Hepatitis C

Jim Shannon Excerpts

Tuesday 12th June 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Let me express special thanks to the hon. Member for Southend West (Sir David Amess) for setting the scene. He said that he was not the master of the debate, but he was certainly the master of delivery. He told us about all the important issues, with the help of the two learned doctors in Westminster Hall today: the hon. Members for Central Suffolk and North Ipswich (Dr Poulter) and for Central Ayrshire (Dr Whitford).

As my party’s spokesperson on health, I take an interest in all health matters in the House. Some people would say, “He takes an interest in just about everything in the House,” but that is by the bye. Health matters are my specific interest, so I am here to make a contribution in that capacity and will make a comment from a Northern Ireland perspective. Obviously, that will come into the debate.

First, I commend the all-party parliamentary group on liver health for the report that it has put forward. The hon. Member for Southend West is absolutely right: if people listen and read its recommendations, they will realise that the APPG has a really firm and dedicated interest in this matter. I am most impressed by the APPG’s recommendations and report; I am sincerely impressed by the work carried out by it. In my research for my contribution to the debate, I learned a lot from its recommendations and from the work that it does. The contents of the report are informative in the extreme. It provides lots of detail and information, which I hope will help us to contribute to the debate in a positive fashion.

I sincerely hope, too, that there will be such an opportunity for the Minister, who is always responsive and helpful. We are pleased to have a Minister who clearly has an interest in the subject matter. When he speaks, we will understand just how important that is. However, we need to implement the recommendations for so many people throughout the UK. I am also pleased to see in her place the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson). I know that she will be equally positive.

The hon. Member for Southend West referred to George Best. He was the greatest footballer this world has ever known, according to Pelé, and what better person to say that than a man who many think was the best footballer in the world, even though whenever he has been asked he has said that it was George Best.

Unfortunately, George Best had problems; that was just the fact of it. With his talent and expertise came a problem, and the problem was alcohol. For a time, he and his wife lived in my constituency, just outside Portavogie, and he was very much someone who everyone wanted to associate with and spend time with. We well remember the day that he died and his funeral at Stormont. It was unusual for someone to be given the accolade of being buried from Stormont. I remember that it was a rainy day, but the crowds came from all over the Province just to be there and be part of what was a very poignant occasion as we laid to rest one of Northern Ireland’s greatest and, indeed, one of the world’s greatest when it came to playing football. I just wanted to say that, as the hon. Member for Southend West introduced it in his comments.

My parliamentary aide first went to Africa on a humanitarian aid project. She is a member of the Elim Church in my constituency. Elim Missions Ireland does some fantastic work out in Swaziland and Zimbabwe when it comes to helping with medical and education projects, as well as general all-round giving. It takes out a number of containers every year to help with that. When she told me about the list of vaccinations she had to get, one of which was for hepatitis A and another for hepatitis B, she said, “All I am really missing is hepatitis C.” Little did we understand in the office that the hepatitis C vaccine is greatly needed not simply on the plains of Africa, but in our own country. The hon. Gentleman referred to that.

The Northern Ireland Hepatitis B & C Managed Clinical Network is a website with great information that helps us to construct our speeches. Hepatitis C is an infection of the liver caused by the hepatitis C virus, which is carried in the blood stream to the liver. We know that it can cause inflammation and swelling. It can cause fibrosis and the scarring of the liver tissue, and sometimes liver damage. It may subsequently lead to cancer of the liver and possible death. Over the years as an elected representative, I have represented quite a few people who have died of liver cancer, although that is a separate debate. I remember only one person in that time who survived liver cancer to live for a longer period.

In Northern Ireland, there are more than 2,500 people known to be infected. A large proportion of people, however, remain unaware that they have the virus. That is one of the key issues on which we look to the Minister for a response. How do we raise that awareness to address those who do not know they have it, but need to know today? We all know that we need early diagnosis. If we find out early that something is wrong, we can do something about it, but if people are carrying the virus in their system and do not know, that is a real problem.

Like so many unseen diseases, the problem lies in the fact that many people do not realise they have been infected with the virus, because they have not had any symptoms or they may have flu-like symptoms that can easily be mistaken for another illness. I declare an interest as a type 2 diabetic, which is a chronic disease. Every year, I get that flu jab to try to stop flu and colds. By and large it works—it has for the last few years, anyway. People who get colds and flu regularly might wonder whether it is just a cold or flu, or something more. That is the question we are all asking.

With the pressure the NHS is under, as we all know, there are few of us who would not struggle through the winter with a perpetual cold or flu, thinking we were simply run down. Few people would bother their doctor with a cold, yet for some that prevents treatment from being started when it would be most effective.

This is Men’s Health Week. Those of us who fit into that category know that we need to look at our health more seriously. In Men’s Health Week, we need to say, “If you have a problem, go to your doctor.” People say that man flu is one of the worst things to have, but us men, unfortunately, do not respond to our health issues as strongly as we should. We should be going to our GP.

I have learned that there are six types of hepatitis C virus, which all have different genes, which are called genotypes and numbered 1 to 6. Almost all people in the UK who have hepatitis C have genotype 1, 2 or 3. It is important to know which type a patient has, as different types respond differently to treatment. It is possible to be infected with more than one type of hepatitis C at the same time. I remember an awareness event in the House of Commons not too long ago—it may have been last year—on hepatitis C. That day aimed to highlight the issue and make us more informed of the problems.

Hepatitis C is a blood-borne virus and there is some stigma attached, because it can be transmitted sexually or through sharing needles. That is certainly true, but it needs to be publicised that the virus can also be shared through an unsterilized needle in a tattoo parlour or something as innocuous as sharing a toothbrush, a razor or other personal items, because the blood can survive outside the body. An old toothbrush, therefore, can bring about a whole mess of issues. One person in four will clear the virus, but it is possible to catch it more than once.

The APPG’s positive recommendations on how hepatitis C could be eradicated should be central to our thoughts on where we go. All the issues I have mentioned are reasons we are not finding it easy to meet our own target of eradication by 2025 and the World Health Organisation target of world eradication by 2030. People may not be fully aware. Will the Minister confirm what has been done to meet those targets? Can the targets be met? What is new in the way that we address or respond to these things?

We need to ensure that those who present symptoms are tested and those with a history are re-tested. Someone who has had the virus before can have it again, and they might not know. With new drug combinations, it is anticipated that it will be possible to cure approximately 90% of persons with the HCV infection. Those new combinations are effective against the infection in patient groups that were previously described as difficult to treat. We need to focus on those difficult-to-treat areas.

I agree in totality with the recommendation of the APPG on liver health regarding the fact that NHS England has recently entered negotiations with industry to develop a new funding model for hepatitis C, which is expected to guarantee access to treatment without restriction. That is good news. I agree that the resulting deal should include effective mechanisms to ensure that funds are distributed equitably across different geographies and patient populations, so that no one is left behind. I will go further: Northern Ireland must be a key part of the distribution list, not simply the mainland of England, if we are to eradicate hepatitis C and address the issues, whatever they may be.

The hon. Member for Central Ayrshire, who is the Scottish National party spokesperson, will give us not only a Scotland perspective, but a United Kingdom of Great Britain and Northern Ireland perspective. We need to look at how we can do this with the Welsh Assembly, the Scottish Parliament and the Northern Ireland Assembly, despite the limbo land that it is in, through the permanent secretary. Any new funding must be accompanied by a comprehensive and strategic plan to ensure that it is implemented effectively.

To conclude, there is a way forward with hepatitis C. It is treatable. Let us put this in perspective: it can be done. All we need is the will and the strategy to make it happen. People need to be aware that they have hepatitis C in the first place, but other work needs to be done too.

Princess Alexandra Hospital, Harlow

Jim Shannon Excerpts

Tuesday 5th June 2018 Commons Chamber

[Robert Halfon]

I am hugely grateful for the support of my new neighbour, who is a brilliant representative of her area. She is exactly right. We cannot just carry on with Elastoplast solutions, however welcome, because that cannot sustain the hospital in the long term. She also makes the crucial point that we are going to have thousands more houses in Harlow and the surrounding areas, and we need a hospital that is fit for purpose—fit for the 21st century. I think that the Minister will hear the views of my neighbours and realise that this is not just a Harlow issue but something that is very important to Essex and Hertfordshire.

[Jim Shannon (Strangford) (DUP)]

Obviously, I am not one of the right hon. Gentleman’s neighbours, but I am always here to support him on the issues that he brings forward. One of the things that comes to my attention back home, but I am sure that he will have the same issue, is that healthcare needs to be accessible to all people. We can jump in a car and go to the hospital, but other people may have to depend on a bus or a train, or on someone giving them a lift. Does he agree that local trusts need to have accessibility as a precursor to providing care? If someone has accessibility, they can get there; if they do not, it does not matter where the hospital is.

[Robert Halfon]

The hon. Gentleman says we are not neighbours, but we are kind of neighbours in the make-up of the current Parliament. He is absolutely right, and he makes the wider point about the support needed for the NHS.

The hospital also experiences issues in recruiting and retaining staff. Harlow’s hospital now has 27 more doctors and 35 more nurses than in 2010, and the leadership has made great efforts to improve staff retention and staff stability at the PAH. It is now among the best in the sustainability and transformation partnership. However, the trust still runs an 11% vacancy rate, with a key deficit in nursing recruitment and retention. The vacancy rate and recruitment are a perpetual worry, and the reasons for that appear to be twofold. The first is proximity to London, which makes pay weighting a serious factor. The second is perhaps more significant. The hospital leadership has told me that opportunities for career development, or the lack thereof, are off-putting for potential recruits. The hospital must compete with Barts and UCL in specialist training and career development. Last year, the retention support programme established career clinics and clear career pathways, but there is only so much the hospital can do to compete with the huge investment and top-class facilities at London hospitals.

There is unbearable and increasing pressure on A&E services at the Princess Alexandra due to the downgrading of other local healthcare facilities, including Chase Farm Hospital and the Queen Elizabeth II. The population of Harlow and the surrounding area is growing, and the additional influx of patients has led to occupancy levels at the hospital consistently running higher than 98%. The A&E department sees 200 to 300 patients per day—that is 10% higher than the national average. This is a small hospital in a medium-sized town. The Care Quality Commission agreed in its most recent report that that makes it difficult for staff to tend to patients in a timely manner.

While the hospital is working incredibly hard to make improvements and has successfully upped the four-hour emergency care standard record, the chief executive and management have told me that the estate and infrastructure are simply undermining the staff’s ability to carry out their roles well and negatively impacting on the hospital’s overall performance. It is clear from the occupancy level statistics that the Princess Alexandra is fundamental to the health and wellbeing of the population of Harlow and the wider area, including parts of Hertfordshire and Essex, as my colleagues and I have stated today.

In the light of that, I wrote to the Secretary of State for Health last week along with seven colleagues representing neighbouring constituencies: my hon. Friends the Members for Broxbourne, for Hertford and Stortford, for Saffron Walden, for Brentwood and Ongar (Alex Burghart) and for Braintree (James Cleverly), and my right hon. Friends the Members for Epping Forest (Mrs Laing) and for Witham (Priti Patel). We wanted to make it clear that the development of a new hospital health campus is fundamental to the vitality of the community and the economy of the entire region. We asked the Health Secretary for his support for the hospital’s capital funding bid, and I hope to receive his positive response soon.

It is clear that there are a number of complex and interlinked issues at the Princess Alexandra. Those problems make it very difficult for the hard-working staff to provide sufficient healthcare to Harlow residents and those living in my colleagues’ constituencies. The development of a new purpose-built hospital health campus would answer each and every one of those problems. First, it would allow high-quality and state-of-the-art facilities to be developed in a carefully planned manner. The staff would no longer be working in temporary structures, and patients and visitors would be able to find their way around the site easily.

Secondly, the investment in new facilities would draw nurses, healthcare assistants and auxiliary staff to the hospital and provide a welcoming working environment in which they could see out a long career in the NHS. Thirdly, the new hospital health campus would redevelop the emergency care services at the PAH. That would create a working environment in which staff truly had the capacity to meet the needs of the many patients seeking help, without the fear of a bed not being available.

While regeneration of the current site has been considered, it is widely accepted that building a new hospital health campus on a different greenfield site would be most affordable and provide the greatest benefit to the patients served by the PAH. The hospital’s current location in the town centre may partly explain the very high A&E use, and it makes further expansion of the hospital incredibly difficult. A new greenfield site on the outskirts of the town would mitigate these problems and allow the town-centre land to be redeveloped into much-needed housing for Harlow’s growing population. Additionally, developing a new hospital on the current disjointed site would require the existing set-up to be demolished before starting work on the new health campus. This would lead to huge disruption for patients seeking help and for staff who would need to carry on working for a number of years.

As I have previously mentioned, the hospital is vital for the economy of the entire region. Developing a new hospital health campus could act as a centre for degree apprenticeships. I know that the Minister, like me, is passionate about improving skills and apprenticeships in the health service. The hospital health campus could build on the existing hospital’s strong links with Harlow College and the new Anglia Ruskin MedTech innovation centre. It would bring specialist training to the eastern region, and it would send the message that Harlow is a place to start and develop an amazing and long-term career in the national health service. The hospital health campus would allow so many hundreds of my constituents, and those of my hon. Friends, to climb the ladder of opportunity. The degree apprenticeships and training opportunities would help people across the east of England to get the education, skills and training they deserve and to achieve the jobs, security and prosperity that they and our country need.

Finally, I want to explain that this debate is only part of an ongoing and wide-reaching campaign for a new hospital health campus in Harlow. As I have mentioned, I had a debate on this subject last year, and I have tabled 10 early-day motions, asked 40 written questions and kept in regular contact with Health Ministers. As I have said, I am hugely grateful to my hon. Friend the Minister for his regular dialogue with me. In fact, may I ask him now whether he will definitely meet me and the hospital’s chief executive, Lance McCarthy, to discuss the hospital health campus proposals further, and will he actually join us at the hospital in Harlow so that he can see the current site at first hand?

I am here today because of the desperate need for a new hospital campus in Harlow. This is probably the most pressing issue that our town will face for a generation. The new hospital proposal is backed by ten local councils—including Harlow Council, Epping Forest District Council, Essex County Council and the Greater London Authority—and by the West Essex clinical commissioning group and the Hertfordshire and West Essex sustainability and transformation partnership, which brings together 13 local bodies and hospital trusts. It is also backed by the seven neighbouring MPs I have mentioned, some of whom are in the Chamber.

The people I represent, and those represented by my colleagues and constituency neighbours, deserve better. Patients deserve to be treated in a safe environment, without the threat of their operation being cancelled due to sewage—I repeat, sewage—flowing through the operating theatres. Visitors should be able to find their poorly relatives easily, without snaking their way through a muddled and confusing hospital estate, wasting valuable time that they could have spent with their loved ones. The hard-working staff should have top-class and purpose-built facilities so they can tap into their instincts and provide the very best care they can. They should be able to progress their careers at the hospital and to build a community around their working lives—building an even better Harlow and protecting our NHS as they do so. Training opportunities should be provided so that our young people or those who wish to retrain can gain skills and climb the ladder of opportunity, flexibly and close to home. I am here this evening to show the Government that the Princess Alexandra bid for capital funding is not just about the materials from which the hospital is built; it is more important than that. It is time that healthcare in Harlow was brought into the 21st century.

Accrington Victoria Walk-in Centre

Jim Shannon Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Graham P. Jones (Hyndburn) (Lab)]

I should like to raise the not-so-small matter of the closure of Accrington Victoria walk-in centre, a valuable community health asset and a huge support to those in and around my constituency. The people of the area have, with great affinity, taken to their local healthcare services over many decades, and in years gone by, through paying a penny a week, they have funded the local hospital. Yet every decade unelected bodies, supported by the Government, seek to reduce healthcare provision in the area—with the exception of the last Labour Government, who invested in three new health centres, among other things, and rebuilt the local hospital at Blackburn.

“I am grateful for the opportunity to raise the subject of the future of Victoria hospital, Accrington.”

Those are not my words, but those of former Hyndburn MP the hon. Ken Hargreaves, who like his successor, Greg Pope MP—my predecessor—and me, have fought for better healthcare facilities in Hyndburn, particularly the retention of vital NHS services at Accrington Victoria, and in this case today, the GP walk-in centre at that hospital.

On 28 November 1989, under the previous Conservative Government, the honourable and much liked Mr Hargreaves spoke in this Chamber from the Government Benches, stating:

“Thousands of people have signed the petitions and written to their Members of Parliament and to the Secretary of State…we are fighting the same battle now that we fought 11 years”

previously.

“It is equally clear that the people of Hyndburn wish to unite and fight.”—[Official Report, 28 November 1989; Vol. 162, c. 685.]

On the second of this month, I too presented a petition to this place, like my predecessor, with some 24,000 names on it. I can update the House: the petition now stands at 26,000 petitioners. The truth is, the public are not listened to by Governments and unelected bodies, and the people of Hyndburn are, as the former hon. Member Ken Hargreaves described, uniting and fighting once again.

This popular walk-in centre has already survived five attempts to close it. On 16 June, the health authorities—I do not exonerate the Government from this dreadful decision—are going to try to close the Accrington walk-in centre once again. We have a decision that makes little sense and a consultation that was a sham.

My own story sums up why this is the wrong decision. I contracted acute bronchitis—a serious enough illness. I was unaware of it other than feeling very ill. I struggled on until I eventually realised that it was a little more serious than a chesty cough and walked into my local GP surgery. The very helpful staff told me that there was a considerable wait to get a doctors’ appointment—a situation repeated nationally. The average wait to see a GP in the region is 13 days, I am told. If someone needs GP healthcare but cannot get an appointment, what do they do? My constituents widely share my frustration at the lack of GP access. Ringing up the GP first thing in the morning, the person is probably told that they are No. 8 in the queue, and they finally get through to a receptionist only to be told that all the appointments for that day are gone, with the next available slot being at the end of the next week.

The receptionist at my GP surgery helpfully rang through to the new extended-hours GP service to get me an urgent appointment. She told me that unfortunately all the appointments had been filled that weekend. Coughing badly, I had two choices: A&E or the walk-in centre. I went to the walk-in centre, where, following a two-hour wait, my condition was diagnosed. Notes were then sent to my GP and added to my health records. Without the assistance of GPs at the walk-in centre, my health could have deteriorated. I certainly would not have waited 10 days for a GP appointment; I would have gone to A&E.

The value and scale of the service provided by the Accrington Victoria walk-in centre cannot be overestimated. It has received an incredible 42,000 patient visits in the past 12 months. They were people like me who could not get an urgent GP appointment. If it closes, many of those patients will simply go to A&E. This was clearly my next option had the walk-in centre not been open. In fact, figures from the Bury walk-in centre reveal that about 22% of patients will head to A&E—in our case, the A&E at Royal Blackburn Hospital, one of the busiest in the country. This will add considerably to the problems that the A&E already faces, adding some 9,000 extra patient visits at a time when it is overstretched, with ambulances parked outside waiting to refer patients for care. There are financial implications to this, too. An average patient visit to A&E costs about £124 compared with an average patient visit to the walk-in centre that costs about £60.

Mine is not the only story. In fact, the campaign has received hundreds of similar stories through its “SAVE Accrington Walk-in centre” Facebook page. Some of those real-life stories from the people who have benefited from the walk-in centre are incredible. They include people who had to be rushed immediately from the walk-in centre to the Royal Blackburn for life-saving interventions. I must thank the local people for backing this campaign in such huge numbers. I must also thank the three leading campaigners—Chris Reid, Shahed Mahmood and Kimberley Whitehead—for pursuing a more consultative and informative debate than that offered by the clinical commissioning group. I would also like to place on record my thanks to the two local papers: the Accrington Observer, which has been at the forefront of the campaign; and the Lancashire Telegraph. This walk-in centre service means an awful lot to local people. The campaign has included petitions, walks, polls and articles, and has gathered huge support. It has also included letters to GPs.

Since the phased closure started in April, it has been revealed that only 658 people responded to the East Lancashire clinical commissioning group’s consultation—1.6% of the 42,000 patients who have visited. Members should compare that with the 26,000 local residents who signed the petition against the closure.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way; I spoke to him beforehand about this. We cannot ignore his fantastic work on this issue, and I congratulate him on his 26,000-strong petition, which far outstrips the 658 responses that the consultation on this closure garnered. Does he agree that more weight should be given to those opposing the closure, who are 60 times greater in number than those who responded to the consultation, and that the Government should listen to those 26,000 people and not ignore them?

[Graham P. Jones]

The hon. Gentleman makes a valuable contribution. I have yet to meet anyone who filled in the CCG’s consultation, and I will return to the issue of guidelines on NHS consultations and listening to the people.

I want to reflect on the CCG’s consultation. I have grave doubts over its credibility and reliability. To my mind, consulting just 658 invisible people with dubious questions is not a consultation. The CCG asked the public whether they wanted extra GP hours. Just to compare, the walk-in centre provides 88 hours per week. The CCG says that the walk-in centre will be replaced by the new extended-hours GP service, which provides just 19 extra hours’ GP access. That is an 80% reduction in GP access.

In the CCG’s foggy consultation, it said that 61% of people were “in support of” its plans for more GP hours. Which resident is not going to say yes to more GP hours? That is not the same as 61% of people saying, “Yes, and also please close my walk-in centre.” This was a devious consultation. The results of it are grossly misleading, and it is important that the Minister takes that point on board.

In response, I ran my own Facebook poll, reaching out to the four corners of my constituency, and an amazing 6,200 people voted. Unlike the CCG’s consultation question, mine was simple: “Do you want the walk-in centre to remain open?” with an explanation about the 19 extended hours of GP access. Of the 6,200 people who voted, 98% voted to keep the walk-in centre open. That poll reflects the true extent of public opinion in my constituency—98%.

The Minister must stop this closure and ask for a new consultation. She knows that consultation and the views of the public are key to the provision of NHS services. She will know that in national surveys, over 40% of the public say they want to be more involved in decisions about their care. I remind the Minister of the 26,000 people who have signed this local petition to keep the walk-in centre open.

The question is: how has this proposed closure put patients first? Under the Health and Social Care Act 2012, CCGs and NHS England have a duty to promote the involvement of patients in their own health and care. The Minister knows that the guidance is statutory and that CCGs must have regard to it. NHS England’s statutory guidance emphasises to CCGs in the NHS England document “Involving people in their own health and care” that patients must be central to decision making. Clearly they have not been in this case.

The Minister will also know that her Government’s health and social care NHS White Paper included a section entitled “Putting patients and the public first” and promised an NHS that is

“genuinely centred on patients and carers”

and

“gives citizens a greater say in how the NHS is run”.

It embraces the principle of shared-decision making, under which patients make joint decisions about their care with their clinicians. That is clearly not the case with the Accrington Victoria walk-in centre. Notably, the statutory guidance is clear in its description of shared decision making, saying:

“shared decision making is a conversation, or series of conversations, that should include evidence-based information about all reasonable options”,

such as a loss of GP hours. The loss of hours and the walk-in centre were never mentioned.

As pertinent is the recent publication of long-awaited guidance by NHS England, which lays out the future of urgent care services and expectations for local NHS commissioners. The guidance, which the NHS has released early, contains a clear expectation and commitment to retain walk-in centres as part of local integrated health services. I note the reassurances given in it that walk-in centres will remain a vital component of health service provision. The new guidance commits to the establishment of GP-led urgent treatment centres, open at least 12 hours a day, with nurses and other clinicians also available, along with a range of simple diagnostic facilities—a walk-in centre by another name, offering the same services currently offered by Accrington Victoria walk-in centre.

In conclusion—I just want to make a final point, Mr Speaker—patients will be able to book appointments in the new urgent care units using the NHS 111 service, through their GP or, crucially, as at the walk-in centre, simply walk in. NHS England wants these new centres to be co-located where possible alongside other health services, such as Accrington Victoria Hospital. If the Minister wants to put patients first, have a meaningful consultation and roll out the urgent care units, she will see that this closure meets none of those or her Government’s ambitions. I hope the Minister has listened, and will not just defend the decision or simply defer it to the powers of East Lancashire CCG, but accept that this closure runs counter to the NHS England guidance.

Finally, I very gently remind the Minister that thousands of Conservative voters backed the hon. Ken Hargreaves’s campaign to save Accrington Victoria services and today thousands of Conservative voters are backing this campaign once again to save one of the most vital services at Accrington Victoria. I hope she recognises that, were he here today, this cross-party campaign would certainly have been led by my honourable predecessor, Ken Hargreaves. He would want the walk-in centre to stay open, and we would be united in that ambition. I look forward to the Minister’s reply.

Hypothyroidism

Jim Shannon Excerpts

Monday 21st May 2018 Commons Chamber

[Sir Vince Cable (Twickenham) (LD)]

I am grateful to have secured this Adjournment debate on a very specific issue that was originally raised with me by my constituent Liz Barron, who felt sufficiently strongly and sufficiently affected that she brought supporters from Walsall and Northampton to my Twickenham constituency. I then discovered that the health issue that concerns her affects some 50,000, and possibly 70,000, people across the country —an average of around 100 people per parliamentary constituency.

Those people suffer from a condition called hypothyroidism—an underactive thyroid—which leads to a variety of conditions, including chronic fatigue. There is a link to cardiac symptoms and diabetes, and in some cases to mental illness. For many of these people, the condition leads to the absence of a full life, and in some cases it leads to serious disability, leaving those affected on benefits and unable to live life to the full.

Eighty-five per cent. of sufferers, at the very least, are women. Hypothyroidism is very gender-specific. Underlying the issue is a policy failure by Government. I do not mean this particular Government—this is a long-standing problem going back at least 10 years under successive Governments. The problem is a paradoxical one that is rather different from what we normally see in health debates. Typically the argument in health debates is that something should be done but there is not enough money, whereas in this particular case far too much money has been spent on over-expensive drugs, leading to a correction in the form of severe rationing, which is now causing a great deal of hardship.

[Jim Shannon (Strangford) (DUP)]

I have sought the right hon. Gentleman’s permission to intervene. Does he agree that lab tests are just one part of the diagnostic puzzle and that other steps have been taken to address the fact that between 40% and 50% of patients are either over-treated or under-treated, which massively affects their quality of life?

[Sir Vince Cable]

There is a lack of precision in this area, and there are questions both on the number of people affected and on the dosages required. I fully take the hon. Gentleman’s point.

We are predominantly dealing with the questions of cost and of physical availability, but let me develop the argument a little. It is estimated that one in 20 of the UK population have a thyroid condition of one kind or another. The figures vary considerably, and within that aggregate there are people who suffer from hyperthyroidism—an overactive thyroid—and the opposite, hypothyroidism, an underactive thyroid, and then there are people with thyroid cancer, who suffer considerably.

There is a standard treatment for hypothyroidism, and I will attempt to pronounce the drug’s name once—levothyroxine—before referring to it by its more common name of T4. The drug is broadly accepted to be fairly uncontroversial, at least in the UK. It has been seriously controversial in France, where the drug company Merck varied the composition, leading to considerable side effects. There were large-scale protests by hundreds of thousands of people in France, but there has been relatively little controversy about this particular drug in the UK.

What is controversial is where the standard T4 treatment does not work, or does not work adequately, for a fraction of hypothyroidism sufferers, estimated to be roughly 12%—the range goes from 5% to 20%. It has been established by tests over the years, and by successful treatment, that those people benefit from an additional drug, liothyronine, known as T3. We are talking about 50,000 people in this position and, as far as we can establish, only about 6,000 of them are getting the treatment they should have, which would substantially alleviate their condition.

The roots of this problem lie in the charging and costings for this drug. There is a monopoly supplier, Concordia, a company that was originally called Goldshield. The word “gold” was probably so obviously embarrassing, given the way it treated this as a goldmine, that it changed the name to Mercury Pharma, and it has subsequently been changed to Concordia. Some 10 years ago, this company originally produced a packet of these drugs for about £4.50, but the cost then increased to £258 for the same product, which is an escalation of about 6,000%. The NHS was originally spending some £600,000 a year on this drug, but I established through parliamentary questions that in the past three years it has spent successively £22 million, £33 million and £30 million. There has been an enormous increase in cost and an enormous burden to the health service as a result of the extraordinary pricing that this company has adopted. The consequence is that a large number of clinical commissioning groups have stopped supplying the drug and a large number of people no longer have access to it.

The Government, to their credit, have responded in the past year or so with two specific interventions, the first of which was referring the matter to the Competition and Markets Authority so that it could examine the abuse of pricing. The CMA has provisionally reported that the drug company has been seriously abusing the market and charging excessively. In addition, the Government have engaged in a consultation exercise on limiting the availability of the drug. There was a strong negative reaction and some 30,000 people petitioned the Government on those potential restrictions, but they have proceeded with guidance, at least in England, and the drug has been removed in many situations. The guidance is somewhat ambiguous but, in essence, it says that the drug should be made available only through secondary care—through hospitals. A user has to obtain a consultation with an endocrinologist in order to have the drug prescribed, and often this is difficult to secure. What are the consequences of that? In some 23 to 25 CCG areas in England the drug is no longer available on prescription, and 90% of CCGs have said that they wish to stop supplying it, so we have a postcode lottery.

In addition, a lot of users have realised that they can get round these restrictions by going on the internet or travelling to Europe, because in many European countries the drug is available at cost. Remarkably, the NHS is paying some £9 per tablet, whereas in Germany it is available for 25p. People who have become aware of that can order it on the internet or go to Italy, Germany or Greece, where the drug is freely available. We are dealing with a combination of a postcode lottery, some well-off people able to pay the full market cost, and others who are using the drug unsupervised through internet purchases.

I shall round off what I want to say by posing questions on a series of issues to the Minister, the first of which relates to the history. We have had 10 years of a scandal that may well have cost the taxpayer some £200 million in overcharging, so I want to ask him whether he has any plans to retrieve that money. I established through parliamentary questions that the Government have been active in the High Court in cases of this kind and have recovered money for the taxpayer in previous cases of seriously abusive charging by companies. Do the Government have any plans to do the same in this case?

Why did it never occur to anybody in the NHS over the past 10 years to bring in these drugs from overseas? They are produced in Europe at standard quality, so there is no problem. Why is that not NHS policy? Perhaps I can recall a former Member of the House who was recently remembered because of his infamous “rivers of blood” speech: Mr Enoch Powell, who was once a highly respected Secretary of State for Health. One thing that he did in his period in office was to help the NHS to overcome issues of scarcity and cost by bringing in imported drugs in situations of this kind. There is a long precedent and I cannot understand why that option was not used on this occasion.

My second concern relates to current supply. Why are the Government not using the powers recently acquired through Parliament—in the Health Service Medical Supplies (Costs) Act 2017—under which they can force companies to cut their costs? That appears not to have happened in this case, and I am intrigued to know why. Two other companies have been licensed to break the monopoly; are they now producing the drugs, and at European-level costs? Are those drugs being made available to the NHS so that the problem can be resolved?

Finally, on the availability of the drugs to patients, will the Government introduce revised guidance to help a much larger number of patients to obtain prescriptions through their GP, as they did before, rather than having to go to a hospital? It is often not possible to get a consultation and, even if there is one, a prescription is difficult to obtain. Will the Government therefore issue revised guidance to help the large number of people who currently do not have access to the drug?

I conclude by quoting Sir Anthony Toft, a former physician to Her Majesty the Queen who was for many years president of the British Thyroid Association. He summarises the case from the point of view of an experienced professional:

“Experience of managing more patients with thyroid disease than most over a period of some 40 years is being trumped by inflexible guidelines; truly a remarkable state of affairs. Others hide behind guidelines to avoid the cost of prescribing liothyronine, which in the UK is exorbitantly priced by the sole supplier…when well-travelled patients can obtain supplies for a few euros in Italy and Greece and beyond.”

He strikes me as an authoritative and reliable source of advice. I do not know whether the Minister is aware, but 25 May—at the end of this week—is World Thyroid Day. He will make a lot of people very happy if they are able to celebrate that day with an advance in Government policy.

Fortified Flour

Jim Shannon Excerpts

Wednesday 16th May 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the hon. Member for Pontypridd (Owen Smith) on bringing this debate to Westminster Hall. I congratulate him on presenting his case so well, as he did at the awareness day that some of us were able to get down to. As the Democratic Unionist party spokesperson for health, I am aware of this issue and very supportive of the fortification of flour.

All the speeches we have heard were tremendous. I commend my right hon. Friend the Member for Belfast North (Nigel Dodds) for telling a very personal story. Personal stories in these debates always carry substantial weight. His was a story that he and his wife have walked, and although we might have known something about this issue, we have heard a whole lot more. I commend him on that and assure him of our support. He knows that it has always been there for him, but on days when we tell personal stories we feel it a bit more.

When my parliamentary aide was pregnant, we got a surprise. In the mornings when she was under a little pressure, instead of shouts of “coffee” coming from her desk she would ask for water. By the time of her second baby, we all knew what “no coffee” meant—baby on board. You can imagine the apprehension I felt, Mr Hanson, on a Friday morning when I said to the staff in the office, “Girls, who’s for coffee?” If they said no, I knew they did not want coffee, but was there anything they wanted to tell me? That, however, is by the way. Why did my aide do that? It is simple: she told me, “Coffee makes the baby’s heart beat faster, so I need to stay away from it.” I wanted to make a contribution to the debate because she has lived through this.

Almost every mother I have ever known, as soon as they have that pregnancy test, has made changes to their lifestyle. They do it automatically, and in many cases right away, for the sake of the baby. They stop having alcohol and start on vitamins, reduce caffeine and increase their fruit and veg. By doing that, they naturally create—to use an Ulsterism—a better wee home for their child, which is what the mother is trying to achieve.

This is a personal story from my aide. They are told by the doctor to take folic acid, and of course they do, because it is important, but the problem is that ladies who have been on contraceptive pills find their folic acid store completely depleted. If they have not taken folic acid before pregnancy, it may be too late. With approximately 40% of UK pregnancies estimated to be unplanned, that is certainly an issue, so we look to the Minister for a good response. I mean this respectfully: larger ladies who have a higher body mass index should be taking more folic acid than the usual pregnancy dose. That is not talked about widely, but it is important to put on record how important folic acid is for anyone who is pregnant, and perhaps those showing signs more than others.

I read an excerpt from the NHS Choices website regarding flour and folic acid that made things very clear to me. It describes how a randomised controlled trial from 1991 first indicated that taking 4 mg of folic acid during pregnancy—10 times the current recommended dose—could prevent about 80% of neural tube defects. On the basis of that trial, it was concluded that such defects are due to a vitamin deficiency that needs correcting before pregnancy. However, it said that, despite campaigns, a study of nearly half a million women in England showed that less than a third took folic acid supplements before pregnancy. That tells me clearly that action is needed, and it is needed now.

[Paul Girvan (South Antrim) (DUP)]

On adding folic acid to flour, we have potentially been putting fluoride into water, and that has virtually no health benefits. That has only dental benefits, which are about lifestyle choice, and that is different from those suffering because they are not getting folic acid through their diet. It is great that this issue has been brought forward, and we should look to put folic acid into flour and ensure that everyone gets it, because there are no negative sides to that.

[Jim Shannon]

I wholeheartedly agree with my hon. Friend. We are already putting additives into many products we eat, to our benefit, and that is what we should be doing.

To return to taking folic acid supplements before pregnancy, of the half a million women in England surveyed, less than a third did so. The figures varied by age, with the highest use in women aged 35 to 39, of whom 38% took it before pregnancy, compared with only 13% of those aged 20 to 24 and 7% of those under 20. There was also a marked ethnic variation, with 35% of white women taking it compared with 20% of south Asian women and 18% of Afro-Caribbean women.

Just under two thirds of all women took supplements in early pregnancy, but the researchers say that that is already too late. The current strategy of encouraging women to take folic acid before pregnancy is inadequate and, in particular, putting younger women and minority groups at a disadvantage. People always talk about stats, but the fact of the matter is that they tell a story—and these stats tell a clear story. When women take folic acid before and during pregnancy, it makes a difference. However, there is clearly either no knowledge or not enough information about it. We look to the Minister and the Government to step forward and do what is right.

I would also like to mention that whenever people come to my office for benefit claims and I see what medication they are on, as we need to do—it must be the same for everybody’s offices—I find it surprising how many are, for different reasons, in receipt of folic acid. That is because folic acid helps to get their bodies back into kilter. That is important: folic acid has benefits not just for those who are pregnant but for those who are in ill health.

While I understand the Government’s reluctance to become a nanny state who enforce rather than guide, we should remember that flour fortification is not new. To white flour, the UK adds calcium, iron, thiamine and niacin to replace the nutrients stripped and discarded when the bran and germ are removed from the wheat grain. That was introduced after world war two to help improve the nation’s heath. We did it then for that purpose, so why in 2018 can we not do it for the purposes we are presenting to the House today? I do not agree with the nanny state argument. Sometimes, Governments have to take the initiative and do things that are important.

Today, milling is even more efficient at stripping the nourishing layers from the endosperm, which means that even less natural folate is left in white flour than there was when replacing other lost B vitamins was deemed necessary. There is, therefore, a greater need today for folic acid than there was in the past—even after world war two, when that was seen to be important.

I will conclude, because I am conscious of the timescale you gave us, Mr Hanson. The Government must consider this issue. I give my full support to the hon. Member for Pontypridd for bringing the debate forward, and to my right hon. Friend the Member for Belfast North and other speakers. We have all come here with the same message, in an attempt to highlight this issue to the Government. Anything we can do to bring healthy babies into this world should be done without any delay. This seems to be a cost-effective way of helping mothers and their babies from the earliest opportunity. I am fond of the Minister, and he knows that. I look to him for a substantial response—no pressure whatsoever—on what we have proposed, with reasons.

Infection Prevention and Control

Jim Shannon Excerpts

Tuesday 15th May 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered raising standards of infection prevention and control in the NHS.

This issue has been brought to my attention by a number of health organisations, and by lobby groups within the House as well. We are very aware that 5 May marked World Hand Hygiene Day and I am very glad to have secured this debate, to draw attention to the importance of infection prevention and control in the NHS and, in particular, the role of good hand hygiene in raising standards.

The first time the matter came to my attention was when my brother Keith had a serious motorbike accident some 12 years ago. Whenever we visited him in the Royal Victoria Hospital, we were told by the nurses to wash our hands: “Everything has to be very, very hygienic in here.” We washed our hands almost to the point of obsession because in that ward people were between life and death, and infection could have meant the end of a life.

This year, World Hand Hygiene Day focused on raising awareness about sepsis. We all know about sepsis through our constituents and the stories in the press as well. The World Health Organisation estimates that sepsis affects some 30 million patients worldwide every year. In response to a business question that I put to the Leader of the House, she suggested I seek a debate in Westminster Hall on the matter. As I am not very often here, I thought I would introduce a debate myself for a change—it would perhaps be an occasion. Here in the UK, there are 44,000 deaths from sepsis every year and it is a priority area for the Secretary of State. Effective hand hygiene plays a key role in reducing the risk of healthcare-associated infections such as E. coli, which are a major risk factor for developing sepsis.

I told Professor Didier Pittet, director of infection control at the World Health Organisation, that a debate on infection control was taking place in Parliament—I wished to inform him about what we were doing.

[David Simpson (Upper Bann) (DUP)]

I congratulate my hon. Friend on obtaining the debate. Yes, he is not often here and it is good to see him speak. On infection control, when we go to hospitals it is amazing to see patients standing in their dressing gowns, outside the front doors, smoking—human rights and all the rest of it—some of them running about with a drip in. All that infection is brought back in. Does my hon. Friend agree that something surely needs to be done from that end as well?

[Jim Shannon]

My hon. Friend is right. I hope that hospitals will take note of what is said in this debate and take action accordingly. It is all very well a visitor washing their hands almost to the point of obsession—every time they go out and come back in again—but hopefully that same level of hygiene control is being done by the hospital as well.

When I notified him of the debate, Professor Didier Pittet said:

“In the early 2000s, the NHS was the first ever health system to use a hand hygiene promotion strategy modeled on the World Health Organisation’s. This strategy went on to be active in 186 of the 194 UN member states. I call for the UK and the NHS in particular to reinvigorate hand hygiene promotion as the main strategy to reduce infections. The WHO hand hygiene promotion strategy saves between 5 and 8 million lives in the world every year, and will save hundreds of thousands in the UK.”

So, the importance of the debate is clear.

I spoke to the Minister before the debate and gave him a copy of my speech, to make him aware of what we are trying to do and the questions I want to ask him. I have absolutely no doubt that the shadow Minister and all of us here will be saying the same thing. We are looking for the same thing. There are some pilots in place and some recommendations coming from across the NHS, and we want to look towards those as well.

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

My hon. Friend talks about similarities and about issues being the same. Does he agree that, on the various standards—all of which are improving all of the time across the United Kingdom—we should all strive for best practice, with the most successful practices being replicated right across the United Kingdom in all the devolved institutions?

[Jim Shannon]

What my hon. Friend says is wise—we always hear very wise words from him, no matter what the debate. If we have best practice in Middlesex, Edinburgh, Cardiff, Newtonards, Bangor or Belfast—wherever it may be—let us replicate it everywhere else. My hon. Friend is absolutely right.

It is true that here in the UK we have made good progress in reducing the number of healthcare-associated infections over the past 10 to 15 years. The introduction of mandatory reporting of infections in the early 2000s has certainly helped to track the trends. When we look at some of the things we have done, there is good news. In 2003-04 the average quarterly count of MRSA bacteria was 1,925, but by 2008 it had reduced by 57% to 836—a significant reduction. Although that should be a cause for celebration, rates of healthcare-associated infections remain stubbornly high. Today’s debate is really about getting to the stubborn hard-core hygiene-related infections that do not seem to want to move.

The results of the most recent point-prevalence survey show that the number of patients contracting an infection in hospital is staggering. Every one of us knows how important the matter is. When my dad was in hospital for a time, he was always catching infections there. I am not saying that that was the fault of anyone, but I had thought that the possibility of infection would be greater at home—in hospital you expect it to be lower. Unfortunately, in the cases that I am aware of of people going into hospital with an illness, the rate of infection is high. People worry about that. My constituents worry about it, and I believe that everyone else’s do as well.

One in every 16 patients contract an infection in a UK hospital. That is only 6.4%, but it is 6.4% too many. There are 5,000 patient deaths every year from healthcare-associated infections. That is the thrust of the matter. If we are having deaths in hospital due to these infections we need to address the issue, and I look to the Minister for some thoughts on how we can do that. I am confident that he will come back with something that will help us in our debate.

The human cost of infection goes without saying. However, healthcare-associated infections also have a significant financial cost, which cannot be ignored. The health issues are one consideration, but the financial spin-off is also great. If we can address the infections early on, we can reduce the financial implications and also the deaths and infections. At a time when the health service is facing an unprecedented strain on services, reducing that financial burden is all the more pressing. It is estimated that hospital-acquired infections cost the NHS in excess of £l billion a year, which is 0.8% of the health service’s total budget. That is not an insignificant amount; £1 billion would change a lot of things for the health service and also, I believe, for people’s lives. That amount includes the immediate costs of treating patients in hospital, and also downstream costs due to bed-blocking—we all know the problems with bed-blocking. The costs are especially relevant, given the challenging winter that the NHS has just come through, with hospital capacity reaching 100% in some cases.

If I ask my constituents back home, where we unfortunately have a non-functioning Assembly, what the key issue is for them, they will say that it is health, and it will continue always to be health. If I may make a political statement, but not for any reason other than to illustrate the point: if Sinn Féin were to grasp what is important—and health is one of the things we can agree on—we could move forward together.

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

I congratulate the hon. Gentleman on securing this important debate. I spent some time in hospital a few years ago and it was a positive experience with a happy outcome—and I escaped infection. Does the hon. Gentleman agree that it is important to get right locally the fundamentals of fighting the global threat of anti-resistance to so-called superbugs?

[Jim Shannon]

The hon. Gentleman is absolutely right; we have got to get it right in our own hospitals and across the NHS and the whole United Kingdom of Great Britain and Northern Ireland, and then we can look further afield to other countries. He reminds me that last year I had occasion to be in hospital three times for various operations. I never had any infections. I had nothing but the best care. The surgeon’s knife went in the right direction and removed what had to removed. It was important to do that. The important thing is that we have hospitals and an NHS that are excellent. When the NHS works well, it is the best in the world, but sometimes we need to think about things.

The cost of infections to the NHS includes the immediate costs of treating patients in hospital, bed-blocking and so on. There are also issues with hospital capacity, which has reached 100% in some cases. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, so improving hand hygiene must play a central role in any strategy to reduce hospital infections. It would be remiss of me not to note the work carried out by the Secretary of State to improve patient safety in the NHS—let us give credit where credit is due. In November 2016, there was a commitment to halve gram-negative infections by 2020. The Secretary of State announced he would appoint a new national infection prevention lead, Dr Ruth May. Both are important steps in bringing down infection rates and show a commitment to do so.

Given that 50% to 70% of hospital infections are transmitted by hands, I was encouraged to see alongside those measures a commitment for the NHS to publish staff hand hygiene indicators for the first time. If hand hygiene is done—it should be, and perhaps there are indications of places where it has not been—then publishing hand hygiene indicators will allow benchmarking between hospitals and help drive up standards of hand hygiene. If we can have a system that can help drive hand hygiene, we should have it. Perhaps the Minister can respond to that point in his summing up.

The policy should not be implemented by weighing or counting cartridges used in hospital hand sanitiser dispensers. If it is done by the number of cartridges used, we might be under the impression that things are going the right way, but there has to be a wee bit more to it than that. Without factoring in patient bed numbers and staffing levels, the information is, I gently say, somewhat meaningless in showing hand hygiene compliance levels. The intention is right, but other factors need to be looked at.

The Secretary of State is a strong proponent of the use of reasonable technology in the NHS. Like me, he believes it has the power to radically change how we deliver care. Electronic monitoring technology can monitor hand hygiene to deliver real-time, accurate data to drive behavioural change. We want to see behavioural change where staff are not as active on hand hygiene as they should be.

Electronic monitoring is an innovative practice that is used internationally. Studies from a hospital in the US have shown that following the adoption of the technology, hand hygiene compliance improved by 30%. If we use that methodology, hopefully we can replicate what has happened in the US and reduce infections. That 30% increase corresponded with a 29% decrease in the number of MRSA infections, saving that one hospital more than $400,000. Here in the UK, electronic monitoring is being piloted at a number of hospital trusts in what the Care Quality Commission describes as “outstanding” and “innovative” practice. It goes back to what my hon. Friend the Member for Upper Bann (David Simpson) said in his intervention: where we see good things happening, we should be doing those things across the whole United Kingdom. My hon. Friend the Member for East Londonderry (Mr Campbell) also referred to that.

If the results from the US are replicated here in the UK—they can be—the national adoption of electronic monitoring technology could see 30,000 fewer infections, saving the NHS more than £93 million. More importantly, it would mean less infection, fewer people staying in hospital and fewer deaths. Dr Ruth May, the national infection prevention lead, said that,

“the collection, publication and intelligent use of data…will ensure organisations improve infection control and help…poor performers get the support they need”.

Those are very wise words. While I welcome the announcement of the hand hygiene indicator policy, it appears that progress on its implementation has stalled. I suppose that is the point I am coming to and the reason for this debate. The Department of Health and Social Care has missed its own deadline to publish the data by the end of 2017. Data is so important in drawing up a strategy, policy and vision of how we can address the issue.

We have been collecting mandatory data on the number of healthcare-associated infections, such as MRSA and Clostridium difficile, since 2004. When hand hygiene is so critical to reducing the number of healthcare-associated infections, it is difficult to see why it has taken more than 14 years to publish data on staff hand hygiene—data that we are yet to see. I find that incredible. I spoke to the Minister last night, so he knew I would raise this issue. The key issue for me is how we use the data we have to make a policy and a strategy from which we can all benefit. To mark World Hand Hygiene Day, the World Health Organisation is calling on Health Ministries worldwide to make hand hygiene a marker of care quality. If we do that right, we will be going in the right direction.

Will the Minister consider making hand hygiene a national marker of care quality? Will he, on behalf of the Secretary of State, outline who is responsible for the implementation of the policy? Will he set out a clear timeline for the collection and publication of this data, which is critical to driving up hand hygiene standards in hospitals? Someone walking through the door of any hospital will always first notice the smell. They will probably notice the warmth of the hospital, because it is there to care for patients and those who are ill. They will also see nurses running about with their gloves on. Hand hygiene is important for them, but we need to drive it a wee bit harder from the ministerial point of view and the local hospital point of view, to ensure that it happens.

Publishing data on hand hygiene compliance is a simple first step in improving hand hygiene, which is essential to raising standards of infection prevention and control in the NHS. It will save lives and money, and we cannot afford further delay. The UK and the NHS have been at the forefront of worldwide infection prevention and control strategies since the early 2000s. While a good deal of progress has been made since then—we welcome that progress, some of which has been significant—there is much work to be done to realise the Secretary of State’s ambition: that the NHS will be the safest health service in the world. We should strive to be the best. In many cases, we are the best, but we can certainly do better. The role of good hand hygiene in reducing hospital-acquired infections and improving patient safety cannot be overstated. We must also acknowledge that the current method of direct observation in monitoring hand hygiene in hospitals is no longer fit for purpose, and that technology can and should play a role in changing behaviours.

I look to the Minister for his response. I thank all Members for taking the time to come to Westminster Hall on a Tuesday morning to make a contribution. We look forward to those contributions.

[Mr George Howarth (in the Chair)]

I do not propose setting a time limit on speeches. It might be helpful by way of guidance to suggest that if everyone speaks for no more than 10 minutes, it should be possible to accommodate everyone who has indicated that they want to speak.

--- Later in debate ---

[Lee Rowley (North East Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. As my hon. Friend the Member for Moray (Douglas Ross) said, the hon. Gentleman has attended some of the debates that I have led in previous months, so I am grateful for the opportunity to speak in a debate that he has introduced. I know the topic is important to him, and he made a great and passionate case when introducing the debate.

Like my hon. Friend the Member for Amber Valley (Nigel Mills), I am not sure whether I can do justice to some of the issues that have been outlined. I do not wish to repeat things that have been said in a far better way than I could say them—I am by no means an expert in this area. My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) and I have known each other for many years. I know how difficult it was a number of years ago, with the loss of her father, and what a passionate advocate she has become for infection control and resolving some of the issues that have been mentioned. I cannot hope to match some of the discussion that we have had today.

As a relatively new Member of Parliament, I have been surprised in the 10 months since the election by the number of people who have come to my surgery to raise these sorts of issues. I am not new to politics—I was a councillor for eight years before becoming a Member of Parliament—and perhaps because previously I was looking at a different section of government and how it operated, but I was taken aback by the harrowing stories and challenges that many constituents have highlighted and have been willing to share with me.

There are a couple of issues in particular that have come through. The first is anaemia and the second is sepsis, which the hon. Member for Strangford has raised, and I have tabled some parliamentary questions on them. On anaemia, the best way to prevent infection is to prevent people from going into hospital in the first place. We need to reduce admissions, but it is a challenge to achieve that in our health service. One reason why many people are admitted is that they have undiagnosed illnesses, they experience problems and they automatically go to A&E. They present in a way that could be avoided.

The Anaemia Manifesto Steering Committee estimates that around 4 million people live with iron deficiency. It can be a secondary diagnosis, which means that people present with symptoms that they think are something else, but which in fact are anaemia. That costs the NHS up to £50 million every single year. Recognising and acknowledging that, and doing more work on anaemia, might help to address some of the admissions issues we have. Anaemia is the fourth most common cause of admissions for people over 75. It is, by common consent, an underdiagnosed and undertreated condition, and addressing that could be a route to reducing infections, by reducing the number of people in hospital in the first instance.

Sepsis has been discussed. I have heard about a number of cases about sepsis in my surgery: a lady with a young child whose life has been completely changed as a result of contracting sepsis, and who now has a completely different outlook and different requirements in how she lives her life, because of the limitations that sepsis has created; and a family who lost their mother to a sepsis infection that was not identified early enough. I could see the pain on their faces when they were talking about this hugely personal challenge that they had faced and which was created by sepsis.

There is recognition of the problem, and the Department of Health and Social Care is doing an incredible amount to raise sepsis awareness, and to move forward the acceptance that more needs to be done, but there remain challenges in diagnosis, in ensuring effective monitoring when people are in hospital, and in appropriate and adequate treatment. I am aware of the sepsis action plan and the public information campaigns on sepsis that are under way and which no doubt will continue. My parliamentary question was answered a number of months ago; it remains the case that there is a gap in understanding and focus in the health service on sepsis. I am sure that the Department of Health and Social Care and the Minister are seeking to close that gap as quickly as possible, but there is more work to be done, particularly with more than 100,000 cases a year and the deaths that the hon. Member for Strangford has outlined.

[Jim Shannon]

I thank the hon. Gentleman for his kind comments earlier. To underline the number of deaths, Northern Ireland had a peak in 2008 of 191 deaths where C. diff was mentioned on the death certificate. That has been reduced to 67. It comes down to the hard core of problematic infection that is still there. That is where we are looking for some direction from the Minister.

[Lee Rowley]

I absolutely agree. I think everybody would recognise that there is more work to be done.

I will not take up any more time. I welcome the commitment from the Government on matters such as sepsis. There is acknowledgment across the House and from the Government, I hope, that there is more to be done in this area—there is public concern and a desire for public focus—and that process is already under way. I hope it can be restated and redoubled. We all recognise that there is further progress to be made so that we are not here in five or 10 years’ time, debating the same subjects, listening to the same stories in our surgeries.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their significant and helpful contributions. The shadow Minister mentioned that everyone was on the same page and saying the same thing. I love debates of this type, because they show that we can all work in a cross-party way and make significant and helpful contributions. Let me look at the thrust of what we are trying to achieve. We are trying to bring deaths down—we have got them down to a certain level—and to implement a constructive strategy and policy to move forward with diagnosis and monitoring. Members also referred to the desire for increased public focus, and to the failure of buildings.

I am sure Members will not mind me saying that we are blessed to have the hon. Member for Central Ayrshire (Dr Whitford) here. I think we all acknowledge that she brings a wealth of knowledge to this place. I say that sincerely—I mean it, as I think we all do. We can all benefit from what she knows and from what is being done in Scotland.

The Minister told me before the debate that he was standing in for a colleague. He stood in very well, and I thank him for his constructive responses to every one of our comments. Much progress has been made. We are encouraged that a strategy is in place to try rigorously to reduce infection. Members’ contributions were all helpful, constructive and positive, and I hope that the debate leads us to where we all want to be, with disease reduced and perhaps someday done away with in all hospitals. The Minister referred to a shared objective. Yes, everyone in the House has a shared objective, and we all hope that together we can make it happen. I thank each and every Member for their contribution, and I wish them well.

Question put and agreed to.

Resolved,

That this House has considered raising standards of infection prevention and control in the NHS.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 8th May 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is right that once children become obese they are going to become obese adults, with all the health problems that come with that. I do not want to steal the thunder of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), but rest assured that we will examine what more we can do to tackle obesity in children.

[Jim Shannon (Strangford) (DUP)]

I declare an interest as a type 2 diabetic. Bearing in mind that three out of five people with diabetes have mental health issues, will the Minister outline what support services GPs should be able to offer at the first diagnosis of diabetes? Early diagnosis is key.

[Jackie Doyle-Price]

I could not agree more. We need GPs to understand that they must consider a patient’s needs as a whole, not just the condition that is presented at the time, and that message has been sitting behind the guidance that we have been issuing to GPs on how they manage patients with long-term health conditions.

Breast Cancer Screening

Jim Shannon Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Speaker]

Order. As colleagues know, I like to call everyone on statements, and I do not wish to make an exception today, but I remind the House that we also have a ten-minute rule motion and a very heavily subscribed Opposition day debate. In pledging to try to get all remaining colleagues in, I ask them to do us all the great favour of being extremely brief. I am sure that Mr Shannon has in mind just a short sentence without any preamble or subordinate clauses.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and for his compassion and care. Is he aware of any discussions on the continued alignment with the European Medicines Agency’s drug licensing process to ensure that our breast cancer patients, and indeed all cancer patients, have access to the benefits of the European trials and UK citizens are able to participate in clinical trials? This is very important.

[Mr Hunt]

That is a slightly different topic, but we have no greater priority than to ensure that Brexit does not interrupt the cancer care of UK patients.

Mental Health Services (Norfolk and Suffolk)

Jim Shannon Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Dr Poulter]

Yes, that is absolutely the right way to provide integrated services and joined-up care, because we cannot necessarily have a one-size-fits-all approach across Suffolk or Norfolk. We need to look at the local healthcare need. That is partly about working not just with housing providers, social services providers, primary care and GPs, as I believe is happening in my hon. Friend’s constituency, but with the voluntary sector, other third sector providers and local charities, many of which have knowledge of the needs of patients, families and carers. When we are providing joined-up, holistic mental healthcare, it is just as important to make sure that the approach is joined up and holistic in that regard, and I believe that the project in my hon. Friend’s constituency will have a very good chance of improving services for patients.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Dr Poulter]

I will make a bit of progress first and give way in two or three minutes.

The challenge from a lack of bed capacity is acute; 36 beds have been closed in recent months, 28 of them temporarily to be reopened as soon as possible. One of the challenges, as my constituency neighbour, the hon. Member for Ipswich (Sandy Martin) said, comes from the lack of joined-up working and a failure of commissioners, to some extent, to work collaboratively with the trust to identify short-term solutions. None of us wants to see patients travelling outside Suffolk. The commissioners have not worked well with the trust, because beds are available. My neighbour, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is unable to speak because of her Government role, has rightly highlighted that bed capacity is available at the Chimneys in Bury St Edmunds—18 beds, including specialist eating disorder beds, which are available and could be commissioned if the commissioners worked more collaboratively and supported the leadership of the trust more effectively. I hope that will come out of the collaborative and pioneering work on which the trust’s partners are now supporting it.

None the less, there are some positive things to point towards. Building work is going on to deliver some new wards, and it is hoped that Lark ward in Ipswich, the psychiatric intensive care unit, will be able to reopen later this year. There are hopes that more can be done for child and adolescent mental health services, with continuing expansion in the number of beds.

--- Later in debate ---

[Jim Shannon]

I congratulate the hon. Gentleman on securing the debate. I sought his permission to intervene beforehand and told him why I wanted to. With the prevalence of mental health issues 25% higher in Northern Ireland than in the rest of the United Kingdom, and with our NHS unable to meet the demand on the service, does he not agree that mental health reform must be UK-wide and undertaken urgently, before people who simply need a bit of help to cope become people who need in-patient care and a strong drug regime to survive? Do it now and it can stop problems later.

[Dr Poulter]

I agree entirely with my hon. Friend. He is always a strong advocate for the needs of his Strangford constituents. He is right to highlight that early intervention and early support can be very effective. That is partly because it often prevents some of the other unwanted effects of having a mental illness. When people have been untreated for a long period, they may well lose their job and struggle with their relationships. A number of the supportive and protective factors that can help to support someone through mild and moderate ill health, such as being in work or in a supportive relationship, can be lost. If we can do more to help people in the early stages, that is a good thing—quite apart from it potentially reducing the number of acute admissions later on.

I want to make the important point that the staff shortages at the trust are one of the major challenges that need to be addressed. It is frankly, and I do not use this word lightly—I do not think I have ever used it before, even though we often hear it used by politicians—a scandal that there is such a shortage of staff at Norfolk and Suffolk mental health trust. I hope the Minister can think of better ways to fund and support the trust. Without enough staff, it cannot expand services or deliver safe services. The trust has struggled with CQC inspections because there are not enough staff on the ground to deliver the care it wants to deliver. That is not entirely the fault of the trust, however, as it is constrained by its funding.

I will outline some of the issues that the trust faces. It has had difficulty recruiting band 5 registered mental health nurses—there are approximately 125 full-time vacancies; there are 35 full-time equivalent vacancies for psychiatrists, partly owing to a national shortage, but also owing to particular challenges in the east of England; almost one in five medical posts at the trust are vacant—that means that doctors who should be there treating patients are not because of staff shortages; and 16.02% of qualified nursing posts are vacant. That is not acceptable or sustainable. If we are to improve patient care and help the trust to turn around, the fundamental issue of recruitment has to be addressed. There are fewer than 15 psychiatrists per 100,000 people in the region, which is much lower than the national average. In fact, the east of England has the fewest psychiatrists per head of population in the country.

Doctor recruitment is not a good story either. Issues with the junior doctor contract might not have helped, but we are where we are. Recruitment for CT1 junior doctors in 2017 saw only 16 of 45 vacancies filled—that is 36%—so only one third of the number of doctors who should have started training at CT1 level are working in the trust. That is a big rota gap to fill and will of course affect patient care. In 2015-16, about one third of ST4 vacancies in child and adolescent psychiatry were filled. In general adult psychiatry, which is the bread and butter of psychiatry, only nine of 18 posts were filled in 2015. In 2017, only five of 22 posts were filled, which means that less than a quarter of posts for registrar trainees in general adult psychiatry are filled. The story goes on and is equally bad in older-age psychiatry—and we have a lot of older people with dementia to look after in the east of England.

Recruitment, then, is vital. We have to do more to recruit psychiatrists. The current strategies are not working, so I ask the Minister to look at what has been successful overseas—in Queensland, Australia, and other places—and to put financial incentives in place to support nurses and doctors to come and work in the east of England, because at the moment patients are paying the price for a lack of doctors on the ground. The trust is doing its best to recruit, but it needs extra financial support through Health Education England, and it needs to be given support and the go-ahead from the Department. We know from elsewhere in the world that financial incentives work in rural and coastal areas, as long as doctors and nurses are helped with a relocation package. The Department’s successful health visitor programme is a good example of how financial incentives can work. I hope she will look at that.

The pressures on the trust’s finances have been there for many years—since the merger of Norfolk and Suffolk mental health trusts—and we know that mental health has been underfunded nationally for decades. The trust needs £9.2 million to meet CQC recommendations for improvement. Some £4 million can be funded from the capital budget, but given that the CQC has criticised the building’s infrastructure, it seems ironic to raid the capital budget for buildings and infrastructure and put it into the revenue budget to deal with immediate quality of care issues.

Even with that £4 million, however, there is still a shortfall of £5.2 million, and that was the subject of a recent funding bid to NHS England. The bid will be resubmitted fairly soon, and I hope the Minister will encourage NHS England to look favourably on it. It is important that the trust is given the financial wherewithal to deal with the quality issues raised by the CQC, to reinvest in vital community services and to undertake the vital work on integration that my constituency neighbour, the hon. Member for Ipswich, mentioned in his intervention.

There is some positive news. The ligature reduction project is proceeding successfully, and some good work is being done in the rebuilding programme at Chatterton House. The Norfolk and Waveney perinatal mental health service was launched in September. I pioneered support for the expansion of perinatal mental health services when I was a Minister, and I am pleased to see that it is now happening on the ground. In February a specialist perinatal mental health service was launched in Suffolk, which is a very good development. However, severe challenges remain and need to be addressed.

Finally, let me say something about services for patients with addictions. I will be brutally honest: I think that we created a problem with effective addiction treatment through the Health and Social Care Act 2012. The commissioning of addiction services has been transferred to local authorities, although the bulk of mental health services and physical health care for patients with addictions is still run by the NHS.

In the east of England, the amount invested in drug misuse services has been reduced by about £6 million over the last four years. Drug misuse is a serious challenge in areas such as Lowestoft, Ipswich and Norwich, not just as a result of underfunding but because those services are not working in a joined-up way with mainstream physical and mental health services. That must be addressed as a matter of urgency, because patients are falling through the net and not receiving the holistic care that they need. Many end up in the criminal justice system as a result, and the police and, in some cases, communities are picking up the pieces because of the failure to provide joined-up care for those patients. The lack of substance misuse services as part of any NHS system affects the dynamics and practicalities of good care, such as the sharing of information. Barriers are created, and the good intentions of staff on the frontline are undermined. That has an adverse effect, and I am sure that we will continue to see a rise in the number of drug-related deaths as a consequence.

Let me ask the Minister some questions. What additional support can be offered to the trust to help it to deal with its historical and current financial challenges and transform its services in the wake of the CQC’s report? There is a shortfall in funding; the trust has submitted a funding bid, and I hope that the Minister will support it. What additional resources can be made available to improve the recruitment and retention of psychiatrists and nurses, and what can be done to attract junior doctors to the east of England? One in five doctors who should be at work are not there because of staff vacancies. What steps are being taken to stop the transfer of patients out of area for treatment? Finally, what can be done to ensure that there is proper integration of addiction services with mental health services in our region, to ensure that patients are given a better deal?

It is time for the rhetoric about mental health to join up with the reality, and for patient care to improve. It is time for Norfolk and Suffolk mental health trust to be given the support that it needs, so that it can do the best for its patients.

HPV Vaccination for Boys

Jim Shannon Excerpts

Wednesday 2nd May 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Henry, I think for the first time. I congratulate my hon. Friend the Member for North Thanet (Sir Roger Gale) on securing the debate and bringing this important subject to the House. He was in the Chair the last time I was in Westminster Hall, which was just yesterday. I am surprised that so few Members are present for the debate. As the shadow Minister suggested, perhaps matters elsewhere in the House and outside are occupying their minds.

As my hon. Friend the Member for North Thanet mentioned, our expert group, the Joint Committee on Vaccination and Immunisation, is considering this matter, and it is important that I do not pre-empt its final advice, as he rightly said. That does make the timing of the debate challenging, but I will respond as fully as I can and give as much context as possible.

I will first set out some of the context. In 2008—before I was even a Member of the House—on the advice of the JCVI, an HPV vaccination programme for girls was introduced. The primary objective was to protect against cervical cancer. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) kindly said, my mission in life—not just in my job—is to challenge and beat that dreadful disease. While I am on the subject, I pay tribute to Jo’s Cervical Cancer Trust and the brilliant Rob Music, who leads it—I know that the hon. Lady knows them well. The trust’s work in this area over many years, including with me as Minister, has been truly transformative for many women’s lives.

The HPV vaccine that is used in the UK offers protection against the two types of HPV that are responsible for about 70% of cervical cancers, and since the introduction of our vaccination programme the number of young women infected with HPV has fallen dramatically. Protection is expected to be long-term, eventually saving hundreds of lives each year, which I am sure we all agree is very welcome. Today, however, our focus is on boys and men.

[Jim Shannon (Strangford) (DUP)]

Is the Minister aware of the paper on this subject by Dr Gillian Prue of Queen’s University Belfast? Dr Prue’s six recommendations are very similar to what the hon. Member for North Thanet (Sir Roger Gale) and others have put forward today. They include: first, that both men and women should be vaccinated against HPV-related diseases; and secondly, and more importantly, that the significant human cost of HPV-related diseases should be the primary consideration for including boys in vaccination programmes. If the Minister has not been made aware of the paper, I am happy to furnish him with the copy. Its recommendations are integral to moving forward on the issue.

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.