Nurse Training

Jim Shannon Excerpts

Wednesday 5th September 2018 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a great privilege to be drawn for one of these end-of-day Adjournment debates, as they give Back Benchers such as me the opportunity to debate a subject dear to their heart. Tonight’s topic is fairly dry, but it is very important. I hope the House and those watching will forgive me if I plough into a lot of detail, because the detail is important on this issue. I welcome the Minister, for whom I have a high regard, to his place. Another advantage of these debates is that the poor Minister has to sit there and listen to me, and there is nothing he can do—he cannot escape. So I hope my words will fall on receptive ears.

This debate follows a recent public meeting on Portland hospital in my constituency; the beds at the island’s much-loved community hospital have been closed, but more on that shortly. We have heard it before, and it needs to be said again: we are facing a desperate shortage of nurses. Health Education England believes there are 36,000 nursing vacancies in England, whereas the Open University says it is 38,000 and the Royal College of Nursing gives a figure of 40,000. That last figure equates to an 11% vacancy rate, with learning disability and mental health nursing the most affected, followed by community nursing. These gaps may be filled by bank or agency staff on a temporary basis, but Health Education England estimates that 1% remain permanently unfilled. The knock-on effect places nurses under “relentless pressures”, according to a report this January by the Select Committee on Health. It added that

“nurses felt their professional registrations were at risk because they were struggling to cope with demand.”

Meanwhile, any increase in nurse numbers is swallowed up by the demand for more of them. For example, although the number of new nursing positions created between 2012 and 2015 rose by 8.1%, the number of those who actually joined the profession increased by only 3.2%. What is the consequence? Well, obviously, costs rise. Temporary nursing staff are expensive, with NHS trusts paying an average of 61% more for every extra hour they worked compared with that paid for a newly qualified, full-time, registered nurse. A Freedom of Information Act request by the Open University in January revealed that, if the hours worked by temporary staff were instead covered by regular nurses, the NHS could save as much as £560 million a year. The independent health think-tank, the King’s Fund, revealed that on average NHS trusts were spending nearly 7% of their salary budgets on agency staff, with the figure rising to more than 25% in some cases. Dorset HealthCare, which covers my constituency, forecasts an overall spend of £4 million this year on agency staff alone. That is down from a staggering £12 million three years ago but still represents a significant share of the healthcare budget.

As I mentioned at the start, 18 beds were closed at Portland Community Hospital last month due to a lack of nursing staff.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way: I sought his permission to intervene beforehand. He is outlining the shortage of nurses in his constituency, but there are nurse shortages in many other parts of the United Kingdom, including in Northern Ireland, which has a shortfall of some 1,800 in nurse numbers. Does he agree that the training of nurses must be a priority for trusts and the Department of Health and Social Care? Part of the way to attract new nurses is to show how we value our current nurses through decent pay and working conditions. It is important to ensure that nurses are regarded highly for the work that they do—and paid accordingly.

[Richard Drax]

I do not disagree with anything that the hon. Gentleman has just said, and I will come on to his points a little later in my speech. Of course all nursing staff should be appreciated and paid properly. One of the issues, as I shall describe in a minute, is the work environment, which is one of the factors leading to fewer nurses—or insufficient numbers—entering the profession.

Before the intervention, I was talking about my community hospital in Portland, where almost half of all nursing positions were unfilled this summer. Agency staff, costing as much as £58 per hour—and £135 per hour on bank holidays—were still hard to find. The trust’s chief executive, Ron Shields, for whom I have enormous respect, decided he could no longer safely keep the beds open. So, despite the understandable protestations from islanders who wish to keep their frail and elderly relatives close by, the beds were migrated to a hospital in Weymouth, where the nursing staff available can be consolidated. I suspect that that situation is not uncommon across the rest of the country.

The crux of the matter is the recruitment and retention of nurses. Recruitment depends mainly on training new nurses for the future. The numbers required are traditionally set by Health Education England, which then commissions the nursing places from further education and training establishments, including colleges, universities and the Open University. Standards are set and approved by the Nursing & Midwifery Council, ensuring uniformity across providers. Those establishments, in turn, invite applications, for registered nurses, nursing associates, nursing apprenticeships and Nurse First.

The first role requires a degree, the second a prior healthcare qualification, the third is a joint initiative between individual health trusts and further education establishments and the fourth is a new initiative for high-flying graduates and follows the lines of Teach First. The three-year degree option remains the main route into nursing. While many, including me, dispute the need for a degree, the Nursing & Midwifery Council says that that is to misunderstand modern nursing. Registered nurses are now an “officer class”, according to Geraldine Walters, the NMC’s director of educational standards, with much of the work for degree-level nursing now highly technical and demanding. In some cases, registered nurse prescribers replace doctors and indeed even run their own primary care clinics in London.

So far the nursing associates programme has been a success. In December 2017, 2,000 nursing associates were in training. This year, it is hoped that figure will be 5,000, rising to 7,500 in 2019. The Nursing & Midwifery Council is clear that more recruitment and widened access into nursing training are essential, as is the diversity of training provision.  The Open University, for example, provides for those who, for a variety of reasons, would not gain access to the profession via the traditional, campus-based route.

Since 2002, the Open University has offered a four-year registered nurse degree apprenticeship in addition to the straightforward apprenticeship. This is aimed specifically at existing healthcare support workers who welcome the chance to earn while they learn. So far, it has trained more than 1,000 applicants as registered nurses, with 940 more currently on the programme in England. One huge benefit to the scheme is that participating trusts seem better able to retain the nurses they have trained. Compare this with the 24% drop-out rate for student nurses on the degree course. As the NHS is the nation’s biggest contributor to the 5% apprenticeship levy, it would be odd for it not to participate.

The loss of the bursary scheme has been keenly felt, with the Royal College of Nursing saying that it is a serious own goal. It was a support package including tuition fees, a non-means-tested maintenance grant, a means-tested bursary itself, and other elements designed to help students with placement, travel and childcare costs. It was overwhelmingly popular, attracting more applicants than there were places. It was replaced by the student loan scheme, requiring students to borrow money to pay for their training.

The problem is that nursing is a vocational training and does not cater for school leavers unsuited to the profession. Significantly, following the removal of the bursary, the number of applications for nursing through UCAS has fallen by a third since March 2016. Although the Department of Health and Social Care says that there are 52,000 nurses in training—more than ever before—the number of those accepted on to courses is still down by 9.3% in England. That threatens the pipeline of new nursing talent and, at the very least, should and could have been anticipated. Much-needed mature applicants, many with care experience, are also deterred by the burden of debt and loss of earnings, and Ms Walters told me that these are exactly the people the profession needs. Mature applicants also tend to choose careers in specialist areas worst hit by the staffing crisis, such as learning disability and mental health.

New figures from UCAS show that applications for nursing degrees and from mature students are down by 33% and 42% respectively since March 2016. As the latter group are the very people who would be grateful for any support given, and probably remain in the organisation until retirement, Mr Shields suggests that trusts should provide some form of financial support in the absence of bursaries. A recent survey by the Open University showed the effect of the loss of the bursary on recruitment. Only 30% of nurses asked said they would have been willing to self-fund or partially self-fund their initial nursing education. In addition, more than half of those surveyed believed that applications would continue to fall.

Attracting nurses back into the NHS after they have left is another crucial focus for recruitment. The return to practice campaign, run by the Nursing & Midwifery Council, which provides refresher training and a re-entry route back into the NHS, has already recruited almost 2,500 former nurses and is currently registering another 1,800. However, as the Health Committee report states,

“too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”

The Committee cites many causes, including workload pressures, an inability to meet patient expectations, concerns about providing adequate care, poor access to continuing professional development, poor organisational culture, pay restraint and budget cuts. The impact of Brexit was another reason, although—interestingly—briefings from the Library show that overall EU staff numbers in the NHS have, in fact, fractionally risen since the referendum, with numbers of EU nurses falling by just 0.3%.

Another issue is the current pensions arrangements. Senior and experienced staff who might want to work beyond 55 are leaving because their pensions reduce in value if they stay on. Mr Shields has recently lost two senior and valued members of his team, and believes the Government must look at this urgently.

A partial solution to increase nurse numbers is to recruit from abroad, including Commonwealth countries. However, this was, until recently, severely limited by immigration rules, which were wisely relaxed in June after an intervention by the Home Secretary.

In December 2017, Health Education England published its draft health and care workforce strategy for England to 2027. “Facing the Facts, Shaping the Future” anticipates a significant shortfall in nursing numbers due to an increase in the number of posts needed. The Health Committee has emphasised that future projections of demand for nurses should be based on demographics rather than on affordability alone. A final workforce strategy is expected from Health Education England at any minute. Perhaps the Minister can enlighten us, as it was expected, as I understand it, at the end of July.

Finally, I thank all those who work in our NHS for the wonderful job they do, not least the fantastic teams in South Dorset.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

My hon. Friend makes a good point, which he made in last week’s debate. Public Health England and NHS England will continue to work with local areas in our constituencies to promote evidence-based ways of identifying and supporting pregnant smokers to quit. The overall ambitions in the tobacco control plan, which I published a year ago last week, will touch the general population, which of course includes the partners of pregnant women.

[Jim Shannon (Strangford) (DUP)]

Has the Department carried out investigations into the effects of vaping during pregnancy? If so, what are the results?

[Steve Brine]

Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.

Tobacco Control Plan

Jim Shannon Excerpts

Thursday 19th July 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

First, I thank the Minister for bringing forward the plan. As always, he is very active in health matters, and he certainly has a passion for this. I also thank right hon. and hon. Members who have spoken. Their information and evidence-based contributions have added greatly to the debate. Their knowledge is certainly greater than mine, but I must say that the hon. Member for Stockton North (Alex Cunningham) and the right hon. Member for Rother Valley (Sir Kevin Barron) have made significant contributions.

I am my party’s health spokesperson in this House, and I want to provide a bit of background about Northern Ireland. The right hon. Gentleman referred to some of the facts from Ireland, and I will look at this from a Northern Ireland perspective. We in the Democratic Unionist party set out our health policies in “Our plan for a world class health service”. When we had a functioning Assembly, that was one of the things we were very proud of; I hope we will get back to those days very soon. One of the aims was to improve the health service, and one of the pillars and listed successful health outcomes over the past few years was a decrease in smoking.

We have clearly had a policy and a strategy to address this issue. In 2012, the Northern Ireland Public Health Agency published its public health strategy “Making Life Better” for 2012 to 2023. In 2015, it published “Tobacco Control Northern Ireland”, which stated:

“Smoking has been identified as the single greatest cause of preventable illness and premature death in Northern Ireland”.

The tobacco control paper noted that in 2014, about 16% or one in six of all deaths in Northern Ireland were attributable to smoking. Over the ten years to 2015, smoking caused between 2,300 and 2,400 premature deaths per year. That indicated how important it was to reduce tobacco smoking and its take-up.

Across Northern Ireland, the standardised death rate due to smoking-related causes in the most deprived areas was 54% higher than the overall regional rate and 129% higher than the standardised death rate in the least deprived areas, and relative health inequality was getting worse. A general theme coming through from all those who have made contributions is the take-up of smoking in areas of deprivation across the whole of the United Kingdom of Great Britain and Northern Ireland. There is also a related gender gap. The standardised death rate due to smoking-related causes was highest among males in the 20% most deprived areas, more than twice that of males in the 20% least deprived areas, and almost five times that of females in the 20% least deprived areas. According to the report, smoking cost Northern Ireland some £450 million a year.

We quite clearly had a big issue that we were trying to address, and I believe the strategy implemented through “Tobacco Control Northern Ireland” was a methodology to do just that. Reducing smoking prevalence remains central to Northern Ireland’s public health policy, and we clearly support what the Minister has said, and what other Members have said, because they also recognise that. Although health is a devolved responsibility, many other areas of public policy relevant to reducing smoking prevalence remain the responsibility of the Government in Westminster, and our contribution takes that into consideration.

If I may, I want to comment on e-cigarettes. The right hon. Member for Rother Valley very clearly outlined the advantages of e-cigarettes and vaping. Some of the figures are incredibly important. Vapour particles from e-cigarettes are 73% water, which means that they quickly evaporate into the atmosphere, and the evidence of experts shows that 99% of the nicotine is retained in the vapour. It is very important to appreciate the advantages of e-cigarettes.

According to the UK national health service, there is no evidence of direct harm from passive exposure to e-cigarette vapour, and if we look outside the United Kingdom, evidence from other countries—France is one example—suggests there is no harm from passive vaping, based on current scientific knowledge, facts and figures. In 2016, the UK Government issued advice to employers to encourage workplaces to adopt pro-vaping policies so that it would be as easy and convenient as possible for workers to switch. That was on the basis that international peer-reviewed evidence indicates that the risk to the health of bystanders from exposure to e-cigarette vapour is extremely low. Again, there is an evidential base. Not so long ago I asked the Department of Health and Social Care whether it would consider introducing vaping areas in hospitals. People who are visiting hospitals go outside to smoke, and those who want to vape do not necessarily want to go to those smoking areas. I hope that the Minister will consider that idea.

In Newtownards, the major town of my Strangford constituency, a number of shops sell e-cigarettes. I suggest that those shops function because of the take-up of e-cigarettes—that is why they can pay their bills and why they exist. Very often, someone walking down the high street in Newtownards and elsewhere can see puffs of smoke. They are almost taken aback, and then they get the smell of strawberry, raspberry or cashew nuts, and realise that someone is vaping.

I want to comment on that point because it is important. The hon. Member for Harrow East (Bob Blackman) mentioned the US, and a survey carried out there suggested that vaping flavours may discourage smokers from returning to cigarettes. It stated:

“The results show that non-tobacco flavours, especially fruit based flavours, are being increasingly preferred to tobacco flavours by adult vapers who have completely switched from combustible cigarettes to vapour products.”

That was a survey of 20,000 adult frequent vapers in the United States, and of those 20,000, 16,000 had completely switched from smoking to vaping, and 5,000 were dual users who smoked and used vaping products—I want to add that point to the debate, because we must consider those results and look at the best ways to tackle this issue.

Hon. Members have asked how we can advance our strategy further. The Tobacco Control Northern Ireland report stated that exposure to smoking behaviour

“continues to occur in films deemed by the British Board of Film Classification as suitable for children and young people…this tobacco imagery extends beyond the film industry into mainstream television broadcasts”.

More than 60% of incidences of tobacco use occur before the 9 pm watershed, thereby providing a possible source of young people’s exposure to tobacco. 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. The greater the exposure to smoking—however it is depicted—the greater the risk of smoking uptake, and I am sure that the Minister will come back with his thoughts about that.

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?

In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the Tobacco Register of Northern Ireland, with a final deadline of 1 July 2016. That built on a similar scheme already in place in Scotland—the hon. Member for Linlithgow and East Falkirk (Martyn Day) referred to that—and a scheme is due for implementation in Wales. Lessons can be learned from such schemes, and I believe that we can learn greatly from the other regions of the United Kingdom of Great Britain and Northern Ireland, and bring our thoughts together to do something collectively that will benefit us all. Although registration schemes have the benefit of enabling public health authorities to identify where tobacco is sold, as currently constructed they appear to have had limited impact in preventing the sale of tobacco to underage children, or the sale of illicit tobacco.

I know this point is not the Minister’s responsibility, but I would just like to put it on record. In Northern Ireland, paramilitaries are involved with illegal tobacco smuggling and cheap cigarettes flood the market. The Police Service of Northern Ireland and the customs authorities are involved in trying to address the issue, but if I may I would suggest that Her Majesty’s Revenue and Customs could be more involved across the whole of the United Kingdom.

In conclusion, will the Minister ensure that his officials and their counterparts in HMRC 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 from the experience of the devolved Administrations? We can look at live these issues collectively, bringing our knowledge from the regions we represent. Hopefully, out of that we can construct a tobacco control policy that can help us all.

Perinatal Mental Illness

Jim Shannon Excerpts

Thursday 19th July 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), and I thank the hon. Member for Stockton South (Dr Williams) for setting the scene so well. He obviously has a passion and a knowledge of the subject—not just as a father, but from his previous job. I have a knowledge of it through people who work for me and who I have social involvement with, including the lady who writes all my speeches—she is a very busy girl—who always wanted to be a mother and had two miscarriages. I am very conscious of her story, and I will tell that today.

The wife of my hon. Friend the Member for Belfast East (Gavin Robinson), Lindsay Robinson, who set up a charitable group in Northern Ireland, has also given me permission to tell her story, which I will do in the way she told it to me. It is important to record those stories. We have come together on a Thursday afternoon to tell the story of why perinatal illness is very real, and to think about how we can help, which is the real reason for being here. I always say that we try to provide solutions so we can do things better. For the record, I should say that I have already apologised to the Minister and the shadow Minister, and to you, Mr Davies, for having to leave early, because I am committed to a later debate.

The work of the NCT is vital and a great support to parents all over the world. In Northern Ireland, we have three active branches that offer local mums, dads and families vital information, resources, connection points, community and friendship when they need it most. I thank the charity for the time and energy it has put into the research for the #HiddenHalf campaign, which has focused our attention on the issue of maternal mental health. It is clear from its work, and that of all those in the maternal mental health arena, that too many women go undiagnosed and unsupported. This debate must be a way to address those issues verbally, and we look forward to the Minister’s response about how she will help us.

NCT’s #HiddenHalf statistic that the problems of almost 50% of women who were surveyed, and who struggled, were not identified by a healthcare professional and that they did not receive any help or treatment is shocking. We must work together to change that. All the hon. Members who have spoken so far have reiterated that point.

My parliamentary aide, Naomi Armstrong-Cotter, who is also a local councillor, has spoken out in a personal way about her experience of miscarriage, of successful pregnancies afterwards, and of the fact that a leaflet handed to someone is not enough to give them the tools to deal with the emptiness of that loss. Our local paper, the Newtownards Chronicle, gave her an opportunity to tell that story; coincidentally, that appeared last week. Her plea was for greater support during and after pregnancy; for a network whereby someone did not have to search for help, but it was ready and waiting; and for follow-ups to be given more effectively. She is now blessed by God with two children, and I have no doubt that her family’s support kept her life together when she was having great difficulty trying to adjust to what was happening to her.

My party fully supports the #HiddenHalf campaign and I attended an excellent event in Parliament two weeks ago to raise awareness of its work on the issue, where I heard stories from mums whose lives have been marked by the illness and by not receiving the timely help that was necessary to make a difference. The event was hosted by my hon. Friend the Member for Belfast East, who understands only too well the devastating impact that maternal mental illness can have on women and the wider family unit. He was the other half who lived with the difficulties that his wife Lindsay was having. She struggled and suffered for two years before getting help. She has given me express permission to use her experience in this place to highlight the failings and the need for a brighter future.

From her experience, Lindsay spearheads the campaign in Northern Ireland for mums, dads and their families to get the support they need and deserve via her movement, “Have you seen that girl?” At the event that I and others attended, the impact of the NCT NI volunteers was clear. She also plays a role in the Maternal Mental Health Alliance’s Everyone’s Business campaign, of which NCT is also a part. Many charities and bodies have come together to offer support.

From the point of view of the two ladies whom I have referred to—my permanent parliamentary assistant and speechwriter and the wife of my hon. Friend the Member for Belfast East—the Church has also helped. It is important to have a faith and to have access to that at an important time.

Having met Lindsay—I spoke to her this morning, just before she left here—I understand that 80% of Northern Ireland still does not have access to specialist perinatal mental health services and that funded community-based peer support is limited. I understand that the Minister is not responsible for Northern Ireland, but from a Northern Ireland perspective, unfortunately, I would be surprised if we were not behind the rest of the UK, which is not good. We need to be up alongside and equal to other countries across the United Kingdom, as the hon. Member for South West Bedfordshire said, but treatment and support is a postcode lottery with too many mums and families being let down when they are at their most vulnerable.

The campaign for change is based on three areas. There should be provision of a mother and baby unit. Unlike in England, Scotland and Wales, a mother and baby unit is not available in Northern Ireland, which is disappointing—nor is it on the whole island of Ireland. The Minister is not responsible for that either, but it shows hon. Members that across north and south Ireland, we have not moved to make that happen. That means that mum and baby have to be separated should in-patient treatment be required. That is a very negative thing. I want to give a perspective on where we are in Northern Ireland and also say what has happened there recently. Some headway has been made—not enough, I have to say, but some at least.

The situation is simply not good enough and can have further negative effects on the mum and the family. There are five health trusts in Northern Ireland, but such specialist services for mothers are currently only available in one: the Belfast Health and Social Care Trust. Although that trust’s services are fantastic, they cannot meet the needs of the whole population of Northern Ireland; that would be impossible for one trust. Mums and families outside the Belfast trust’s area also deserve access to specially designed care and support.

Community-based peer support is also important. I am informed that currently great support is provided in the community and in the voluntary sector, often by mums themselves. How often do mums all come together to support each other? My wife had great support when we had our children; that was not only family support but support from other mothers who had had children at the same time. Again, however, in Northern Ireland we are without proper funding to successfully grow that kind of work.

I make a plea. I am aware of the NCT’s Parents in Mind programme, which is running very successfully here in England—on the mainland—and doing tremendous work. MPs from the mainland will know that and welcome it. NCT Northern Ireland volunteers are keen to source funding to bring that programme, or a similar one, to parents in Northern Ireland. We look forward to the day when that happens. For many parents, peer support is a lifeline, offered by those mothers who have faced a similar battle and who are keen to receive training so that they can provide help to others.

I am also aware from my party colleagues in Northern Ireland that Lindsay Robinson and Tom McEneaney, working with the Maternal Mental Health Alliance, led a team of campaigners to meet the all-party working group on mental health at Stormont; although Stormont and the Northern Ireland Assembly are still not functioning as they should, meetings still take place. The campaigners presented the information and asked all the Northern Ireland parties to sign a consensus statement, pledging their commitment to action all of the issues that I have mentioned as soon as possible. I am delighted that my party—the Democratic Unionist party, for which I am the health spokesman—has signed up to that, and I am assured that other parties have also signed up to it. We are keen to meet further with the team and give them our support. I hope that we are considering a strategy that will take us right through the next period, hopefully with a functioning Assembly. However, the strategy will certainly work, whether or not the Assembly is up and running.

I will close now, Mr Davies; I am always very conscious that there are other speakers to come. In closing, I again offer my full support to the NCT’s #HiddenHalf campaign and its goals here in England—on the mainland—and I thank the NCT for its continued support for the campaign in Northern Ireland. The NCT is supporting our campaign in Northern Ireland and we thank it for that, because it is very important that we have that support. As I have said often, we are better together—the United Kingdom of Great Britain and Northern Ireland—with all regions working on things that are of mutual interest to us all. I understand that the NCT is fully behind all that is happening and will become further involved in the coming months, and I look forward to that.

Also, I commend Lindsay Robinson and all those who have been campaigning in Northern Ireland for improvements to maternal mental health. We know that they are making a difference, both to the parents in their communities and also with decision makers. However, we must also take action in this House. We must do what we can to honour the bravery of those who lay their experience on the line for people to see and bring about changes that support mothers and families across the UK.

Again, I congratulate the hon. Member for Stockton South on securing this debate and other Members who have spoken or who will speak; I look forward to hearing all the contributions to the debate.

NHS Whistleblowers

Jim Shannon Excerpts

Wednesday 18th July 2018 Westminster Hall

[Dr Whitford]

I utterly agree. It is important to be clear that a disclosure in the NHS, which is what we are focusing on, regarding patient safety as opposed to employment issues, which are quite separate and dealt with differently, is in the public interest. The problem is that in cases where whistleblowers have been punished and have suffered detriment, what starts as reporting becomes a bullying and harassment issue that ends up in a normal employment tribunal setting, and the original concern is not dealt with.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall for consideration. Some 7,000 staff raised concerns about bullying or patient safety in 2017-18. Over the same period, some 356 whistleblowers said that they had experienced repercussions, ranging from subtle persecution, such as career opportunities being closed off, to being fired unjustly. That is truly shocking. Does she agree that the Minister may have to look at a full investigation into just how far-ranging these matters are?

[Dr Whitford]

I thank the hon. Gentleman for his intervention. I hope that this is just the first little step towards putting the matter on the agenda. The tragedies at Gosport brought the whole issue back. A nurse had come forward years and years ago, and could have saved hundreds of lives had she been listened to. Not being listened to is almost the least that can happen to a whistleblower, in that often they suffer detriment or reprisals and even lose their jobs.

The one change that Sir Robert Francis suggested to PIDA that has been made in England and Scotland is redress for discrimination regarding new employment—that is, applying for a new post within the NHS. Work is under way to introduce that in Wales as well. However, the main Act remains as it was. The first key weakness of PIDA is that it does not ensure an investigation of the whistleblower’s concern. Given the risks they take when they come forward, the detriment they may face, and the months or years of tribunals or other stages, it is crucial that the concern that made them step forward is not either overshadowed or completely ignored. I think that is their biggest frustration.

The Act most certainly does not protect whistleblowers. It describes itself as protecting whistleblowers from detriment, intimidation and reprisals, but PIDA can be used only for litigation after the detriment. Once someone has lost their job they can take their employer to an employment tribunal and attempt to have redress. The problem at that point is that the whistleblower has to prove that it was their disclosure—their coming forward and speaking up—that drove the loss of their job. Of course, employers will find all sorts of other excuses, such as, “Oh, they didn’t get on with their colleagues,” or, “They were a trouble maker,” or, “They were late for work.”

The success rate of litigation under PIDA is 3%, which is appalling, and shows how utterly weak the law is. Whistleblowers suffer further detriment while going through litigation. They know that they may face being landed with the costs. They may face bankruptcy, and stress that could go on for extended periods. Furthermore, between 2013 and 2017, people had to pay for employment tribunals. That, of course, closed that avenue off to many whistleblowers.

I make the simple case that we need a new public interest disclosure law. It should not sit inside employment law. It should not be a tweak to what we have now. We should recognise that the Public Interest Disclosure Act covers all sectors. The NHS may be one of the most common sectors to have whistleblowers, but the Act covers finance, research and business. We need a specific law.

It must be utterly clear that such disclosures are in the public interest, and that is where I disagree with the hon. Member for Stirling (Stephen Kerr), who may speak later. I do not agree with paying bounties to those who would disclose. Whether or not it creates a conflict of interest, it certainly gives the impression of doing so. It is utterly important, in the defence and protection of whistleblowers, that they can show that the only reason they have come forward is to protect patients or whoever the consumer is in their service.

Access to Orkambi

Jim Shannon Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Ivan Lewis (Bury South) (Ind)]

We are living in an era when public confidence in a mainstream political class is at an all-time low. Too often the public suspect that we choose the low ground when they yearn for us to build common cause in pursuit of the high ground. Tonight we have a chance, in a small way, to prove them wrong, by using this debate to show the relevance and humanity of Parliament in the cause of human dignity and human life. I pay tribute to colleagues here, especially the hon. Members for Dudley North (Ian Austin), for South Cambridgeshire (Heidi Allen), for Erith and Thamesmead (Teresa Pearce), for Bury North (James Frith) and for York Central (Rachael Maskell), the right hon. Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Strangford (Jim Shannon), for championing this issue so passionately and effectively over a long period of time. I also want to place on record our appreciation for the tremendous work of organisations, including the Cystic Fibrosis Trust, which ensure that the voices of people with cystic fibrosis and their families are heard and heard loudly.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for being so generous. The fact that so many Members have stayed behind tonight is an indication of the importance of the issue. It was my privilege to attend an event at Belfast City Hall this month, standing side by side with CF sufferers and their families calling for Orkambi to be made available. Does the hon. Gentleman agree that medication that is proven to improve the quality of life for CF sufferers must be made available regardless of postcode? The Department must again ask the National Institute for Health and Care Excellence to enter into negotiations with a pharmaceutical company to provide this drug and allow CF children to progress and CF adults to achieve a good quality of life. Once again, I congratulate him on bringing this issue to the House. It is very important.

[Mr Lewis]

I agree entirely with the hon. Gentleman. It is absolutely vital that we see an engagement process that leads to action. I will develop that argument as I make my contribution here this evening.

NHS Trusts: Accountability

Jim Shannon Excerpts

Tuesday 10th July 2018 Commons Chamber

[Sir Mike Penning]

The right hon. Gentleman is absolutely right. The gentleman did not stay very long, but he caused carnage in our NHS trust and morale went through the floor. I am sure some of the books might have looked a bit better, but certainly acute care was really struggling. The gentleman left after two years, or something like that, and he went to Great Ormond Street Hospital as the chief executive. I am sure he went on a huge pay cut—no, I am being cynical: I doubt it. He has now retired.

On the right hon. Gentleman’s point, before that gentleman there was another chief executive involved in investing in our health, who went off under a cloud. I managed to get him summoned to the Health Committee, when I was a member of it, to find out the truth about what was happening with the closure programmes. The right hon. Gentleman is absolutely right because, a few years later, he appeared back in my constituency as the chief executive of the community trust. He then had the audacity to ask, “Can we put all that behind us, as this is a new job and a different project for me?” Yes, it goes full circle: just as the right hon. Gentleman said in the previous debate, it is jobs for the boys, and they come back round again.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on securing this debate, in which he is highlighting a very specific issue. Does he not agree that there is a duty of care on Government-funded bodies, which quite clearly pay people from Government funds, to ensure that employees at every level are accountable to trusts? More must be done to inspire confidence in the NHS—this is quite clearly a confidence issue—as well as to provide transparency and clear accountability.

[Sir Mike Penning]

I could not agree more with the hon. Gentleman. We have discussed and debated this before, and this must be like “Groundhog Day” for the Minister. I should have thanked him earlier for bearing with me in what may be a much longer debate than he probably assumed when he saw it on the Order Paper.

It is important that there is proper due process when we employ people who work in the NHS, and in relation to salaries. I am sure that the Minister will now go away and check with the Treasury how this happened. My understanding was that such remuneration—and we are going back a couple of years—would not have been allowed even then. Trust in the NHS is vital. There are other examples, which I will produce, that will show that although the NHS is absolutely world renowned, there are errors in it that infuriate the people who it is supposed to be representing and looking after.

Transforming Care Programme

Jim Shannon Excerpts

Thursday 5th July 2018 Commons Chamber

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

Once again, I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate, but I regret that more of our colleagues are not in the Chamber for what I consider to be a very important debate.

I hope that the right hon. Gentleman and the House will forgive me if I come at this purely from the angle of autism, but, having the privilege of chairing the all-party group on autism, I tend to refer to it on every occasion, as many of my colleagues know. I have just come from a lunchtime event in the other place with the Baroness Browning, Angela Browning, who entered the House in the same year as I did and who was the original inspiration behind the Autism Act 2009, a private Member’s Bill that I took through the House. She was entertaining a group of people from an organisation called Fixers. I appreciate that we are not allowed prompts in the Chamber, but its report, “Feel Happy on the Spectrum: Young Autistic People Speak Out”, has already left an impression on me. Two very impressive young people, Jenny and Gabriel, talked us through their experiences.

As the right hon. Gentleman talked about employment, I had a look at the recommendations in the report, and of course they include something we would all like to see: more education on autism in the workplace. It contains testimony that I thought would be interesting to read into the record from a young person who has obviously found an employer who is understanding and welcoming of their autism. They wrote:

“Civil Service fast-stream is really good for people with autism. They go out of their way to accommodate your autism in their entrance exams with things like extra time and they don’t discriminate if you disclose”.

That is a positive note on which to start my remarks in a debate that is partly a reflection of the very sad and disturbing stories that came out of Winterbourne View care home. The transforming care programme was developed in response to that atrocious scandal. No one could have failed to be moved by the shocking abuse of adults with learning disabilities and autism in that private hospital, which was supposed to be an assessment and treatment unit—it most certainly was not a treatment unit; it was a maltreatment unit. Following that, the Government committed to moving about 3,000 adults with learning disabilities and autism out of in-patient settings and into community-based support by next April.

Although we have seen a small reduction in the number of people in in-patient settings, about 2,500 people are still in hospital, as the right hon. Gentleman said. Some 10% of those patients are under 18—that number has more than doubled since 2015; 61% have been in hospital for over two years and some, sadly, for over 10 years; and 46% have not had a care treatment review in the past six months, as mandated. As he also told us, and as I also understand from an excellent organisation called Dimensions, which provides personalised social care services to people with learning disabilities and autism, more than 22% of people are placed more than 100 km from home. So although there has been a reduction in the number of people living in hospital and some real success in moving people into community support, too many people are still being admitted or readmitted to hospital, and there remain obstacles to moving some of the original cohort considered under the programme into real homes.

The success of the programme relies on the right support being available in the community to prevent people from being admitted in the first place or to help them move out of hospital. The number of autistic people recorded in in-patient units has increased by over a third in the three years since data collection began in March 2015. That is a phenomenal increase. According to the latest figures, almost 48% of people covered by the transforming care programme are in fact autistic. While some of this increase may be put down to better identification of autism, it still displays a concerning over-reliance on hospitals rather than homes. Put simply, if transforming care does not work for autistic people, I am afraid that it will not work. If the programme is to continue, all mental health staff will require better training on and understanding of autism and the right community support will have to be made available.

It is crucial that we hear from the Minister what plans there are beyond March 2019 to ensure that any progress made is not lost and that there is a focus on areas where better progress needs to be made, specifically in supporting autistic people.

[Jim Shannon (Strangford) (DUP)]

I am sorry I was not here earlier, but I was in a one-hour Westminster Hall debate. I commend the right hon. Lady for the hard work she does on autism across the United Kingdom. As she will know, Northern Ireland has an autism strategy that leads the United Kingdom. It is similar to the programme in Wales, but we are leading the way. Will she kindly suggest to the Minister that the Government look at the plan in Northern Ireland, along with the one in Wales, as a good way of proceeding?

[Dame Cheryl Gillan]

Yes, it is very important that we look at what arrangements the devolved countries make for people with autism. Certainly a few years ago, Wales was well in advance with its plans for autism, which I found most commendable, but I think it now needs to revisit and update its plans, because none of these plans must be left to one side; they need to be constantly reviewed and updated.

I am pleased that next year we will have the opportunity to conduct a 10-year review of the Autism Act. I hope the right hon. Gentleman will contribute to the work that many Members are doing on both sides of the House in various areas, from education to employment, healthcare and even the over-representation of people with autism in the criminal justice system, so that we can put down a marker for the Government after 10 years on what progress has been made and how much further we have to go. If the hon. Member for Strangford (Jim Shannon) would be good enough to send me a link to the plans in Northern Ireland, or point me in the right direction, I am sure they will be taken into consideration as we carry out the review.

I am pleased to see the Minister in her place, as she obviously has a lead role, but I think that all relevant Departments need to play their part. I still have a feeling that we need a cross-departmental ministerial taskforce to cover the areas that I have just been highlighting, such as health, education, housing, and justice, all of which we will include in the APPG’s summary and presentation to the Government next year. Let me put down a marker for the Government. I want to know what plans the Minister has for the future of transforming care, whether she will establish that cross-departmental taskforce to lead the process, and what steps she will take to reduce the number of admissions of autistic people and improve the community services that should support them.

I work closely with many autism charities, and in particular with the National Autistic Society. Alongside Mencap and the Challenging Behaviour Foundation, it has been leading research on the experience of families who have been affected by the transforming care programme. It wanted to look into exactly how relatives came to be in mental health hospitals, and what was getting in the way of their being discharged back into the community. I commend to the Minister the report “Transforming Care: our stories”. It contains the very powerful stories of 13 families, and I think that she will find it very useful, if she or her officials have not yet been able to read it.

The report found that, despite the existence of a national programme, five areas needed real focus to make the programme successful. The first is

“Making sure the right services are available in the community”.

I think we have covered that. The second is involving and listening to individual families, and helping them to be heard through advocacy if necessary. The third is improving the quality of in-patient care. The fourth is

“Making plans for discharge and sticking to them”.

The fifth is providing specialist support from trained and understanding staff. For me, that last one is key. When we have met someone with autism, we have met just one person with autism. Everyone is different. Staff really need to understand that, and to be trained to understand people with autism.

Universal Health Coverage

Jim Shannon Excerpts

Thursday 5th July 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the role of universal health coverage in tackling preventable and treatable diseases.

I would first like to thank the Backbench Business Committee for granting this debate. I have been lobbied fairly heavily on the subject and a number of organisations asked me to approach the Committee and request a debate. I am pleased to see the Minister in his place. He and I have discussed the matter before. It is probably one of those issues that involves not only the Department of Health but perhaps the Department for International Development. He once told me that he took part in a debate that covered five different Departments—I suppose he is a man of many talents—so he will be able to answer wisely for the Departments covered in this debate. I thank hon. Members for coming along to Westminster Hall on such a warm day, and given the almost end-of-season approach we seem to have to matters now.

I wish to begin, as we approach the 70th anniversary of our NHS, by thanking all those who have made that institution all that it is. I have said that in other places, but I wanted to say it publicly now in Westminster Hall. Many political parties have had the opportunity to be part of the creation of our great NHS, and many of us have had the opportunity to be cared for by it, both surgically—in operations—and through the care that nurses provide in hospitals, which I personally have had on three occasions over the past year. I am thankful to every person involved in the NHS, from the porter to the paediatric consultant, from the occupational therapist to the oncologist, from the scrub nurse to the surgeon, from the auxiliary nurse to the audiology clinician, and all people in between. I thank them all very much for all that they do for us as patients, but also for us as a nation. I want to put that on the record.

I thank NHS staff for making the NHS work in situations that often seem unworkable, due to stress and pressure. As the Democratic Unionist party’s spokesperson on health, I am frequently contacted by those who need more than the service has to offer. A great many times we focus on the problems of the NHS and where we are—that is the way life is—but we also need to reflect on how good it is and how much we owe it.

People often come to us with their problems; they do not necessarily come to us to tell us how good a job we are doing. Perhaps half a dozen people will call in a week to say what a good a job we are doing, but hundreds of others will come to us with their complaints. That is the nature of the job. It is not about complaining; it is part of the job. I believe that I must highlight where we are going wrong, or perhaps where we can do things better. We must see if we can do things along those lines.

Today it is my desire to thank all those who work in the NHS so tirelessly, who do not always get the recognition they deserve. The NHS is our nation’s greatest asset. A Member said in the main Chamber today during business questions that the NHS was probably our nation’s greatest accomplishment. I tend to agree, as I am sure would many others. The NHS embodies our British values of compassion and fairness. It represents our nation’s strong sense of justice and the desire to help those in need. With its quality of care and pioneering scientific research, it is a world-leading institution.

Across the whole of the United Kingdom of Great Britain and Northern Ireland, the NHS works in partnership with many universities and private companies on research and development for drugs that can help save lives. Queen’s University Belfast is one of those universities, and I know that because it is one of the institutions that I would call in on. Indeed, just three months ago I visited its cancer research team to see the scientific work they are doing. They were over here this week, along with staff from breast cancer charities, in the Attlee suite in Portcullis House, and we had a chance to catch up. What they are doing to try to find cures for cancer at all levels is incredible. There is also the complexity of breast cancer treatment to consider, because many people have different variations, so the drugs they take must be just as varied.

The NHS is the type of British export that can help underpin the UK’s global Britain vision, which I believe we lead the world on and which we can be the forerunners for. Health for all, which is the bedrock of this most beloved institution, is a principle that the UK originated in 1948, when it first embarked on the altruistic duty of creating a national health system to provide care to everyone, everywhere, without their having to experience financial hardship.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

I agree with everything the hon. Gentleman has said so far about the NHS. I saw its merits at first hand when I had a baby two years ago. However, I wish to make a point about the current shortage in the NHS of the BCG vaccine, which is used to treat tuberculosis. My constituent, Hussein, is 11 months old. He was born in Lebanon but is a British citizen. His parents have told me that their GP said that Hussein cannot have the BCG vaccine on the NHS because he was born outside the UK. Does the hon. Gentleman agree that although our NHS has a fantastic track record in tackling diseases and providing care, in order for it to have a successful future every British citizen must be entitled to the preventive medicines on offer?

[Jim Shannon]

I thank the hon. Lady for that intervention. I know that the Minister, like me, listened carefully to what she said. If there is clearly the anomaly that she outlines, the NHS should reply and make the vaccine available. I am quite incredulous that someone who is a citizen of the United Kingdom of Great Britain and Northern Ireland cannot have it. That is almost impossible to understand. I am sure that the hon. Lady will receive a response from the Minister in whatever time is left at the end of the debate.

The NHS is the purest and simplest definition of universal health coverage, and it is the world’s oldest and most successful model. The World Health Organisation estimates that half the world’s population lack access to essential healthcare services and that 100 million people are pushed into extreme poverty by healthcare expenses. We have problems as well. I get frustrated sometimes when constituents come to me. I am referring to Northern Ireland, where health is a devolved matter and therefore not the Minister’s responsibility, but I believe that these cases illustrate some of the issues. A constituent told me this week that a consultant had said to them, “Well, you’re going to have to wait maybe 53 weeks for an operation.” If people want to have an operation through private healthcare, however, they are told that it could maybe be done before the end of the month. As always, if someone can pay for something, they can have it done. We have these problems within the NHS in Northern Ireland and, I suspect, across the rest of the United Kingdom.

As I said, the World Health Organisation estimates that half the world’s population lack access to essential healthcare services and that some 100 million people are pushed into extreme poverty by healthcare expenses. Behind these horrifying statistics are tragic human stories of unnecessary loss and suffering. My parliamentary aide, who does a lot of speech writing and research for me, has travelled to Africa to work every summer, usually in Swaziland but also in Zimbabwe over the past couple of years. That is through Elim Missions, which is a church group in my constituency. She used to visit Africa every summer, during the recess, but she now has two young girls and has not been for a few years. When she came home each year, the tales she would tell about the hospitals she visited would break your heart.

Let me tie together these two stories: first, our NHS; and secondly—perhaps this is for DFID—the responsibility that I believe we have to reach out and help other countries. I referred to that in my earlier discussion with the Minister. My aide’s stories would really have broken your heart. The children’s ward was full of the cast-offs from hospitals in the UK. I do not mean that disrespectfully, because we do that in Northern Ireland—Elim Missions and many other groups do it. We fill containers with second-hand hospital apparatus that might need repairs and we send it out to Zimbabwe, Swaziland and other countries around the world. The equipment can still be used, but sometimes it is worse for wear. We would not put our children anywhere near some of those conditions, but the staff we met made use of all that apparatus and all those materials.

Children in orphanages went without basic medical care until nurses from the UK gave up years of their lives to provide medical training to local communities, for example on the importance of sterilisation. Sometimes the issues can be small, but necessary, such as the simple effect of drops. The hon. Member for Stafford (Jeremy Lefroy) and I were talking this morning about some other things. He said that when he was in Africa his son was taken very ill with pneumonia at eight months old. They did not have the small antibiotic drops that were needed, but once his son got them he became much better and got over the illness. That shows how small things can make a difference and how important it is that we do them.

The Luke Commission is a charity that has been operating since 2005. It takes free healthcare and hope to the most isolated populations in Swaziland. Mobile hospital outreach sites are set up in the remotest parts of that small country. The population is scattered and dispersed. Patients are tested, counselled and linked to treatment for HIV/AIDS. Swaziland has some of the highest levels of HIV in the whole world, and the whole of Africa in particular. Those suspected of having TB are X-rayed and started on medication. Voluntary male circumcisions are performed in an on-site 11-bed operating room, as studies have shown that the rate of HIV transmission is cut by 60% in circumcised males. Those are practical actions that can be taken to change things. More and more evidence indicates that lack of male circumcision is one of the primary reasons why the HIV prevalence rate is so high. These actions can reduce that. Nurses travel back to rural communities to check on newly circumcised men to ensure that they are healing, to answer questions and to provide HIV prevention education.

At the mobile hospital sites, schoolchildren are treated for skin and intestinal problems. Young people are fitted with new shoes. Those are practical, small things that can make a difference. I put on record my thanks to the Elim church charity and to the many other charities and churches across my constituency that gather products, whether clothes, shoes, medication or hospital apparatus—whatever it may be—to help fit out some of these places in Swaziland, Zimbabwe and further afield.

Handicapped people are analysed by Luke Commission medical personnel and given bush wheelchairs—they need a wheelchair that is practical. Follow-up treatment for patients with HIV, chronic disease, complex medical disease and various cancers is offered. Those with poor eyesight receive vision services and glasses, if needed. There is an ophthalmic surgical programme primarily focused on the removal of cataracts, which are a serious issue in parts of Africa. Those practical changes can be made easily. They do not need a lot of money or investment, but they can change lives. Can you imagine, Mr McCabe, not having your eyesight? Of all the things in the world that you would never want to lose, it would be your eyesight. I say that as someone who has worn glasses since I was eight. I understand the importance.

Packets of medication are distributed by the thousands every day, each prescribed by a doctor with instructions on usage in the mother tongue so that they are understood. Psychosocial and grief counselling is available, too. The pain and the tears they have are no less than the pain and tears we have. Some of the things that happen to them happen because they do not have medical treatment available. The Luke Commission team of nearly 100 people treated more than 61,000 patients in 2015. We can do a lot more with small things, but how many more could we affect?

Most recently, a young lady from my constituency gave up her time during her summer to help the Luke Commission. So many others from the UK give up their time to make a difference. Would the Minister be so kind as to outline the initiatives that are in place? I understand his remit may not stretch to that, but it would be helpful if he could give us some idea. What initiatives are in place to encourage our knowledge and skills to be shared worldwide, like the schemes of Doctors Without Borders and the Luke Commission? How are the Government sharing and disseminating the expertise and learning generated from the NHS with Health Minsters in developing countries?

We have great partnerships and the wonderful NHS. We are celebrating the NHS’s 70 years of tremendous work, but we should be trying to show other countries what we can do. Will the Minister give us some idea of how we can help developing countries? I believe that is our duty, and I would like to better understand how we can fulfil it. We need to take up the mantle and do more in our constituencies. We are doing practical, physical and financial things through churches and other charities that directly help in Africa and other countries across the world.

Countries in the developing world are already showcasing their ingenuity and political will in delivering universal healthcare. For example, Bangladesh has achieved wonders in national health in the last 25 years. More than 95% of Bangladeshi children are now fully immunised—that is tremendous. There have been other massive improvements: breastfeeding is near universal, and the level of stunting in children under five declined from 51% in 2004 to 36% in 2014—a significant decrease, showing what we can do if we influence and help both physically and practically. Community outreach by a skilled cadre of female community workers was instrumental in achieving almost universal immunisation coverage, the world’s highest coverage of oral rehydration solution, greater uptake of family planning, and innovative solutions for community-based management of sick newborn babies and severe and acute malnutrition.

Bangladesh is a world leader in reducing child mortality, but pneumonia remains a major challenge for policy makers. Sadly, childhood pneumonia is prevalent across many countries. The stats are alarming: every minute of every day, including today, two young lives are lost to pneumonia; in 2016, it claimed nearly a million children under the age of five in developing countries—more than HIV, TB and malaria combined. If we had the antibiotics available, we could tackle a lot of those problems. Pneumonia is a killer that leaves children gasping for breath and fighting for their lives, but it is also a disease that we have the power to prevent, diagnose and treat. We can do that, so how can we do it better to save those million children’s lives?

We know that an accessible and free health system is the most effective way of treating pneumonia. A fully integrated universal healthcare model can care for a child from the moment they are born until they reach adulthood. That will prevent deaths from pneumonia, which is the biggest killer. We are here today to find out what more can be done to provide UHC in countries around the world, including those in Africa and the middle east, India, Pakistan, Bangladesh and other countries where these problems occur. Millions of people around the world are denied their most basic rights of access to healthcare. We have UHC in this country, and I would like to think that one day we will be able to make it available across the world. As beneficiaries of the NHS, everyone in this room must believe we want everyone to have what we have: a system that is fair and free. We must therefore take steps to change things.

Pneumonia is a prevalent issue within the Commonwealth, too. Save the Children has calculated that children under the age of five living in Commonwealth countries are two and a half times more likely to die from pneumonia than children living in non-Commonwealth countries. When we hear those stats, we realise how big the difference is that we have to try to reduce. Will the UK Government raise the subject at the next Commonwealth Health Ministers meeting? If the Minister is in a position to use that power, I ask him to do so. He should certainly contact the relevant Department to ensure that it happens. What leadership role can the UK Government play, given that the UK is the chair of the Commonwealth for the next two years? I would like to think we can use that influential role. I know we will, but perhaps we should be reminded that we have that opportunity. We should try hard to make things happen.

I am incredibly pleased to have one of the world’s foremost research and medical centres in the wonderful Queen’s University. The steps taken in improving healthcare worldwide have been tremendous, including the most recent breakthrough regarding the targeting of antibiotics for pneumonia using groundbreaking cancer treatment technology. I mentioned Queen’s at the beginning of my speech, but I mention it again, because it is at the coalface of breakthrough technology. I asked Queen’s for a little more in-depth information regarding the breakthrough. That information is certainly something to be proud of. The Queen’s research team indicated that our struggle against infectious diseases is far from over, but they, with other universities, research and development bodies and private companies, are doing their best to make things happen. Globalisation has increased the risk of pandemics, which we get regularly, reminding us that whenever we accomplish something, another disease and pandemic comes along, and sometimes existing drugs are useless.

Unsurprisingly, antimicrobial resistance—AMR—is included in the recently released UK Government national risk register of civil emergencies that may directly affect the UK over the next five years. Our Government have been instrumental in assisting and responding, and it is always good that they do that. More than 80,000 deaths in the UK are estimated if there is a widespread outbreak of a resistant microbe. Far from being an apocalyptic fantasy, a post-antibiotic era in which common infections and minor injuries can kill is a very real possibility for the 21st century. We can never rest on our laurels with what we have done. We need to step forward and be more aware of what we need to do in the time ahead. New diseases are always developing, and there is always a need to match them. We should pay respect and give credit to organisations that do that well.

The O’Neill review on AMR sets out the global threat by highlighting that drug-resistant infections already kill hundreds of thousands of people a year globally. By 2050, it could be as many as 10 million—one person every three seconds. If we needed a reminder of the importance of the issue, that would be the figure. I am not sure if anybody in the Chamber will be around in 2050—I certainly will not be—but those who are could well face one of the debilitating diseases that we need to research now.

Of particular concern is the mounting prevalence of infections caused by multi-drug-resistant gram-negative bacteria, in particular Klebsiella pneumoniae. That pathogen has been singled out as an urgent threat to human health by the UK Government, the US Centres for Disease Control and Prevention, and the World Health Organisation due to extremely drug-resistant strains. Notably, Klebsiella infections have increased by 12% in the UK alone over the last five years. That tells us how things are developing, and that we need to be prepared.

Professor Chris Scott, the interim director of the Centre for Cancer Research and Cell Biology, is an expert in nanotechnology. In June, he teamed up with Professor Jose Bengoechea, director of the Wellcome-Wolfson Institute for Experimental Medicine, who is a world expert on infections by multi-drug-resistant pathogens, chiefly Klebsiella pneumoniae. Professor Bengoechea’s team discovered that it is possible to use the nanotechnology approaches that Professor Scott is developing for cancer to try to treat the bacteria that reside inside human cells and combat that pathogen. We have to listen to the experts and ask them to take things forward in the right way.

Although there is clearly a need for new antibiotic drugs, which must be the Government’s main focus in tackling the potential tsunami of antimicrobial resistance that we face, Queen’s research shows that with effective delivery of antibiotics we will gain a better therapeutic effect against a main protagonist of pneumonia. The complex scientific work that Queen’s is doing should make a difference. Patients may need to take an inhaler of particles containing antibiotics, as opposed to a simple tablet, in the specific case of pneumonia. It is possible that an advanced formulation of drugs could slow resistance developing in some instances and generate better outcomes for patients. It may also mean that we could extend the useful lifespan of some of our current antibiotics. To take that to patients, we need to prepare clinical grade material, but advanced formulations such as nanomedicine are difficult to manufacture. Life is never straightforward, but when we are given a challenge we have to take it on.

Investment is needed in the UK to provide facilities that can advance these excellent therapeutic strategies before they can be tested on humans. We have a process to go through and we must walk along those lines. When we come to the end of the road, we want to ensure that the medication is appropriate and safe. Additional funding needs to be allocated to new approaches to treat infections. Again, the Minister may wish to tell us how the Government are working through the Department of Health and Social Care with universities, companies and research and development on how that process can work, and perhaps how it can work better.

By thinking outside the box, as exemplified by the Queen’s University Belfast research, we will find much-needed new therapeutics. Several projects at Queen’s University Belfast are reaching the pre-clinical stage and are being stalled by the lack of investment, since pharma are still not interested in supporting this essential work. There are ways of going forward, but we need a wee bit of security as well. The lady from Queen’s University who was here this week talking about breast cancer research was funded through one of the Government Departments in Northern Ireland. Queen’s University also gave her a position, which brought her a bit of income. That meant that she could do her research here in the UK, and we in the UK can get the advantage and try to advance that as well. Other UK Government schemes, such as those supported by Innovate UK, also fall short in supporting pre-clinical work because there is still no commitment from pharma. I ask the Minister to consider standing in the breach, if that is possible, and supplying the necessary support and funding for Queen’s and other research centres to help us to do better.

It is expected that by 2035 more than 500,000 people in the UK will be diagnosed with cancer each year. To ensure that our health service can meet future demand, action to prevent cancer and other diseases must be at the forefront of any approach. We have heard today some of the figures, certainly on the mainland in relation to cancer and some of the delays. There are many problems in the NHS, but we are here to help the Minister and to encourage him and the Department of Health to move forward.

The Government must train and employ more staff to diagnose and treat cancers earlier. We can be proud of what the UK Government—our Government—do on healthcare, but we strive to do more, and the Minister strives to do more. The Department of Health is already looking across the world to see how it can share expertise. The Department for International Development is helping countries to strengthen their healthcare systems. What else could we achieve if we joined up the dots and worked together more on implementing universal healthcare?

We should encourage countries to raise their own domestic resources for healthcare, which could have a transformative impact. DFID has been fantastic at supporting the health system to strengthen, but that is not always free, which leaves behind the poorest and most marginalised. I referred earlier to those who are unable to get their operation through the NHS, but are offered the opportunity to pay for it. I am very unhappy with that system; it suits some people, but not everyone. We have to be ever mindful that some of the poorest and most marginalised people in countries across the world are at the bottom rung of the healthcare ladder. We should share our expertise on domestic funding for the NHS with Governments around the world, encouraging Governments to spend more on healthcare.

From 2011 to 2015 there was a cross-Government strategy on global healthcare. An update strategy could include recommendations on domestic resource mobilisation. I understand that the Department of Health has a global health team. It would be helpful to know the remit of that team and how they co-ordinate with DFID on global health issues. What is the connection? Do they have any input to the policy, strategy and the way forward? Do they have regular meetings?

In February 2014, the world watched in horror as Ebola swept across many parts of Africa. We in this country did our bit immediately to respond. We sent our service personnel, our experts and our medication. We were not found wanting, and we never will be. The horror turned to pride as we saw that role that UK aid and our healthcare professionals played in stopping Ebola and saving lives. We should be immensely proud of what our people did, and what our Government did and continue to do. That was the UK Government at their best. They co-ordinated the response to a major global health crisis and supported a country’s health system. How well that was done! We owe thanks to those personnel and to our Government for leading the way. We would never wish for Ebola or something similar to return. What can be done to implement that sort of cross-Government approach to supporting health systems?

I thank hon. Members for coming along to support me, and the Minister for coming along to respond. I thank hon. Members for their time. How does the Minister believe we can excel, improve and achieve an even higher level of global care?

--- Later in debate ---

[Jim Shannon]

I certainly would, Mr McCabe. I thank you for chairing the debate so well. I also thank the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald)—my pronunciation is probably all wrong—and for Washington and Sunderland West (Mrs Hodgson), whose contributions were immense. The hon. Member for Hampstead and Kilburn (Tulip Siddiq) highlighted important issues with the BCG vaccine.

I thank the Minister for his comprehensive response. He always says that he is pleased to be in his position because he has a deep interest in the subject, and that was illustrated by his responses to everyone who spoke. He was right to say that we are celebrating the 70th anniversary of the NHS and its excellent work, and to focus on what we can do both here and around the world. I am glad he mentioned the importance of remembering, whenever we think about diseases and healthcare in this country, that we also have to prepare for the diseases that come into the country from outside. We have a joint approach, in which the NHS delivers great healthcare here and we share that healthcare around the world. For that, we are eternally grateful.

Question put and agreed to.

Resolved,

That this House has considered the role of universal health coverage in tackling preventable and treatable diseases.

Child Migration Programmes (Child Abuse)

Jim Shannon Excerpts

Tuesday 3rd July 2018 Westminster Hall

[Lisa Nandy]

I am very grateful to the hon. Gentleman for attending this debate and for raising that point. One of the reasons why it was important for me to bring this issue to the House for the first time for a full debate is that many Members have a strong interest in this area and in pursuing justice for the affected families. It is important that those suggestions are heard, and I hope the Minister has heard them.

Like Marcelle O’Brien, many of those who survived that horrendous period are still living with the consequences. Four years ago, the Prime Minister—then the Home Secretary—commissioned an independent inquiry into child sexual abuse. MPs from various parties, including me, welcomed that decision. The inquiry’s first full report is on this subject, and it is damning.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this issue to Westminster Hall. It is a pity that there are not more Members here to contribute, but I commend her for leading the charge. Does she agree that, given that every child migrant was exposed to an equal level of risk due to the failings in the system she has referred to, they must all be entitled to an equal level of redress?

[Lisa Nandy]

I am grateful for the hon. Gentleman’s interest in this issue. Although I agree that it would be great to see more Members of Parliament in the Chamber, one of the problems is that this issue did not get the coverage or attention it deserves until relatively recently. I hope that by bringing it to the House, I will help more Members to understand what is happening and more survivors to come forward so we can start to see action, which is long overdue. The hon. Gentleman makes a very important point: the report recommends equal compensation for equal risk. I have no desire to see survivors and victims have to prove what happened to them and recount those horrific stories again. The report was absolutely right to make that recommendation, and I would be grateful if the Minister could respond to it.

I mentioned the first full report from the wide-ranging, comprehensive inquiry into child sexual abuse. It acknowledges the role of churches and charities in causing harm to children, but it concludes that the British Government were primarily to blame for the continued existence of child migration programmes after the second world war. They failed to act, even when warned about allegations of sexual abuse. The report is devastating in its conclusion that

“the main reason for HMG’s failure to act was the politics of the day, which were consistently prioritised over the welfare of children.”

The Government did not want to risk their relations with Australia or to offend the voluntary societies that participated in the scheme. Ministers in successive Governments were cowed by the patronage and power of those who were involved in the schemes.

Despite that, the children were stronger. The truth began to emerge more than 30 years ago, thanks to their determination and courage. Even in the face of their bravery, successive Governments failed to accept responsibility. As the current Government recently acknowledged, the UK Government continued to maintain that it was a matter for the Australian Government until well into the 2000s. It is only because of the Child Migrants Trust, led by Dr Margaret Humphreys, who has rightly been described as the “conscience of Britain” on this important human rights issue, and a number of brave and persistent survivors here and across the world, many of whom will be watching this debate with interest today—some have had to stay up quite late to do so—that this became a matter of public attention that is still being pursued now.

The report of the independent inquiry into child sexual abuse was published four months ago. It recognised the importance of the public apology made by Gordon Brown in one of his last acts as Prime Minister, and of the family restoration fund, for which he and Andy Burnham, the then Health Secretary, found £6 million, and which has enabled more than 1,000 people to be reunited with their families. The current Government have since announced an additional £2 million for that fund, for which I am grateful. It is very welcome. I will return to that subject in a moment.

The report made just three recommendations: that the sending institutions that have failed to apologise publicly and in person to the children abused in their care do so; that all institutions that sent children abroad put in place robust systems for retaining and preserving easily accessible records of individual child migrants; and, finally, that adequate financial redress be made to the more than 2,000 surviving former child migrants. It also made it clear that this is urgent—many have died and others are dying, and it was unequivocal that the scheme must be up and running within 12 months.

In the four months since that urgent, devastating report was published, the silence from the Government has been deafening. Confusion about which Department is responsible has reigned. The Home Office made a short statement in March, when the report was published. The Department of Health and Social Care later responded to written questions. After four weeks of back-and-forth between those two Departments, I resorted to raising a point of order in the Chamber. In response, I was told that I could seek to raise the matter with the Prime Minister, which I did. I had to resort to going to the Prime Minister a month after the report was published just to get clarity from the Government about which Department is responsible. Four months on and multiple attempts later, the Government are still no clearer about their response and have still not told us when it will be made.

I am not the only one who has hit this brick wall. The Australian law firm Hugh James, which acts for former child migrants, shared with me a letter it sent to the Health Secretary. It said:

“We hand delivered a letter concerning this matter to the FCO on 26 April 2018. We served the enclosed letter on the Prime Minister’s Office on 29 May 2018. On 5 June 2018 we were informed by the Prime Minister’s Office that both of our letters were passed to your department. We are disappointed we are yet to receive a response from you and we ask you to contact us as soon as possible.”

That was two weeks ago. I ask the Minister, when will that firm get a reply on behalf of those former child migrants?

I want to say something really serious to the Minister today. The Child Migrants Trust tells me that, in the time that the Government have sat on the report, 10 former child migrants have died. Ten people died not knowing whether the Government will now draw a line under one of the darkest periods of our history, and whether they are committed to truth, redress, justice, and learning lessons to ensure this never happens again. That is the legacy those people deserve. Still now, the state, which did so much harm to them at the beginning of their lives, continues to do harm to them all the way through until their death. That cannot go on.

Will the Minister explain the reason for the delay within Government? Will she assure us that this is now the highest priority and is being dealt with a matter of urgency? As well as being a clear question of justice, this goes to the heart of whether any of us can have confidence in the child sex abuse inquiry that the Prime Minister established. She told the House when she set up the inquiry that she believed it to be essential that the lessons that come out are not only learned but acted upon. As the Minister knows, the inquiry has been beset by problems since. It has been through four chairs and has faced serious allegations of misconduct. It has cost £64 million so far—the costs are rising—and has lost the confidence of many victims’ and survivors’ groups, which have walked away over that time. Many, however, continue to invest time and energy in the inquiry, because they hope that it will make a difference. That first report must have been a sign of encouragement to them that the inquiry would not shy away from asking the difficult questions and telling the truth.

Now the Government must show that they are serious about taking action, and get on with doing so. It has been four months, and at least 10 people have died in that time, so will the Minister tell us today, do the Government accept the report’s three clear recommendations? If she cannot tell us today, will she at least commit to a full and formal response to the report before the summer recess? That request comes directly from child migrant groups, and I would be grateful for a clear answer.

The inquiry made huge progress in ensuring that apologies were made. Many organisations, including the Children’s Society, where I once worked, took the opportunity afforded to make a welcome but long-overdue apology. Will the Minister tell us, however, what progress has been made to ensure that the records are kept and made available? I have been told that the Prince’s Trust—it took over Fairbridge, which was involved in the child migration programmes—has not yet made all its records available. Have the Government contacted the agencies listed in the report to ensure that such measures are in place? What has been the response of those agencies? If the Government have not yet done that, will she commit today to doing so?

What progress has the Minister made on the question of financial redress? Has she assessed the numbers of those who might qualify? Has she done a scoping exercise to determine potential costs? In the past four months, what discussions have the Government had with the independent inquiry into child sexual abuse and the Child Migrants Trust about implementing the recommendations? Does she accept the principle, mentioned by the hon. Member for Strangford (Jim Shannon), of equal compensation because children were exposed to equal risk?

Let me compare the UK Government’s response and their position with Australia’s. In December 2017, a royal commission in Australia published the results of its five-year investigation into child abuse and recommended a national redress scheme. Within two months the Prime Minister had responded and set a deadline of 1 July. Legislation was fast-tracked through Parliament last month, and the scheme began accepting applications on Sunday, as promised. The scheme offers not only monetary payments but access to counselling and a direct personal response. Survivors who are elderly or ill will be fast-tracked but, in any case, the promise has been made that claims will be processed within weeks. Redress payments will not be taxed. The average payment is expected to be about 76,000 Australian dollars, which is about £42,000 in our money.

Surely it should shame us that the country the child migrants were sent to is responding, but not the country that sent them there—the country that was responsible for their care and welfare at the time. How can it be right that the Australian Prime Minister can respond to a report with 409 recommendations in only two months, but our Prime Minister cannot respond to a report with only three recommendations in more than double that time? Has the Minister made contact with Ministers and officials in Australia to understand how they established that scheme and to learn the lessons? Will she tell me today that the Government at least accept the principle of financial redress? Will she confirm that a scheme will be up and running by March next year, as per the IICSA’s recommendation?

The Minister is aware that when Gordon Brown made a formal apology in 2010, the full extent of the abuse was not known. He and many of the survivors therefore believe that a full apology is overdue. In this matter, I have to disagree with the conclusion of the independent inquiry’s report—not to recommend a further apology—because the harms caused by the migrant programmes are many and complex. That is why it matters that we recognise not simply the harm done to children by separating them from their families and countries, but the additional sexual, physical and emotional abuse laid bare so starkly by the report and the harm of our failure to confront it over successive Governments and many decades. Will the Minister commit to that today, or at the very least provide us with a date by which time the Prime Minister will respond to that specific request?

Another pressing need is a commitment to continue the family restoration fund beyond 2019. One thousand people remain to be reunited with their families, and there is a waiting list. I welcome the Government’s commitment so far, and the £2 million that they made available to the fund, but its continuation is of central importance. Many of the mums and dads of the former child migrants went to their graves not knowing what had happened to their children or even whether they were dead or alive. They never found out that they had become grandparents, and they never saw or got to hold their children ever again.

The family restoration fund has enabled some of those deep wounds at least to start to heal, and important work remains to be done before it is too late. The Minister knows, as I do—as we all do—that many of the former child migrants have died and that others are seriously ill and dying. Every day counts. The fund will enable nothing less than a restoration to families of the rights stripped away from them many decades ago. Will she give us a commitment that the fund will be continued until all the former child migrants have been able to seek to be reunited with their families?

This has been one of the most shameful episodes in British history. For 30 years we have known about the scandal but failed to act. The harm that was done then is compounded by our knowledge that it continues to cause harm to people in this country and across the world, yet still nothing is done. The secretary of the International Association of former Child Migrants and their Families, Harold Haig, put it movingly when he said on the day of the formal apology by Prime Minister Gordon Brown, that

“our thoughts are with those child migrants who have died and particularly those who ended their lives because the wounds were too deep and too painful”.

At least 10 people have died that we know of since the report was published four months ago. I hope that the Minister will tell us today that no more will die suffering harm from the British Government, and that we shall finally deal with one of the darkest periods in our history.