Hemel Hempstead Urgent Care Centre

Jim Shannon Excerpts

Tuesday 13th March 2018 Commons Chamber

[Sir Mike Penning]

Thank you, Mr Speaker. I have even longer to pontificate, which is great news.

Justin Dealey acquired an interview with the said Ms Fisher, the chief executive of West Hertfordshire Hospitals NHS Trust. It was quite a long interview, in which Ms Fisher indicated:

“This is a short-term measure which is us acting in the interest of patient safety because, for the next few weeks over the festive period, we are unable to secure GP cover.”

I think most people would understand that, but not if they knew that the GPs were working in the room next door. But that is a separate issue. Justin went on to suggest that surely Ms Fisher understood that local constituents would have real concerns, and asked her whether she would be concerned if she lived in the area. She said:

“I completely understand their concerns, but what I want to reassure the residents of Hemel is that if there were to be any permanent change it would be our absolute intention to include people fully”

in that decision. She went on to say that

“legally we would be obliged to consult for a permanent change of that nature.”

That press release was issued not before Christmas this year but in December 2016. We have had no night provision at all in Hemel since then. Everybody has to go for urgent treatment to Watford A&E. Alternatively, they have to dial 111, which is an excellent service, but after they have been triaged they apparently get sent to Watford A&E. Watford has just come out of special measures, and I praise the work that has been done at the hospital but there is still a lot more to be done.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Gentleman for giving way. I sought his permission to intervene on him beforehand. He is outlining very well the issue with the Hemel Hempstead urgent care centre. Does he agree that, although there is immense staffing pressure, closing or scaling back on urgent care units and minor injury units only adds to the pressure on A&Es? There must be more investment in these mid-level centres if we are to prevent the A&Es from crumbling under the weight of the work they have to do.

[Sir Mike Penning]

I clearly agree with my hon. Friend. It was kind of him to come and tell me that he wanted to intervene on me on behalf of other parts of the country that are facing similar pressures.

This was not about money. Normally, when our constituents come to talk to us, especially about the health service, it is about money. They tell us that they are really concerned that there is not enough money to provide the services, but on this occasion we were told that this was nothing to do with money. It was to do with the contractual problem with the GPs. We kept on asking what was going to happen, and then—completely out of the blue and still without consultation—we were told that the Government had said that there should be no more urgent care centres and that they should become urgent treatment centres instead. I was repeatedly told that it was the Government saying that this should be done. I asked whether the Government had said that the centre should not be open 24/7. I was told no, but that we had to move to being an urgent treatment centre. In the past couple of weeks, the unit has changed from being an urgent care centre to being an urgent treatment centre. Interestingly enough, that means that paramedics and nurse practitioners are running the facility, and in many cases—without being rude to our GPs—they have more skills than a basic GP. I have to declare an interest, in that I was a military paramedic, so I am slightly biased about these things.

Was there a consultation before that decision was made, not just to close the UCC but to change to a UTC? No, there was not, even though it is a legal requirement to have one. We are now in a consultation, however. I could not believe it when I first heard this, but I have now heard from several constituents that in the actual meetings that took place—not when people were writing in—when different plans and options were being put to my constituents, a member of the clinical commissioning group staff was at the table trying to convince the public what sort of option they should go for. If we are going to consult the public, surely we should trust them and then have the confidence to listen to them.

What I find really fascinating about what is happening in my part of the world is that people from nowhere near my constituency—from the other side of Watford—are being consulted. They would never come to my facility in a million years—unless they just happen to be in the area—but they apparently have the same rights in this consultation as my constituents, who are again losing facilities hand over fist. Those other views are being taken into consideration because they happen to be part of the trust area. My constituents just scratch their heads and say, “This is illogical.” This facility, even though it is part of the NHS and anybody could come to it, is obviously being used by the largest town in Hertfordshire and the other towns and villages within Dacorum. However, I have no problem with the people of St Albans being consulted over this, because they are clearly part of the process.

Trust has been severely damaged. A highly paid chief executive of an NHS trust went on the radio—telling an MP is one thing, but going public is another—and tells listeners, “This is temporary. Please do not worry; it will all be okay. By the way, if I did actually change the service, that would be illegal because I have not consulted.” Frankly, when they then did not consult—the UCC is quite clearly never going to open again—that breaks the trust.

I have raised the accountability issue in the House before. It is absolutely right that my good friend the Minister on the Front Bench does not make decisions about what A&Es and UCCs are open and how many beds there should be. Those are quite clearly clinical decisions that should be based on knowledge and demand in the area—that is not what happened when our A&E was closed—but we seem to have moved from one extreme to another. I am told that if we want to challenge the consultation, the only way is to put the decision to judicial review based on the consultation. We tried that when the A&E was closed and we got a judicial review. The judge was generous and said, “You have a moral case, but you probably don’t have a clinical case. You don’t have a case in law, because the consultation was done.” However, if the consultation was a complete sham or did not take place at all, where do we go?

I have asked Ministers, I have tabled questions and I have been to see the Secretary of State. At the end of the day, who are these people accountable to? I know that we can go to the health committees at the local council, but they do not have the powers to say that an individual or a trust has brought the NHS into disrepute, and yet that is what has happened here. Nobody was twisting the chief executive’s arm to go on the radio and say what she said. We all listened to it—I got a transcript the following morning—and I sat with Justin and said, “Well, that’s it, Justin. We’re okay.” I was not at all happy about the facility being closed over the 2016 Christmas period, but at least we knew that GPs were going to be recruited and that we were going to get there.

However, the exact opposite has happened. We are not getting the GPs back, and now the facility being open 24 hours a day is only one of the options. I know that the Minister’s notes will say how many people used to go to it at night and so on, but half the problem was that it was never properly promoted. There are access issues at the A&E because so many people are turning up and being triaged when a huge percentage of them do not need to be at an A&E but somewhere else within the NHS. I would argue that they should be at a UCC or UTC or that a GP should come out to them, but that is a separate issue because hardly any GPs make home visits in my constituency.

I know exactly how things work, because I was a Minister for a while and know about the advice that comes down from the trust and the clinical commissioning group, which will say things that are different from what I have said. However, I can honestly say that if there is one issue in my constituency that absolutely unites every political persuasion on my patch, it is the acute health provision in my constituency. We pushed a coffin on a hospital trolley all the way from Hemel Hempstead Hospital to Watford, to indicate that lives would be lost. We had debate after debate with the ambulance service, which said, “Don’t worry, we can get the ambulances there on time.” It probably could, if it rushed them through on a blue light in the middle of the night—if an ambulance was available. Because of the previous Administration’s botching of the regionalisation of the ambulance service, there are often not that many ambulances available, even though the ambulance depot is on my patch.

People do not want to clog up A&E; they want to have the confidence that there is somewhere safe that they and their kids can go for treatment. We have no idea what the conclusion of this retrospective consultation will be. We have no faith that even if the conclusions are in agreement with what we want, we will actually get it. Not all my constituents agree with me, but in a treatment centre I would rather have a highly qualified paramedic nurse practitioner than—I have to choose my words carefully here—an ordinary GP, simply because the paramedic nurse practitioner has so much experience in that area. That is where the modernisation of the health service has been so brilliant. But after telling me that the decision was not about money, it is, frankly, disgusting to sit people down at consultation meetings and try to convince them that it would be better if the centre was not open 24 hours a day.

I hope that the Minister understands how passionate we are about the matter. My constituency is 17 minutes from London and it shares a boundary with yours, Mr Speaker. People in the top part of my constituency all go to Luton and Dunstable—quite rightly so; it is an excellent facility—and those in the bottom part of my constituency, or anyone who comes off the M1 and the M25, end up going to Watford for their acute care.

I want Watford General Hospital to succeed. I think the location of the site is completely ludicrous, and we need a new general hospital for the growing population in our part of the world. I know that you have pressures on housing, Mr Speaker, as we have. But I want the houses, because I want people to have somewhere to live—so many families are struggling at the moment—and if we are to build those houses, we need facilities, such as schools and everything else. When my constituents go to bed at night, they need to know that the urgent care centre is open in case something happens; and that if they cannot cope, we can blue-light them to Watford or to Luton and Dunstable.

I have tried for weeks and weeks to get this Adjournment debate. My hon. Friend the Minister is lucky, because I had been asking for a 60-minute debate in Westminster Hall. We may yet end up there, but that will depend a lot on what he says from the Dispatch Box.

Respite Care for Vulnerable Adults: Teesside

Jim Shannon Excerpts

Monday 12th March 2018 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I am grateful for the opportunity to highlight an issue which is specific to Teesside, but which I am sure will have parallels throughout the country. Let me start with a well-worn quotation:

“If you’re one of those families, if you’re just managing, I want to address you directly. I know you’re working around the clock, I know you’re doing your best, and I know that sometimes life can be a struggle.”

Ministers are probably fed up with Opposition MPs quoting those words spoken by the Prime Minister just 20 months ago, on the steps of Downing Street. We keep mentioning them in many different contexts while we see our communities suffer as the promise that followed fails to meet their needs.

Parents of some of the most vulnerable people in our community believe that there is a respite care crisis in Teesside. No one works harder around the clock, doing their best and struggling to cope and care, than the parents and siblings of vulnerable adults, some of whom have the most complex needs imaginable. Those vulnerable adults, with some of the most extreme personal needs, may be in their 30s, 40s or even 50s, which means that the parents caring for them are in their 50s, 60s or 70s. We as a society owe those parents and carers a huge debt of gratitude. They choose to care for their loved ones at home. They do not hand them over to the state because they cannot cope; they get on with the job. They endure the sleepless nights, they clean up after their family members, and they give them the love and dedication that they need. To be honest, they do not ask for much in return for the huge burden they shoulder on behalf of us all, yet we often let them down by failing to provide the support they need, and on Teesside that appears to many to be getting worse instead of better.

I know that this issue is not exclusive to Teesside, but this evening I want to speak on behalf of the parent carers whose loved ones use the residential provision at Bankfields and Aysgarth on Teesside, and all those families who rely on residential respite care to give them a break from caring and have just a little bit of time for themselves.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate; we have almost an hour and fifteen minutes to speak on the subject, which will be nice. One in 10 people in Northern Ireland are carers, and what the hon. Gentleman is describing is happening in Northern Ireland as well. Does he agree that short-term respite care must be provided to assist in securing the long-term benefit of keeping people in their homes and semi-independent, and that respite care should be offered, and should not have to be begged for?

[Alex Cunningham]

I thank the hon. Gentleman for his intervention, and I agree with him: the longer people are supported to stay at home, the longer they are not an even greater financial burden on the state. I will develop that theme later.

Such is the crisis in health and social care in our country that our NHS commissioners face difficult choices, and families are very worried that they could be facing a substantial cut in the provision offered to them as the local clinical commissioning groups seek to stretch the limited resources they have to meet an increase in demand for support. The CCG for north Tees and Hartlepool and the South Tees CCG are reorganising the way they provide residential respite care. When I met the north Tees chief executive on Friday, she told me of the need to have needs-based services and the plan to review exactly what each individual needs. I know, and so does the Minister, that we must have equity in the system and meet the needs of each individual, and I do not have a problem with that, but, sadly, the review is being interpreted by the families as a cut in provision, with some believing they could lose up to half their respite nights, which they are very anxious about.

I definitely agree that provision should be right to meet the needs of the individual, but this issue is much greater than that: it is also about the needs of the whole family, and perhaps the CCG should have conducted a needs assessment before deciding on the review. In fact, I have always thought that the respite care was very much for the family— an opportunity to take a break from their caring responsibilities, to recharge the batteries and to prepare to resume what they see as their duties.

The CCG has been at pains to stress to me that its proposals do not necessarily mean that there will be a huge reduction in the number of respite nights, but it recognises things will change for some people and is working with families and piloting different ideas to try and improve provision and reassure them. While I think the CCG could have handled this whole business better and understood more comprehensively the issues from the perspective of the families and the various local authority and joint health scrutiny groups who oppose the plans, I cannot say it is its fault.

--- Later in debate ---

[Dr Paul Williams (Stockton South) (Lab)]

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate. I also congratulate him on his leadership in this area and on his engagement with the families and the clinical commissioning groups.

The challenge of being a carer for an adult with complex needs is a lifelong challenge. I have enormous respect and admiration for the people who do this work. My grandmother’s sister—I have just worked out that she is my great-aunt—has spent her life looking after several different adults with complex needs. She adopted them as children and has cared for them. I have seen the enormous amount of love and compassion that she has given them, and I have seen in all my constituents who have contacted me, and in my work as a GP in my constituency, the love and compassion that go into looking after adults with complex needs. But this comes at a cost for carers, mainly to their health. They often prioritise the needs of the person they are caring for and do not think about preventing their own ill health problems or about properly looking after problems as they arise. There is also a time cost. Being a carer for an adult with complex needs is a massive time commitment, a money cost and a career cost. So there is huge cost.

[Jim Shannon]

It is also important to get the issue of young carers recorded in Hansard. I have a vibrant young carers association in my constituency, in Regent Street, Newtownards. The work they do with elderly family members is the reason those families are together, so the issue of young carers is so important. Does the hon. Gentleman encounter the same issues I have in my area when it comes to young carers? Does he agree on the importance of keeping families together and of what young carers do?

[Dr Williams]

I thank the hon. Gentleman for highlighting the needs of young carers. In my constituency, as in those of all Members in this House, there are young people who grow up suddenly when they find themselves needing to be carers and who really do hold families together.

In the context of how difficult this caring can be and the tremendous efforts that people make in order to keep their loved ones well and look after them, the provision of occasional respite is the least we should be doing as a society. It is the least we should be doing to say thank you and to sustain the incredible efforts that these people are making. Like my hon. Friend the Member for Stockton North, I give some credit to the two CCGs involved, Hartlepool and Stockton-on-Tees CCG, and South Tees CCG, for taking some responsibility for this. We all see the constant jostling between local authorities and commissioners of health services about who should fund these issues in a time of austerity, but our CCGs have stepped up to the plate and taken ongoing responsibility for funding these issues.

However, a number of constituents have contacted me in what I can only describe as a state of panic during these consultations and since the outcome of the consultations was announced. They are fearful that their much-needed breaks are going to be taken away from them. As my hon. Friend pointed out, their fears may well prove to be ill-founded, but this should not mean that they should be discounted. Change is always difficult for people, but the possibility of services being cut has caused genuine anxiety for these people and we should rightly be recognising it. We all know that caring can be physically demanding, but it can also be mentally demanding, especially if it is being done for long periods of time. Adequate respite is essential if these carers are to be able to maintain their own health and wellbeing. It is also essential that carers are closely involved in any decisions about what is adequate and appropriate for their family members and for themselves. As he has said, a respite package should be designed around the needs of the whole family, not just those of the individual with complex needs.

What we are seeing, though, is limited funding. I do not know whether this is ring-fenced funding that the CCG has or whether it is taken from an overall pot, but there is limited funding. CCGs have a number of conflicting priorities. We know that throughout the health service demand is increasing and outstripping any increase in resource that it has. The limited funding and the rising need for this particular kind of care mean that for some people packages of care are likely to be reduced. That is causing people significant anxiety.

Before I finish, let me say that our experience on Teesside illustrates that health and social care do not exist in isolation from each other. Some small steps have been taken, including by changing the Department of Health’s name to the Department of Health and Social Care, but respite care is a really good example of where some more concrete steps can be taken to bring together health and social care funding. There should be a partnership between local authorities, clinical commissioning groups, parents, carers and the people with complex needs, so that they can work together. Respite care is an issue on which we should be seeing integration at its best. If we are talking about integration, I have to take the opportunity to talk about the forthcoming Green Paper on social care. It is inconceivable for me that in 2018 we should be considering social care in isolation. Will the Department think about whether the Green Paper should really be on health and social care together, rather than just on social care?

I pay tribute again to the carers who have come together to fight for the very best services for their loved ones. They deserve for us to listen, to consider and to act, so that they get the respite services that they need for themselves and their families.

--- Later in debate ---

[Caroline Dinenage]

That will of course be a matter for the Secretary of State, who will deal with it in the appropriate way.

The Care Act also requires local authorities to take a preventive approach to addressing people’s needs in taking steps to intervene early to prevent or delay any worsening of an adult’s need for care and support. This would of course include the carers about whom the hon. Gentleman and his colleagues care so passionately. It is really important to allow carers to take the respite that we have spoken about.

The hon. Gentleman might be interested to know that the Autism Act 2009 requires the Government to have a regularly reviewed autism strategy and to issue guidance to local authorities, NHS bodies, and foundation trusts. In addition, the Children and Families Act 2014 introduced a new statutory framework for children with special educational needs and disabilities. This gives commissioners very clear responsibilities towards those with learning disabilities and autism, including those who may be affected by the review on Teesside.

[Jim Shannon]

I think that everyone in this Chamber will have a knowledge of autism. The Minister will be aware that we have an excellent autism strategy in Northern Ireland, and there is also a very good strategy in Wales. Has she had a chance to check out both those strategies in order perhaps to introduce them, in full, to England?

Childhood Obesity: Bexley

Jim Shannon Excerpts

Tuesday 6th March 2018 Westminster Hall

[David Evennett]

That is a very valid point. Recipes, portion sizes and calories need to be looked at and addressed. I urge all restaurants, fast food outlets and food manufacturers to look seriously at how they can reduce people’s salt, sugar and calorie intake. We have to address that, as I am sure the Minister will accept later.

The statistics for childhood obesity in Bexley are mixed when compared with those for the rest of England. There are areas of public health where we do much better, and I will highlight the stop smoking campaign, which has been very successful across our borough, but unfortunately childhood obesity is a real issue in the borough and needs attention.

It is widely accepted by health experts that once weight is gained, it is difficult to lose. The Government have called childhood obesity

“one of the top public health challenges for this generation”.

That is certainly the case for Bexley. The Government are well aware of the issue nationally and are being proactive in addressing the concerns. The childhood obesity plan in 2016 was a welcome step forward, but plans need to be actioned; we are looking for results and outcomes. Measures in the plan included the soft drinks industry levy, which will apply to manufacturers; a recommitment to the Healthy Start voucher scheme, enabling low-income families to buy fruit and vegetables; and action to increase physical activity in schools. We all appreciate that there is no quick fix, but that is the first step on a long journey that aims to

“significantly reduce England’s rate of childhood obesity within the next ten years.”

We do need an understanding and a culture change.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Gentleman for bringing this matter to the House. It is in the news every day—indeed, it is in the news this morning—and it is very important for people back home in Northern Ireland. “Childhood obesity in Bexley” is the heading for this Westminster Hall debate on the Order Paper, but in Northern Ireland we have similar figures—of children aged between two and 15, 17% are classed as overweight and 8% as obese. Does the right hon. Gentleman feel that it is time for the Department for Education and the Department of Health and social care to work together to put in place a strategy to reduce childhood obesity, which would clearly involve schools?

[David Evennett]

I thank the hon. Gentleman for his comments and totally agree with him. I think that the Department for Education and the Department of Health and Social Care are working together, but more needs to be done. I appreciate that this is not just a Bexley issue—it also matters to the people of Northern Ireland and across the country—but I specified Bexley because it is particularly bad compared with other places.

The earlier a child is exposed to obesity, the earlier they can experience medical consequences and problems. In fact, a study by Cancer Research UK found that obesity could cause 670,000 cases of cancer nationally over the next 20 years, plus millions more cases of other diseases, including type 2 diabetes, heart disease and stroke. Obesity and the medical problems stemming from it cause problems for our whole society. It causes a loss of productivity in the workforce. It restricts opportunities for individuals. And it adds another burden on to our NHS. In fact, Cancer Research UK also claims that the cost to the NHS per year by 2035 could be an additional £2.5 billion, over and above what is already spent on obesity-related diseases. Of course, quality of life can also be reduced by being heavily overweight, as that restricts opportunities and choices.

Childhood obesity is strongly linked to adult obesity. According to the Royal College of Paediatrics and Child Health, four in five obese schoolchildren are likely to be dangerously overweight for life. Therefore, we have to act early, before there are serious consequences from something that is avoidable.

I have said that, statistically, Bexley is not performing well, unlike other areas, where provision and action are good. In Bexley, the prevalence of overweight or obesity among children in reception classes is 26.7%. That is worse than in London in general and in England in total. In year 6, the figure in Bexley increases to 39.4%, which is almost one percentage point higher than the London average and more than five percentage points higher than the England average. That is very disappointing. When we consider that in Bexley 12.3% of reception age children and 24% of year 6 children are obese, it is a real cause for concern. Let us look at the trends over time. The number of overweight or obese reception age children in Bexley increased from 20% in 2007 to 26.7% last year. That is why we are raising this issue today with the Minister—to highlight the issues that we have in Bexley.

Diets, of course, play a very important role in lifestyle. Approximately 54% of adults in Bexley meet the “five a day” recommendation for fruit and vegetables. Again, that percentage is below the London and national averages. It does not set a good example for our children. Sadly, children do follow their parents and grandparents, and when habits are formed young, the consequences are great. We need to promote and pursue the importance of fruit and vegetables. Fruit can be an enjoyable snack and an alternative to chocolate, cake and sweets, while a diversity of vegetables is essential to a balanced diet.

Bexley Council—a good, Conservative-led council—is taking action. Just over a year ago, Bexley joined the nationwide Sugar Smart campaign led by Jamie Oliver. The aims of the campaign for us are to educate people and raise awareness across Bexley about the harmful effects of excess sugar consumption, and to reduce individuals’ sugar intake across the borough. The council is encouraging local organisations and businesses to participate in the campaign and support this very important initiative. Bexley has now signed up to the campaign 16 participants, including a number of schools, and I hope that the figure continues to grow during the rest of this year, because that is a very important facility and opportunity.

I am grateful for the information that has been given to me by Dr Anjan Ghosh, who is the director of public health and deputy director of health and wellbeing at the London Borough of Bexley. Dr Ghosh advises that the Bexley health and wellbeing board recently signed off on the development of a system-wide prevention strategy that is far reaching and ambitious in scope and has the potential to harness council, NHS and community assets in improving health and wellbeing outcomes, helping Bexley residents to start well, live well and age well. The strategy is currently in development, and part of that involves developing an obesity strategy for Bexley that has the same population health focus.

Part of the work is to unpick why obesity statistics in Bexley are poor compared with statistically and demographically similar London boroughs. The programme includes a two-tier child weight management programme for children aged four to 11 and their families, a family lifestyle programme and guidance to support healthier living, eating and lifestyles. Each category programme is designed specifically to provide age-appropriate messages, activities and behavioural change that will benefit the whole family. Once the 12-week programme is over, there will still be access for the families and young people to drop in, to update themselves and take the service further.

I know that schools and teachers are doing their very best to advise children, as well as to educate and support them to eat well. However, parents, as the primary educators, have primary responsibility and we need more support from parents. The scale of the issue is huge. I will not go through the statistics of how many biscuits, cakes, ice-creams and all those type of foods are consumed by young people every year, or how many calories those foods and fizzy drinks contain.

One has to say that it is a worry to see secondary school children coming out of school in the afternoon into Bexleyheath, going to the fast food outlets in the town and consuming burgers and chips, which have an enormous calorie intake. That is a huge concern. There has been an increase in our borough of waffle shops, ice cream parlours and other fast-food outlets. While it is good to see business thriving, it is worrying that some are exacerbating the problem and increasing the sugar and calorie intake of our youngsters. Treats are fine for special occasions, but should not be the mainstay of an individual’s diet. I am not a killjoy, but everything should be in moderation. In addition, I think that many of us eat too much and have portions that are too large. That is why the report I have highlighted this morning is so important.

[Jim Shannon]

Further to that point, on the news this morning they were saying that they were not against the idea of fast-food outlets, but we should have smaller portions. In other words, if we start with smaller portions, it will be a step in the right direction and maybe that is the way to go forward.

[David Evennett]

I think that is absolutely right. The hon. Gentleman highlights the calorie content and intake, which is so important.

I also want to highlight physical activity, or inactivity, which is a huge problem that can lead to obesity and is the fourth leading cause of global mortality. Increasing activity levels could help to prevent a number of illnesses, including cancer and diabetes. Regrettably, in Bexley, over 21% of adults are physically inactive.

I was honoured and privileged to serve as Sports Minister in the then Department for Culture, Media and Sport for the first half of 2016, while covering the maternity leave of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch). It was a brilliant experience to go around the country and see first-hand how sport can make a real, positive impact on people’s lives. We must promote the wide range of sports available out there and their benefits. Sports participation is a great way for young people in particular to become physically active, improve their health and fitness, and—depending on the sport—to be part of a team, socialise and be part of something, gain motivation and confidence, and also have fun. We all know that sport is fun.

I know that the Minister will agree with me on that. I used to be a keen tennis player. I do not get time for that now, but I am still a keen walker. We have places such as Hall Place and Danson Park in our borough, where one can have a good walk. It is a really invigorating experience. I also enjoy going to north Norfolk and Sheringham Park with my wife, Marilyn, and we have long walks along the north Norfolk coast. That is important exercise.

In conclusion, we must take action on all fronts. The concern is not only the advertising and promotion—in supermarkets we still see the calorie-laden chocolates and what have you by the check-out, which is a worry too—but what parents are feeding their children and the fast foods. The intake of sugar and salt is too high. The issue is people making sensible lifestyle choices, to ensure that they are eating healthily and looking after their health. I know that my hon. Friend the Minister is aware of the serious issues across the country. Government, industry, schools, the NHS, families and friends all have a part to play to ensure that we are eating and living healthily.

The benefits of reducing childhood obesity are clear. It will save lives, but it will improve the quality of young people’s lives, which is important. Education is the key. We need to educate our children and businesses. We need to encourage everyone to be more active and eat better. We need more promotion of sports and to continue to reduce children’s calorie and sugar intake. We need to educate parents and grandparents on the risks of lifestyle to themselves and their families. Of course, publicity and promotion are important, essential in fact. Politicians at local and national level should get on board too and need to be engaged to achieve results. For our Borough of Bexley, we need results. I look to my hon. Friend the Minister, who I know well, to take these matters seriously and give us the lead.

NHS Wholly Owned Subsidiary Companies

Jim Shannon Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist]

I most certainly do agree with my hon. Friend. We know that NHS trusts are under incredible financial pressure and are looking for ways to stretch the available funds. Some trusts have seen wholly owned subsidiaries as a way of reducing costs. Those trusts include the Gateshead Health NHS Foundation Trust, which provides excellent hospital services to many of my constituents.

The cost savings come about in two main ways: through saving VAT and by saving on staffing costs. For some, there may be a third area of income—advising other NHS trusts on going down the same path, which is one of the reasons why they are spreading across the country. In November 2017, the then Health Minister, the hon. Member for Ludlow (Mr Dunne), stated that:

“NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts”—[Official Report, 14 November 2017; Vol. 631, c. 129.]

We know that more are being created even now.

[Jim Shannon (Strangford) (DUP)]

The issue of pensions is very much at the forefront of the minds of myself and others in this House. Does the hon. Lady agree that it is essential that staff working through the front door of the NHS or the back door of the wholly owned subsidiary company must be entitled to retain their NHS pension? Any attack on the pension scheme must be wholly rejected and the trusts must all be made to understand the position on pensions when these types of actions are taking place.

[Liz Twist]

I most certainly do agree, not just for pensions but also for terms and conditions.

What is the problem with these companies? First, it is that they come at a price, which for the most part is met by the staff who work for them. Secondly, the VAT saved by trusts with these companies is not new money coming into the NHS—the money that trusts save will be lost elsewhere in public services. Already, the Department of Health and Social Care has reminded trusts by letter that they should not engage in any activities that may be construed as tax avoidance, and the loophole could be closed in the future. Thirdly, the establishment of wholly owned subsidiaries leaves the services open to privatisation in the future, continuing the fragmentation of our NHS.

Eating Disorders Awareness Week

Jim Shannon Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Over the years, a number of my constituents have had these problems. Through the good work of the NHS and the Beat organisation, to which he has just referred, they have been able to pull through to the other end. In Northern Ireland, we have some 20,000 people who suffer from eating disorders at any one time. Given that fact, does he feel that the Government could enter into discussions with the regional assemblies across the whole of the United Kingdom of Great Britain and Northern Ireland to agree a strategy that can accommodate where we are in the UK?

[Edward Argar]

The hon. Gentleman makes a very important point. This is one of those issues on which I would hope we can see the widest engagement across the UK, across all involved in government and the provision of services, to come up with a coherent and common approach to beating eating disorders.

Diabetes

Jim Shannon Excerpts

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

I absolutely agree. The hon. Lady makes an excellent point, and I will cover that later in my speech.

As the hon. Lady says, the number of people living with diabetes is rising fast. Every day, around 700 people are diagnosed—that is one person every two minutes. It is estimated that by 2025, 5.2 million people will be living with diabetes. With 10% of the total NHS budget being spent on diabetes every year, it is important that we talk about treatment, prevention and the future of diabetes care, particularly as 80% of these costs are spent on the complications of diabetes, many of which are avoidable through better care.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing the debate. I declare an interest, as a type 2 diabetic, like the right hon. Member for Leicester East (Keith Vaz). There are some 100,000 people with diabetes in Northern Ireland at present, and we have the largest number of type 1 child diabetics in the whole of the United Kingdom. The issues in Northern Ireland are very acute. Does she agree that the NHS should widely fund not only insulin pumps for children with type 1 diabetes, but training, to ensure that children can use those pumps, to make their lives better? I think it is important that we do so.

[Liz McInnes]

The hon. Gentleman makes an important point. I will talk about the technologies that are available for the treatment of diabetes and about education and information, so I hope I will answer his question later in my speech.

The hon. Gentleman emphasises the point that I was going to make, which is that it is really important that we listen to the voices of those living with diabetes. The charity Diabetes UK recently published a report entitled “The Future of Diabetes”, based on a consultation with more than 9,000 affected people. Those people said that, as well as a need for a better understanding and awareness of diabetes, there are a number of ways in which diabetes care can be improved.

In 2016 the Care Quality Commission produced a report entitled “My diabetes, my care”, based on a survey of a smaller number of people, but it came to very much the same conclusions. People living with diabetes want more support for their emotional and psychological health. The effect of varying blood sugar levels on mood and the relentless need to manage the condition can affect mental health.

--- Later in debate ---

[Liz McInnes]

My hon. Friend makes a very important point. It is up to healthcare professionals to encourage those voluntary groups to get together, to enable people to give each other support. That was one of the findings of the Diabetes UK survey: people wanted to come together to offer each other support.

[Jim Shannon]

Further to that point, this morning’s news reported on the millennium child and an increase in diabetes as a result of diet. Does that not underline exactly what the hon. Lady has argued today, which is that we need to do something now? If the millennium child—the adult of tomorrow—is going to have high levels of obesity and diabetes, there is a real need for a strategy right now.

[Liz McInnes]

I completely agree with the hon. Gentleman’s very important point. I was struck by that item on the news first thing this morning. It is coincidental that it was announced today and I will refer to it in my concluding remarks.

For type 1 diabetes, research priorities include reducing hypoglycaemic episodes, exploring the effectiveness of different insulins and technologies, and research into the artificial pancreas, which monitors blood sugar levels and automatically injects the right amount of insulin.

For type 2 diabetes, people want to know whether their diabetes can be cured, for example through surgery or very low calorie diets. Encouraging work is being done on low calorie diets, and a trial funded by Diabetes UK—the diabetes remission clinical trial—showed that almost half of type 2 diabetics who took part were in remission after 12 months.

We need to help people to reduce their risk of developing type 2 diabetes, and that means tackling the reasons for the increasing rates of obesity, particularly childhood obesity. The PREVIEW project—prevention of diabetes through lifestyle, intervention and population studies in Europe and around the world—showed that a weight loss of 10% of baseline weight can decrease insulin resistance, which is a causative factor in diabetes, and this is expected to reduce by 85% the three-year risk of developing type 2 diabetes.

In conclusion, I have two requests for the Minister. The first is that we build on progress being made through the NHS diabetes programme and commit to sustained transformation funding at current levels of £44 million a year until at least 2021. The NHS diabetes programme sets out to improve the treatment and care for people with diabetes. Investing now will allow us to reap substantial financial and social benefits in the future.

My second request is that we strengthen the childhood obesity plan, including measures on labelling and junk food marketing. Just this morning, Cancer Research UK called for the same action. I am sure that the Minister will appreciate that taking steps to tackle childhood obesity will improve the health of the nation and have an impact on all obesity-related illnesses, not just diabetes. We want mandatory traffic-light labelling on all processed foods and mandatory calorie labelling in the out-of-home sector. We also want a commitment to introduce a ban on the marketing of junk food on TV before the 9 pm watershed.

The childhood obesity plan is key in helping us realise a world where fewer people live with diabetes and where it is easier to live a life with a low risk of developing type 2 diabetes. However, as we heard on the news just this morning, the millennial generation are predicted to be the most obese yet, and it is vital that the Government act now to avoid a diabetes health crisis in the future.

Cancer Strategy

Jim Shannon Excerpts

Thursday 22nd February 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing this debate, and I am grateful to hon. Members for their extremely touching, wonderful and very personal contributions. As everyone here can testify, cancer has touched everyone—no family will not be aware of it. In fact, it is said that by 2020 one in every two people will be diagnosed with cancer in their lifetime. My father had cancer three times and each time survived, owing to the skill of the surgeon, the care of the nurses and the prayers he clearly believed in.

We have many problems in Northern Ireland—we all know about the political process—and I am conscious that health is a devolved matter, but I wonder if the Minister could have discussions and co-ordinate with the permanent secretary in the Department of Health, Richard Pengelly, to see if he can help and encourage his Department with the problems facing it. The incidence of cancer in Northern Ireland has increased by 25% in the past 10 years, such that the number of cancer cases each year has reached 9,000 for the first time. That is an indication of the problems.

I thank the many organisations, particularly Macmillan Cancer Support, for the information they have provided to us. There are 2.5 million people living with or beyond cancer in the UK today. The issue is that not all of them are living well: many experience physical, emotional and financial consequences as a result of their treatment. One in four face disability or poor health following their treatment that can persist for many years after treatment has ended, despite the NHS being set up to meet the changing needs of cancer patients and to enable access to the best treatment that is right for patients.

Macmillan is even more conscious of, and concerned about, the financial implications. According to projections in the “Five Year Forward View”, expenditure on cancer services is set to grow by 9% each year, which gives us an idea of some of the issues and takes us back to some of what was said earlier about prevention—I think that the hon. Member for Bristol West (Thangam Debbonaire) and others referred to prevention. We have had cancer patient experience surveys in Northern Ireland for a while now, and it is important that we are able to see what the trusts and CCGs are doing, what the cancer types are and the different aspects of the cancer journey. In England, the cancer patient experience survey has been happening since 2010 and has been proven to encourage hospitals to implement changes, to improve results. That is very important.

I would be very pleased if the Minister came back to us on the following point. Macmillan is concerned that the NCPES will not continue to deliver the same high-quality data, as the current survey model is not likely to be viable under the terms of the national data opt-out model that is scheduled to be introduced in May 2018. It is clear that Macmillan care has concerns. We have collected all the data and all this information through the clinical commissioning groups. The continuation of the cancer patient experience survey in its current format with high-quality, robust data is vital across the whole United Kingdom of Great Britain and Northern Ireland. Again, will the Minister provide the clarity that is needed on the issues that have been outlined on the NCPES to ensure the continued delivery of this essential and robust patient survey? The benefits are there in the data. I thank him for that.

About one in eight people diagnosed with cancer face mental health problems, such as anxiety, depression and post-traumatic stress disorder. Planning is needed to ensure that everyone living with cancer across the whole United Kingdom of Great Britain and Northern Ireland can access the right care and support, whether that means information, financial assistance, vocational rehabilitation or emotional support. Families can give so much of that emotional support, and they do so gladly, but at the same time we need to reach outside that.

Just 68% of people with cancer in Northern Ireland started treatment within 62 days of referral. Again, I am very much in the early diagnosis category and we need that in place. Cancer deaths in Northern Ireland are at the highest level that they have ever been. My party is totally committed to improving the five-year survival rates and believes in targeting resources to tackle deprivation, which is another issue. Cancer incidence rates are higher where there is deprivation.

More needs to be done to provide good continuity of care and to ensure that all patients have supported access to key information about their condition, treatment options and the types of support that are available. Macmillan is funding a second Northern Ireland survey that will be launched in spring 2018. It has invested £7 million in the Northern Ireland specialist cancer nursing plan, because this vital segment of the cancer workforce is not keeping pace with demand. Macmillan recognises that there are shortcomings and it has tried to introduce finance where it can to ensure that things go the right way.

Cancer is the most common cause of death in Northern Ireland. The end-of-life choice is very important. The Northern Ireland cancer registry found that 75% of patients would prefer to die at home. That subject matter is not easy to speak about, but the fact is that this needs to be looked at. Macmillan’s research found that people are more likely to die in the place of their choice when their wishes are recorded and known by their healthcare team. We believe that a new cancer strategy should include commitments to improving end-of-life care and giving everyone who is diagnosed with cancer the opportunity to have advance care planning discussions.

Macmillan has made a number of recommendations, which I will conclude with—it is referred to as the “Delivering Together” strategy. I totally support Macmillan’s reforms, such as producing a detailed implementation plan, including specific actions to improve care and support for people living with cancer and to enhance the patient experience in all trusts and CCGs. It recommends making the recovery package available to everyone living with and beyond cancer, the timely adoption and implementation of NICE guidelines to improve cancer detection, treatment and support, and close working with GP federations to ensure that care is provided closer to home.

The recommendations include long-term cancer workforce planning, integrating health and social care with higher education to attain a more knowledgeable and skilled workforce—it is important to have that—and with effective recruitment and succession across disciplines and settings. They include the better integration and co-ordination of all those things as well, including signposting to the non-clinical support that patients need at each stage of their cancer journey and providing high-quality palliative end-of-life care in all settings on a 24/7 basis. That should begin with cancer patients having the option of advance care planning conversations at the earliest possible stage. The recommendations also include increasing the involvement of people affected by cancer in the development, redesign and delivery of services and a commitment to the ongoing routine use of data collection tools, including the cancer patient experience survey and the peer review programme, to identify any gaps or inequalities in cancer care and pinpoint areas for improvement locally and benchmarking across the UK.

I ask the Minister to take on board all the issues we have all referred to and to do what can be done to help the massive amount of cancer sufferers across the whole United Kingdom of Great Britain and Northern Ireland, so that they have a better journey, a better outcome and better support.

Medicines and Medical Devices Safety Review

Jim Shannon Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

Baroness Cumberlege has honorary fellowships at the Royal College of Nursing and the Royal College of Physicians, so she is well connected with all the organisations that the hon. Lady mentioned.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. As he indicated, our products are world leading, and China and the UK have come to an understanding on medical device regulation, which is great news. However, does the Secretary of State have any information about further such understandings to ensure that we can export our medical innovations throughout the world safely and with as little red tape as possible?

[Mr Hunt]

It is fair and important to say that our regulatory system is admired the world over because we do safety extremely well and take it extremely seriously, but that does not mean that we cannot improve it. The lesson of today is that patients’ voices have not been strong in that process, and that is what we need to change.

PACE Trial: People with ME

Jim Shannon Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan (Glasgow North West) (SNP)]

I beg to move,

That this House has considered the PACE trial and its effect on people with ME.

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

“The doctor doesn’t see me crawl on the floor. The doctor doesn’t know I don’t shower every day or brush my teeth twice a day like everyone else. He isn’t aware of my frequent sore throats, my poor balance, my difficulties with reading, my muscle twitches, or my sound intolerance, and he certainly wasn’t here to nurse me when once I was too weak to eat.”

Those are the words of a junior doctor living with ME, who alongside nearly 1,000 others has contacted me prior to this debate.

Myalgic encephalomyelitis, or ME, has been described in many ways, but labels such as chronic fatigue syndrome or post-viral fatigue syndrome simply do not come close to the living hell experienced by many ME sufferers—a hell that is made worse by the lack of understanding that is faced when seeking help.

ME is estimated to affect about 250,000 people in the UK and is classified by the World Health Organisation as a disease of the central nervous system. Symptoms can include debilitating muscle pain, severe headaches that are often made worse by light or noise, significant impairment of short-term memory and post-exertion malaise that can last days and even weeks.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that there is still huge concern among ME patients that the National Institute for Health and Care Excellence says it will not abandon the promotion of physio-social therapies for ME, despite the widespread scientific criticism of the PACE trial methodology, and that we must ensure that that is addressed as a matter of urgency?

[Carol Monaghan]

I thank the hon. Gentleman for his intervention. I will come on to the NICE guidelines later in my speech.

Although ME is a pathological, not psychological, condition, much about it remains a mystery. The reasons for that are twofold. First, many sufferers are housebound and therefore easy for society to ignore. Secondly, there is a lack of awareness among medical professionals and as a result a woeful lack of quality research. What we do know is that ME is often triggered by a viral infection such as flu, but, unlike healthy individuals, people living with ME do not recover. Into that research drought entered the PACE trial—pacing, graded activity and cognitive behaviour therapy; a randomised evaluation.

The trial was unique in medical research. It was funded by the Department for Work and Pensions to the tune of £5 million, a point to which I will return. From the very start the PACE trial was flawed. In contravention of the World Health Organisation classification, it assumed that ME was psychological and sufferers could recover if they chose so to do. Thus the PACE trial was framed in psychological terms.

Woodlands Hospice, Aintree

Jim Shannon Excerpts

Wednesday 7th February 2018 Commons Chamber

[Dan Carden (Liverpool, Walton) (Lab)]

It is a pleasure to have an Adjournment debate on my local hospice, which is such an important topic. Many people think that a hospice is place where people go to die, but it is actually a place where people go to live. It would not be a debate on a hospice and end-of-life care without reminding ourselves of the words of Dame Cicely Saunders, who is widely acknowledged as the founder of the UK hospice movement:

“You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

When I recently visited Woodlands Hospice in my constituency, that is exactly what I found. Although it may sound counter-intuitive, it was a place brimming with life. Woodlands Hospice is an independent charity situated in the grounds of Aintree University Hospital. It covers a population of 330,000 in north Liverpool, south Sefton and Kirby and Knowsley. The hospice provides 15 in-patient beds with a purpose-built wing. Its wellbeing and support centre, which includes multi-professional assessment days, group therapies, outpatients, complementary therapies and a therapy-driven outreach service, provides services to enable people living with cancer and other life-limiting illnesses to live their lives in a positive and independent way.

[Jim Shannon (Strangford) (DUP)]

I asked the hon. Gentleman beforehand whether he would give way, and he said he would. It is important to put this point on record. Does the hon. Gentleman agree that those who work in hospices, such as Woodlands and the Marie Curie Hospice in Northern Ireland, do tremendous work and are much to be thanked for the tremendous care that they provide, not just for patients, but for families?

[Dan Carden]

I am delighted to agree. This is a great opportunity to thank all those staff and volunteers, wherever they are across the UK.