neill (Bromley and Chislehurst) (Con)]

17. What steps he is taking to ensure that people take greater personal responsibility for leading healthier lives.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Prevention is indeed better than cure. As well as having a right to expect NHS services to be free at the point of use, we all have responsibility for our own health, and to use the NHS responsibly.

[Jim Shannon]

I recently met Breast Cancer Now—the Secretary of State will be aware of it. It has 10 priorities for the NHS long-term plan. Has he made an assessment of the impact of the real-terms 5% cut in public health budgets on reducing the incidence of cancer?

[Matt Hancock]

There are many things we need to do to diagnose cancer early, and of course public health is part of that, but there is a much bigger agenda, and that includes more screening. We have seen an increase in the number of people invited to screening, but we need to get the screening right, so I have instituted a review of all our screening processes for cancer and other diseases.