Health and Wellbeing Services: Essex

Jim Shannon Excerpts

Tuesday 12th March 2024 Westminster Hall

[Priti Patel (Witham) (Con)]

I beg to move,

That this House has considered health and wellbeing services in Essex.

I am grateful that you are chairing the debate, Mr Henderson, and pleased to see that my right hon. Friend the Member for Pendle (Andrew Stephenson) is the Minister responding. He has been very good on many issues that I have taken to him thus far. I will cover a wide and diverse range of health-related issues affecting my constituents and people across Essex. I appreciate that some of those issues fall outside of the Minister’s portfolio, but I know he will take them on board and will feed back to colleagues. He is an excellent Minister, and I know he will respond in a helpful way. I am particularly pleased to welcome to the debate colleagues from neighbouring constituencies, my right hon. Friend the Member for Maldon (Sir John Whittingdale) and my hon. Friend the Member for Colchester (Will Quince), because we care about the provision and quality of health and wellbeing services. It is important to our constituents, and it is important that our constituents know we will work together as neighbouring MPs on some of the issues.

As the Minister and colleagues will be aware, just over a year ago, in March 2023, we were in this very Chamber having a similar debate with a similar title—I think we stretched it to the east of England last time round—and this debate follows on from that one. Everyone here will know that Essex is an amazing county. Our residents, businesses and communities are hard-working, resilient, entrepreneurial, ambitious and aspirational. They obviously back all the Conservative values around lower taxes, being a county of entrepreneurs and the engine of economic growth. We are net contributors to the Exchequer. I never tire of saying that because, as net contributors, we in Essex do not always get our pound of flesh back from the Exchequer when it comes to investment in our public services. It is fair to say that our constituents expect that from the Exchequer, particularly the fact that we should be supported when it comes to our public services, including the NHS, but also wider health and wellbeing services that do not always require medical interventions or diagnostics.

Parts of our county—mid-Essex in particular—have experienced considerable population growth and demographic changes, and that covers the constituencies of Colchester and Maldon. For clarification, we share district boundaries, so our council boundaries are intertwined—we are effectively three integrated MPs, I think it is fair to say, on many of the issues that we stand up and speak for. Those living within Essex County Council’s boundary totalled more than 1.5 million at the 2021 census, up by more than 100,000 people on the 2011 census, which is more than 7% and above England’s average of 6.6% at the time. That includes areas such as Southend and Thurrock. When we include those areas, our county population totals just under two million, at 1.9 million. We are one of the fastest-growing counties in the country, and growth in the city of Colchester, which covers parts of my constituency, continues to grow. With that, demand on public services continues to grow. We see from the census that we have over 300,000 people aged 65 or over, which is 21% of our population. That is higher than the average in England of 18.6% and, by 2035, that number will grow by up to 27%, so just under 400,000 people in Essex. The number of those over 85 will rise by 60%, so we can see that the numbers are growing. We are an ageing not just county but country and, that impacts on the working-age population of 18 to 65-year-olds which, by contrast, is set to rise by only 4%.

We can see the counter-cyclical issues resulting from the fact that a greater part of our population will be elderly. Interestingly enough, with that ageing population we are seeing increasing numbers of young families coming to Essex, which will mean more house building. Our schools are rated good and outstanding, and we are commutable territory, so our towns are thriving and growing.

As I said in the debate last year, there are pressures on social care which have had a very significant impact on the integrated care systems that have been introduced, with further integration taking place. In particular, those pressures have had an impact on spending at the county, district and city council level. We have a number of integrated care boards that cover Essex: NHS Hertfordshire and West Essex; NHS Mid and South Essex, which predominantly covers mid-Essex; and NHS Suffolk and North East Essex, covering Colchester and Tendring.

We also have a number of hospitals, the biggest being Broomfield Hospital, Colchester Hospital, the Princess Alexandra Hospital, Basildon University Hospital and Southend University Hospital. Our emergency services are provided by the East of England Ambulance Service NHS Trust, and the South Essex Partnership NHS Foundation Trust provides mental health services. I am shortly going to discuss those areas, and those trusts in particular.

As hon. Members have heard, we have a range of trusts, hospitals and challenges in Essex. When I was first elected we had the old-fashioned primary care trusts and strategic health authorities. Those were deeply unpopular, hugely problematic and bureaucratic and massively resource-intensive, and the changes in structures we have seen now provide greater integration. What really matters to all my constituents and residents across Essex is not so much the configuration and structure of services, but how those services work together effectively to deliver what those people and their families need: primary care, appointments and access to health services.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady on the debate. It is clearly about health services in Essex, and is therefore not to do with Strangford. However, to add my support to what the right hon. Lady is saying, I note that the problems in Essex she has outlined are replicated across my constituency as well. They include the closure of the local minor injuries unit, which is integral to the local community. That means that constituents have to travel further to get their healthcare—the very thing that the right hon. Lady is referring to. Does she agree that health bodies must focus more on community health and wellbeing to ensure that all constituents have the local access they deserve to efficient health and care services? Again, I commend the right hon. Lady on introducing the debate.

Parents and Carers of Infants: Support

Jim Shannon Excerpts

Tuesday 12th March 2024 Westminster Hall

[Sally-Ann Hart]

I agree with my hon. Friend. The wonderful thing is that we have so many voluntary organisations that do amazing work helping young mothers and parents with breast and infant feeding. Our family hubs focus on that, as does the Start for Life programme. It is not just one organisation; there are lots of services out there that can support parents doing this.

The Bill will achieve its aims by ensuring that local authorities publish a Start for Life offer on their websites and via other means they consider appropriate—for example, by providing physical as well as digital copies of their offer. A Start for Life offer is information on services that a local authority is aware are available in its area for infants, parents or carers of infants, or prospective parents and carers, that are provided by or on behalf of public authorities.

In particular, the Bill focuses on services that support the physical and mental health and development of infants, and that support parents and carers, or prospective parents and carers, in providing support to their infants. The services named in the Bill that local authorities will be under a duty to publish information about are maternity services, health visiting services for current or prospective parents or carers of infants, services promoting positive relationships between infants and their parents or carers, mental health services, and breastfeeding and other infant-feeding services. Local authorities will be able to provide additional information on other services that they consider it appropriate to include information about.

The Bill also includes a regulation-making power so that the Secretary of State may ensure that information on other services provided by or on behalf of a public authority that are likely to support infants, parents or carers of infants, or prospective parents or carers, are included in a Start for Life offer in the future. The Bill introduces a further duty on the Secretary of State to publish guidance to local authorities relating to those duties. It is important that parents receive evidence-based support and are provided with information that is backed by research and proven by parents, such as that of the Start for Life programme.

While I understand that guidance on Start for Life offers already exists, I know there will be a huge amount of learning from the Government’s family hubs and Start for Life programme that could be considered and taken on board as part of new statutory guidance. A duty to consult on the statutory guidance will ensure that local authorities and bodies the Secretary of State consults will have the chance to have their say on what will most help them to fulfil that duty and support families locally.

Finally, the Bill requires the Government to publish an annual report that sets out information about support that is being provided in England for infants, their parents and carers, and prospective parents and carers. The report will also include information that the Secretary of State considers appropriate to include, such as information about the impact of support on outcomes. That is very important as it will create further transparency for prospective parents, and for parents and carers of infants, so that they can understand the support available as they navigate the joys and the challenges of raising a new baby.

I will say a few words on the family hubs and Start for Life programme. Family hubs offer early support to families and young children to help them overcome difficulties and build strong relationships. East Sussex County Council was one of the trailblazers benefiting from the £300 million investment up to 2025. It is leading the way and supporting other local authorities to improve services that are offered to families so that they can be rolled out more widely across the country.

We have three family hubs in Hastings, offering support including maternity and health-visiting services, breast and infant feeding, parenting programmes, budgeting, employability and many other things. I pay tribute to East Sussex County Council’s director of children’s services, Alison Jeffrey, who is soon to retire, for all her dedication, determination and service to all families across East Sussex—especially to ensure that children’s life circumstances are not life sentences.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady. When it comes to the issue of childcare or support available for parents and carers of infants, what she is saying is really important. Just to give a quick point of view from Northern Ireland, there has been an increase of some 14% in the price of childcare—which is part of this topic—in Northern Ireland as of 2021. My party has long pushed for an increase in the tax-free childcare allowance beyond 20%.

The pressure on working-class families cannot continue. More needs to be done to support them financially with childcare, so that they can go out and work and, as a result, make ends meet at the end of the month. The hon. Lady is right to raise this matter. I would press the case of working-class families who are under extreme financial pressure.

[Sally-Ann Hart]

I thank the hon. Gentleman for his comments. The Bill is not specifically to do with childcare; it is also to do with the information given to parents and carers and prospective parents and carers of babies and infants. However, I do take on board his point about childcare. I think the hon. Gentleman will be aware that people who are in receipt of universal credit get free childcare, to some extent. That is worth noting, is it not? I thank him for his intervention.

Strong families are at the heart of communities. It is so important in Hastings and Rye to have high ambitions for and expectations of our families, because supportive families make for more stable communities, better outcomes for children and happier individuals. Investing in families and making sure they get the support they need from birth through to adulthood helps with children’s educational attainment, wellbeing and life chances, while improving wider outcomes such as poor mental health and unemployment. That is why funding allocated to family hubs must continue beyond 2025, and further funding should be allocated to extend the scheme to all local authorities in England beyond the 75 pilot authorities.

My Bill is scheduled to have its Second Reading on 15 March—this coming Friday. I hope it will be successful and that we can work together to ensure that every baby has the best start in life.

Dementia Care in Hospital

Jim Shannon Excerpts

Wednesday 6th March 2024 Commons Chamber

[Theresa Villiers]

Those are very valid points. It is important to keep people out of hospital for as often as possible, but that is particularly the case with dementia patients, given the dislocation and insecurity that comes with moving them to a different environment. Measures to keep people healthier for longer and to deliver care via the primary care system rather than in acute hospitals are an important way to address some of the problems I am outlining.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady for raising this issue. Over the past couple of years, I have dealt with a number of incidents similar to the one she refers to. Does she agree that, for those with dementia and Alzheimer’s, the emotional upheaval of being taken from a safe place where they feel comfortable can often lead to incredible distress, which can, in turn, result in aggressive behaviour? I know of one young nurse who had her arm broken in two places. It was not the patient’s fault, as he was simply beside himself and could not let go of her. Does the right hon. Lady agree that there must be enough staff in place to ensure that one young nurse should not be left screaming in pain, with no one there to help her? Does she also agree that that patient deserves compassion and understanding for their outburst?

[Theresa Villiers]

The hon. Gentleman makes an important point. One problem that emerges from some of the cases I will talk about tonight is that disruptive behaviour by patients with dementia, including shouting, can often be just an attempt to communicate. It is vital that staff understand that. Of course, I agree that it is essential that we have sufficient numbers of staff to ensure that they can give appropriate attention to patients with dementia in these circumstances.

The father of Carer 2 died a month after being admitted to Barnet Hospital. This constituent reported that food and drink was often just left in a tray, with little apparent effort made by staff to feed her father. He was left all day in a chair or in bed, with no attempt made by the staff to encourage him to walk. He was not supported while in the toilet, and when that led to distressing and undignified consequences, including the soiling of his clothes and hands, he was not washed until the following day.

Carer 3 told me that her husband’s condition deteriorated significantly during a stay in Barnet Hospital. Apparently, the nurses complained and said that he screamed all night. My constituent explained to them that that meant he wanted to get up to go to the loo but was prevented from doing so by the side bars on the bed. He was simply calling out for help. She often found food left untouched, yet no one seemed to note that her father had stopped eating. The catering staff just took the uneaten meals away. His medication was also stopped without his family being told, which led to a worsening of his symptoms and his anxiety.

Carer 4 told me about her partner, who has early onset Lewy body dementia and was admitted to Barnet Hospital in April 2022 after a fall. Apparently, until that point he was walking, climbing stairs and coping fairly well at home, albeit that he was a little wobbly on his feet. But the last time he ever walked was when he arrived at the Barnet accident and emergency department.

My constituent was initially restricted in visiting hours and had to fight to be allowed to stay in the hospital outside those times. She felt that the staff, especially some of the agency workers, did not understand her partner’s care needs. She was given the number for the specialist dementia nurse covering the hospital trust, but the phone was never picked up, no matter how often she rang. During his stay in the hospital, her partner deteriorated far more quickly than he had before. He was kept in bed constantly and lost the ability to walk—he is only 55. At one point, after undergoing an MRI scan, he was left distressed and confused in a cold hospital corridor, wearing a hospital gown damp with urine after radiographers had removed incontinence Conveen equipment. After he got out of Barnet Hospital, he said he would never, ever go back, no matter the circumstances.

Carer 5 told me about her father, who was admitted to Barnet Hospital with pneumonia in November 2021. When an ambulance was sent to pick him up, he was able to walk downstairs without assistance and climb into the back. Throughout his stay, it was extremely difficult for my constituent to get to speak to any doctor or nurse about his care.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I sincerely thank my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) for securing this Adjournment debate, and for her powerful speech. She really brought the subject to life through the examples from her constituency of people’s experiences in hospital. They were very difficult stories to hear, and I am very sorry to hear of times when it sounds like the care for people’s loved ones has fallen short.

My right hon. Friend made some powerful points that I want to address, starting with the fact that, as she said, there are many thousands of people living with dementia, and the number is only expected to increase; indeed, there will be more than a million by 2025. Many people with dementia will also be living with other health conditions. At the moment, it is estimated that around a quarter of the beds in hospitals are being used by patients with dementia, so ensuring that people receive the right care when they are in hospital with dementia is really important, as is doing our utmost to avoid unnecessary admissions and ensuring that people are discharged from hospital on a timely basis.

It is really worth emphasising the point that my right hon. Friend made about dignity, and the fact that every single person counts, at whatever stage of their life. There are challenges to ensure that people living with dementia have that dignity, particularly when they are in hospital. I, too, pay tribute to the many unpaid carers who are looking after their loved ones with dementia. I know what a huge burden and challenge that can be. However much someone loves somebody, there is a huge demand on them when they are caring for somebody with dementia. It can be very difficult, very distressing and absolutely relentless, however much they love them. I pay tribute to all carers who are doing that.

My right hon. Friend spoke first about Lisa Rutter, who very sadly lost her mother, who was living with dementia, during the pandemic—in hospital, if I heard my right hon. Friend correctly. I thank Lisa Rutter for the work that she is doing as the founder of Dementia Club UK. It is fabulous to be supporting other people to look after loved ones with dementia, or indeed those with dementia themselves. My right hon. Friend talked about the time Lisa’s mother spent in hospital, and how, for instance, Lisa knew what her mother needed but felt that she was not listened to, and that it may have contributed to her mother’s death. My right hon. Friend also talked about the visiting restrictions during the pandemic. I will talk about those in a moment.

My right hon. Friend talked about another constituent, whose wife was in hospital. She rightly talked about the importance of mobilising somebody with dementia, and how her constituent’s wife was nearly given the wrong medication, which could have been fatal. She spoke about the importance of his intervention. She also spoke about a constituent who was a carer for their father, and the importance of mobilisation, and some of the communication challenges for somebody with dementia.

My right hon. Friend talked about one person who had been screaming all night, as described by the staff. Actually, the family member who knew them understood that they were calling for help, as they needed to go to the toilet. That brings to life how difficult it can be when somebody has dementia and is not necessarily able to articulate their needs and what they want. Those who know them well will often know what they are trying to say or communicate, but that can be difficult in hospital when they may be being looked after by staff who simply do not know them well enough to know what they mean.

My right hon. Friend talked about food being left uneaten. If somebody is not eating in hospital, clearly they are likely to lose weight and their condition may deteriorate. She also talked about medication being stopped, and she talked particularly about somebody whose partner had early onset dementia, and had been coping fairly well at home. He walked into A&E, and that was very sadly the last time he walked. That emphasises the challenge of keeping people moving and maintaining their ability to be mobile during a hospital stay. She also described the fight to visit outside visiting hours.

I very much hear my right hon. Friend’s asks on visitor access, volunteers being trained in dementia care, as well as staff training, and avoiding discharge delays, among other things. I will pick up on some of those.

First, on the challenge of caring for people with dementia when in hospital, many hospitals have worked hard to do better for patients with dementia, for example creating dementia-friendly environments by changing the colour and lay-out, ensuring that staff are trained in dementia, and having dementia leads and dementia-lead nurses, as well as having training for volunteers. Standard training in caring for people with dementia is available through NHS England for staff and volunteers.

Clearly, my right hon. Friend the Member for Chipping Barnet described examples where care fell short. I have no doubt that across the NHS, with the work already taking place, we can go further. I will raise the points that she made about secondary care with my colleague, the Minister for Health and Secondary Care, so that we can work together on ensuring that care is right in hospitals. He also has oversight of workforce, and we should focus on whether the training that I know is available is being taken up by enough staff, considering the number of people in hospital with dementia.

On visiting, my right hon. Friend spoke about a subject that is close to my heart. Having been involved in some of the decisions about social care visiting restrictions during the pandemic and knowing how hard those decisions were—weighing up the infection control concerns and ensuring people could spend time with loved ones—we have been putting in place changes to Care Quality Commission regulation to make visiting a fundamental right, a fundamental part of care and a fundamental standard of care to ensure better access for loved ones to their family members in care homes and in hospitals. I know in particular how important that is for people with dementia, among others. The CQC is consulting on the implementation of the regulatory change, which will be live shortly. I believe we have taken a significant step to address concerns expressed about visiting.

Another thing my right hon. Friend spoke about was faster discharge. I am very alert to the risk of patients deconditioning in hospital, particularly patients with dementia. That is why over the past year or so, we have worked hard with the NHS to get better at identifying patients at greater risk of deconditioning, in particular those with dementia, on their admission to hospital. We have done earlier discharge planning and have been getting care transfer hubs established all across the country, which will do the work on more complex discharges. Often someone with dementia may need more access to social care. We may need to increase the access to, availability and supply of social care, so that it is there for those who will need it when they leave hospital. We have made some real progress on that over the past year.

[Jim Shannon]

Will the Minister give way?

[Helen Whately]

I have very little time, so I am afraid I will not give way.

My right hon. Friend the Member for Chipping Barnet talked about the social care workforce, another subject close to my heart. We have a strategy for the care workforce. We are building care as a career, in particular to boost recruitment and retention among our home-grown workforce. We recently published the first ever national career structure for care workers, and we are launching a new national qualification to boost the supply of care workers.

Avoiding admission is another priority for me. Clearly, some people should be—absolutely must be—in hospital for the treatment they need, but we know that patients with dementia in particular can deteriorate in hospitals, so we are doing more work with the national health service and social care to avoid admission when it is not truly necessary by putting in place alternatives or, at the other end, supporting earlier discharge through the roll-out of the Hospital at Home initiative, or virtual wards, under which we committed to at least 10,000 hospital-at-home beds or equivalent as part of emergency care recovery plans. The NHS has over-delivered on that, so we now have more than 11,000 Hospital at Home beds, which help people who would otherwise be in hospital receiving acute care. They receive that care and are able to recuperate at home, avoiding the risk of a longer hospital stay and deconditioning.

My right hon. Friend talked about dementia research and the new treatments coming onstream. The Government have committed to doubling our investment in dementia research during this Parliament, and we are on track to do that with our dementia mission. We are also working very closely with NHS England to be ready for the breakthrough treatments lecanemab and donanemab coming onstream. I should be clear that we know very well—I have received clinical advice on this—that those treatments have quite significant side effects, so they will not be suitable for everybody and I put a note of caution there. We are waiting to hear whether they are approved by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. In the event of approval, NHS England is taking steps to be ready to put in place the levels of diagnosis required to be able to support those treatments.

That goes hand in hand with the work that we are doing with NHS England to improve the diagnosis rate for dementia. We have a target dementia diagnosis rate of 66.7%. That dropped during the pandemic because dementia services and assessment had to be closed, but it has been gradually building up, and I expect NHS England to get back up to that level during the course of this year. That is really important, because having a diagnosis helps people—the individual with dementia and their carers, for example—to access the support and back-up that they should be receiving.

I am conscious of the clock ticking, so I have tried cover some of the territory that my right hon. Friend set out in her speech, which I thought was very powerful in raising these significant issues for those with dementia receiving care in hospital, their carers and loved ones. I completely agree about the importance of dignified treatment and treating those with dementia with dignity at all times. I know that that can be particularly challenging in hospital, but we have to ensure that that is the case.

We will ensure that we get all the necessary care in place outside hospital, which avoids unnecessary admissions; support people to be discharged from hospital quicker; get ready for the arrival of new dementia treatments; and raise awareness about the significant proportion of dementia cases that can be prevented or at least delayed by looking after our health. In fact, the risk factors for dementia are similar to those for heart disease and other things, and there is relatively low awareness of that. We will see more people with dementia in the years ahead, but we can do more to raise awareness of how people can maintain their health and stave it off.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 5th March 2024 Commons Chamber

[Helen Whately]

Across the country, ambulance response times have come down by a third. We have worked very hard, particularly with areas that face greater challenges, including Shropshire. I have spoken to leaders in the local health system about the ongoing challenges. We are learning lessons about what has worked over the past year, and from where we have not made so much progress, to ensure that we do better in areas such as the hon. Lady’s over the year ahead.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her positive answers; they are really appreciated. Bearing in mind the pressure that GPs are under, which is leading to more pressure on emergency provision, what steps are being taken to provide greater incentives for medical students to take on positions in GP surgeries? That would make a big difference.

[Helen Whately]

The hon. Gentleman is absolutely right to talk about the whole health system. One thing we are doing as part of our work on urgent and emergency care is preventing people from being admitted to hospital unnecessarily, or from being brought to A&E in the first place. Primary care is part of that. In our investment in expanding medical school places, we are particularly encouraging medical schools, such as the new Kent and Canterbury Medical School near me, to train students to work more outside hospitals, including in primary care.

Tackling Obesity

Jim Shannon Excerpts

Tuesday 27th February 2024 Westminster Hall

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I beg to move,

That this House has considered the matter of tackling obesity.

It is a pleasure to serve under your chairmanship this afternoon, Mr Dowd. I am incredibly grateful to be able to raise the important subject of tackling obesity, which I believe is vital to our country’s future. I am grateful to see colleagues here from both sides of the House, as tackling obesity requires a cross-party approach. I particularly welcome my right hon. Friend the Minister, who is also a personal friend. I have worked closely with her in the past, and I know how interested in and concerned about this issue she is.

Obesity is a major public health problem and a global concern. According to the World Health Organisation, worldwide obesity has nearly tripled since 1975. Most of the world’s population live in countries where issues associated with being overweight or obese kill more people than issues associated with being underweight, and 39 million children under the age of five were overweight or obese in 2020. These are quite shocking statistics. However, the problem is of particular concern in the United Kingdom, where we have the third highest obesity rates in Europe, behind only Malta and Turkey, and where we have the third highest in the G7, behind only Canada and the US. Almost one in three adults here is now classified as obese, a dramatic increase from the one in 10 adults in 1970. The increase in this country has been much greater than in other western European countries, such as France, Germany and Italy.

The health survey for England monitors trends in our national health and care. It found that a higher proportion of men than women were either overweight or obese—69%, compared with 59%. The highest rates of obesity were found among the lowest socioeconomic groups. Almost 70% of people in the most deprived quintile of English localities are classed as living with obesity or being overweight, compared with 59% of those in the richest.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman on securing this debate and apologise to him in advance: but for an AGM that I am attending at five o’clock, I would have participated in the whole debate.

According to the Department of Health back home, 65% of adults in Northern Ireland are obese, which is quite a shocking figure. There are now plans for a consultation, which highlights the need to make healthier food more affordable. Does the right hon. Gentleman agree that this must be a priority for every region of this great United Kingdom of Great Britain and Northern Ireland, and that that must be done in partnership with our own agrifood sector? It has a role to play—maybe a financial role, as much as a role in guidance. When it comes to the Minister’s reply, does the right hon. Gentleman agree that partnership with the Department for Environment Food and Rural Affairs might be advantageous?

Heart and Circulatory Diseases: Premature Deaths

Jim Shannon Excerpts

Thursday 22nd February 2024 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Watford (Dean Russell) for setting the scene today. We have spoken many times on this issue. It is a real pleasure to see him back to health and strength, and working very effectively in this House.

The rates of premature death from heart and circulatory diseases do not make for easy reading. The British Heart Foundation has been clear about how stark the situation is. As the DUP’s health spokesperson, I try to involve myself in all health matters—whether they be in ministerial questions or in debates—in this Chamber or in Westminster Hall, because that is part of my duty.

The number of people dying before the age of 75 from heart and circulatory diseases has risen to the highest level in more than a decade. Waiting lists for heart operations and other heart procedures are nearly 100,000 higher than they were a year ago. Those figures are stark and worrying.

I am very pleased to see the Minister in her place. We all have great respect for her. Although we do not want to burden her with questions, we do need to ask ourselves why these figures are so high and what is being done to reduce them. Worryingly, there are more people over the age of 75 waiting over a year for treatment—the rate is 140 times higher than before the pandemic began.

Latest figures show that, in 2022, more than 39,000 people in England died prematurely of cardiovascular conditions, including heart attacks, coronary heart disease and stroke—an average of some 750 people each week. Again, worryingly, that is the highest total since 2008. What is being done to address those issues?

This backwards trend—because that is what it is—has been broadly mirrored in age-standardised premature death rates, which account for changes and differences in population sizes and demographics. Before 2012, the number and rate of deaths from these conditions under the age of 75 were falling, in part thanks to decades of medical and scientific breakthroughs.

But after nearly a decade of slowing progress, recent statistics show that the rate of premature deaths from cardiovascular disease has now increased in England for three years back to back. This is the first time that there has been a clear reversal in the trend for almost 60 years. Again, the question must be: what has brought that about and what has been done to stop it.

The British Heart Foundation has said:

“The reasons for the rise are multiple and complex. While increasing pressure on the NHS and the covid-19 pandemic have likely contributed in recent years, the warning signs have been present for over a decade.”

If those signs have been present for over a decade, the question we must all ask is: what steps have been taken to slow the trend that has been there for some time.

I know that there will be many in this Chamber with opinions as to the cause. I do not hold a medical degree. I am a very simple person, but I do have an interest in health and I do ask the questions. The fact is that the sharp rise needs to be better managed. I can quickly give some examples of what we are doing back home in Northern Ireland. We have a developing plan with the Irish Football Association that includes more defibrillators and CPR training, which is really important. Many people who are fit and healthy—the hon. Member for Watford referred to this—have had heart attacks on the football pitch. Those are things that we need to address. May I commend the Chest, Heart and Stroke charity back home for all that it does?

This month in Northern Ireland, 340 people will die from heart or circulatory disease, around 90 of whom will be younger than 75 years of age. Some 225,000 people are living with a heart or circulatory disease, 320 hospital admissions will be due to a heart attack, 130 people will die from coronary heart disease, and 13 babies will be diagnosed with a heart defect this year. Those are the figures for Northern Ireland. The statistics are shocking, especially given the small size of Northern Ireland. There are an estimated 225,000 people living with heart and circulatory diseases in Northern Ireland. An ageing and growing population and improved survival rates from heart and circulatory events could see these numbers rise still further. It is clear that this really is a ticking timebomb and therefore we do seek some help from the Minister here.

I can see the Minister formulating her response. Both she and I are glad to see that the Northern Ireland Assembly is up and running. As health is a devolved matter, may I ask her in a genuine fashion, as I always do, whether she can indicate what discussions will take place with the Department of Health in Northern Ireland.

We in Northern Ireland are in the situation in which every region of the UK finds itself: there is not enough funding, not enough staff, and not enough support. Across the United Kingdom of Great Britain and Northern Ireland, we need to address the growing problem with solutions, which can only come about with reasonably paid staff and a better system. Let us exchange our thoughts and ideas, and move forward together towards a system where we can help each other. An overhaul of the system is needed, and we look to the Minister for a plan of action, beginning here in this place and extending through the NHS and across the United Kingdom of Great Britain and Northern Ireland.

You told me to finish within a certain time, Madam Deputy Speaker; I have just done it.

National HIV Testing Week

Jim Shannon Excerpts

Thursday 8th February 2024 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for Hammersmith (Andy Slaughter). I thank him for his contribution and his knowledge of his constituency. I also thank the hon. Member for Warrington North (Charlotte Nichols). She led a debate yesterday on mindfulness, which I attended, and she led this debate on HIV testing exceptionally well.

I am the Democratic Unionist party’s health spokesperson, so it is a pleasure for me to be here to make a contribution. I always like speak in such debates if possible. Once or twice I have missed them, but I am very pleased to be here today. We celebrate the fact that HIV is now a disease that people can live with, and can enjoy a better life with. That is something to celebrate.

National HIV Testing Week lasts from 5 to 11 February, and special recognition is deserved for reaching a decade since it started. We should look at what has been done in the last 10 years—how we have progressed and done better, and how people have a better quality of life today. It is important to mark this week in Parliament, as testing is the only way for people to know if they have HIV. The Father of the House said that he would go and get a test, even though he does not need one. He said that people should recognise that testing is important. The latest figures show that rate of HIV diagnosis is falling, but people of a heterosexual orientation are getting more HIV diagnoses, so there is a lot of work still to do. Testing is free, quick and easy, so it is imperative that people of all ages are aware of the services available to them and take advantage of them to prevent passing it on to others.

I would point the Minister, for whom I have great respect—I understand her deep interest in this subject and very much look forward to her response today—to the issue of PrEP, which the hon. Member for Hammersmith referred to. In Northern Ireland, we have had a very successful campaign on that for some time, which seeks to raise awareness, reduce sexual diseases and then, by its very nature, give people longer lives.

Some 69,000 HIV tests were carried out in Northern Ireland in 2020; from those, there were 52 new diagnoses, bringing the total number of people diagnosed with the disease in Northern Ireland to 1,123. With a population the size of ours, we might say that those figures are not bad—I do not think they are. It illustrates that testing and the use of PrEP, among other policies in Northern Ireland, have enabled us to reduce diagnoses and keep them at a manageable figure. That is a decline of 49% from 2015, which is a massive success story. There has been a declining trend in the annual number of diagnoses in people born in the UK. There is no doubt that we are doing our best to encourage people to partake in testing.

It is important to recognise how far we have come since the ’70s and ’80s, when there was a huge stigma around HIV diagnosis, testing and treatment. As I have said, I am my party’s health spokesperson, so I try never to miss these debates. It is amazing to see how far we have advanced since then, both socially and medically, and it is important to say how wonderful our NHS is, being capable of transforming what was once a much-feared virus into something that is now easily treated. That does not mean we become nonchalant in relation to it; it means we have to recognise what we have done, and then recognise what our policy will be for the next period, because people are now able to live long, healthy lives through treatment.

I look to the Minister for a commitment that we will dedicate more resources to educating young people on HIV and other viruses that can be passed on through infected bodily fluids. Many young people will not remember, or even be aware of, the years when HIV was a massive concern to so many. It is crucial that we keep on raising that awareness today, and that young people are encouraged to test, if necessary, and to have those conversations with family and friends, to ensure they do not have the disease and that they are safe, well and healthy.

Where we can do that most effectively is in schools and universities, which have a role to play in ensuring that young people feel comfortable and have a safe place where they can speak to someone privately. The Father of the House was absolutely right: these subjects are sometimes difficult to deal with, and those conversations may need to be private. Many universities already have sexual health clinics, which are fantastic services to offer young people.

So many organisations do incredibly hard work to provide support for other nations with a high prevalence of HIV. In National HIV Testing Week, I want to make a plea to the Minister. Ards Elim church in Newtownards, in my constituency, operates aid and missions out of the church and is incredibly active with missionaries in Africa, especially in Swaziland and Zimbabwe. Every year, a group of young people come to our constituency, every one of whom is HIV-positive—their parents had it, and they have it—but they are living their life today because of the new medications that we have. I feel greatly encouraged when I see them and when I hear them singing in their heavenly voices. It reminds me that we in this great United Kingdom of Great Britain and Northern Ireland have done magnificent work out in Swaziland, Zimbabwe and across Africa. I know it is not the Minister’s responsibility, but could she perhaps give a hint or write a letter to myself and others on what can be done to continue the work on HIV in Swaziland and Zimbabwe? It is of great interest to my constituents who attend that church.

At one stage, 40% of the population of Swaziland were HIV-positive, but today, after receiving medications and doing testing campaigns, the rate there is manageable. If that is not a success story, I would like to know what is. As many will know, there is a high prevalence of HIV in certain parts of Africa, and the ministry is keen to secure help for young children and parents who are suffering. There is so much ambition to help others, as it has been proven that catching cases early through frequent testing hinders the spread and lessens the impact of HIV on an individual. Across the UK, we are successful with our figures. Can the Minister provide some clarity on whether we are able to help other countries in desperate need as well?

This week is another opportunity to encourage people to take advantage of services offered to combat HIV. There is fantastic potential to protect people from HIV and to prevent severe illness and even death. When I think of the royal family, I often think of Princess Diana and the work she did when she was alive. She reached out and was one of those great motivators who tried to make sure that people across the world knew that HIV should not and would not be a death sentence.

To conclude, I thank the local health trusts in Northern Ireland, and indeed across the whole United Kingdom of Great Britain and Northern Ireland, for providing these worthwhile facilities. I call on the Government and the Minister to ensure that we continue to provide sufficient testing services to all across the United Kingdom of Great Britain and Northern Ireland, as testing has proven instrumental in saving lives. Why would we not celebrate an occasion like this, when across this great United Kingdom, many more people are alive today because of what we have done?

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the SNP spokesperson.

--- Later in debate ---

[Dame Andrea Leadsom]

As I just mentioned, there is an additional £20 million for the National Institute for Health and Care Research. As well as delivering the opt-out testing in 47 centres, it will deliver a live dashboard showing the effectiveness of this type of testing. That is in addition to self-testing, which people can do at home or at a testing centre. It is particularly important to note that the public health grant is used in local authority areas, so that authorities can make their own attempts to reach out and identify those who should be tested.

[Jim Shannon]

We in the House may want to reach out further and bring about more testing. Has the Minister been able to explore the possibility of extending this programme to Northern Ireland, Scotland and Wales? This is something that we should all pursue vigorously, and we can do that better if we do it collectively.

[Dame Andrea Leadsom]

I completely agree. We would like to see this being done around the world. The UK is, I believe, the third biggest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which seeks to eradicate those diseases and to which we have donated £5.5 billion, so our interest is in eradicating those diseases throughout the world. Closer to home, the hon. Gentleman is absolutely right: that crucial part of the United Kingdom, Northern Ireland, should also be supported and helped to roll out this testing, and that will be possible now that the Northern Ireland Assembly has been re-established, which I am delighted about.

Of course, there is still much more to be done to smash the stigma attached to HIV testing and treatment. I pay particular tribute to Becky from Sheffield and Akhona from Leeds for coming forward recently and telling their stories to the BBC. They are setting an example for people up and down the country who should come forward for testing or treatment, and we are backing their efforts to spread awareness by funding HIV Prevention England’s HIV stigma symposium in March at the International Convention Centre in Birmingham. The event will bring together community experts, activists, healthcare professionals and affected people to discuss the impact of HIV stigma and look at effective stigma-reduction strategies. I am sure that it will generate promising stigma-reduction solutions, and I will listen carefully to its recommendations. I am pleased that HIV Prevention England is focusing its efforts on giving a platform to speakers from underserved areas.

Of course, HIV prevention goes beyond testing. The use of pre-exposure prophylaxis, commonly known as PrEP, is an important part of combination HIV prevention. It has been called a “miracle drug” that prevents HIV-negative people from acquiring the virus, and it is a vital tool in our battle to end new HIV transmissions by 2030. Oral PrEP has been routinely available in specialist sexual health services since 2020.

However, we recognise that certain groups have challenges in accessing the PrEP they need. That is why we have developed a PrEP road map with colleagues from Government, local authorities, professional bodies and the voluntary and community sectors, and it will be published on 15 February.

Physician Associates

Jim Shannon Excerpts

Wednesday 7th February 2024 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests as a practising NHS consultant psychiatrist.

The UK has a severe shortage of healthcare professionals, amounting to more than 110,000 in England alone, coupled with a growing ageing population with an ever-increasing need for a strong and responsive health service. To address the shortage, the Government in England have introduced the NHS long-term workforce plan, with additional proposals also set out in the devolved nations.

NHS England’s plan sets out a wide range of mostly unfunded workforce measures, including doubling the current number of medical student places to potentially add 60,000 doctors to the workforce by 2036-37. Controversially, it also includes plans to increase the number of physician associates from approximately 3,250 to 10,000, an increase of over 300%, and anaesthesia associates from approximately 180 to 2,000. That is not to say that physician and anaesthesia associates should not have an important role in the future NHS workplace. However, at this time, serious regulatory and safety concerns relating to associates need to be addressed before the NHS seeks to expand their numbers and roles. Furthermore, standardised high-quality training pathways and a properly defined scope of practice are essential.

Physician associates, anaesthesia associates and surgical care practitioners are collectively known as the medical associate professions, and I may use the terms interchangeably. Physician associates and anaesthesia associates currently complete a two year postgraduate course and are employed in a variety of settings in the NHS, including GP surgeries, emergency departments, and medical and surgical settings, and they have also been introduced to mental health settings.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing the debate. The issue is massive—it is massive for me back home, as well—so I thank him for his reasoned and knowledgeable speech, as well as his contribution to the NHS over the years. Without an increase in the number of GPs and doctors, does he agree that the healthcare crisis we face will become an abyss? In small countries such as Northern Ireland, students cannot get places in our small medical schools and are training, working and living in other countries, which is a real loss to future stability. Does he agree we need to do more to keep our young medical staff rather than let them head to greener grass in far off fields?

[Dr Poulter]

I completely agree with the hon. Member. He advocates strongly for his constituents, as always, and for the need to better retain our medical workforce in general, our junior doctors in particular. The Government will have heard his comments. I am sure that things can be done to improve the current offer to junior doctors in England. Indeed, things can be looked at in Northern Ireland, too, with the restoration of political arrangements.

An agreement could be put in place that will properly renumerate junior doctors, and also look at the other terms and conditions of employment that are important in respect of retaining the medical and healthcare workforce. These situations are not always about pay; it is also about wider terms and conditions. The Government could certainly look in more detail at student debt, for example, as the Times Health Commission outlined this week, which may incentivise people to stay in medicine for longer.

We have diverged slightly into the broader healthcare challenges, so I will return to physician associates, which was the point of this evening’s debate. There are concerns about the regulation and training of this particular group in the medical workforce. Physician associates and anaesthesia associates are not currently regulated. There have been a number of recent high-profile cases of patient harm as a result of being seen by medical associate professionals, including, sadly, some deaths. We know, for example, of the tragic case of Emily Chesterton from Salford who died of a pulmonary embolism having been seen twice and had her deep vein thrombosis misdiagnosed as a musculoskeletal problem by a physician associate at her local GP practice.

Anybody who watches the TV programme “24 Hours in A&E” may have seen some fairly enlightening scenes in respect of the clinical skills of some medical associate professionals, including physician associates. There are many examples of poor clinical diagnosis and judgment, including, for example, making initial decisions to send patients with compound fractures home without an X-ray when the patient actually required surgery.

In my own clinical practice, I have worked alongside some very competent physician associates, but there is a high degree of variability in their training and skills. Only last year, I was forced to directly intervene to prevent patient harm following a paracetamol overdose by a patient who attended A&E. The physician associate incorrectly informed me that they did not require N-acetylcysteine treatment because their liver function test was normal, in spite of the fact that they were over the treatment line as a result of their paracetamol overdose. Of course, at that time, the patient’s liver function tests were normal, but they would not have been for very long. The consequences of that diagnostic decision by the physician associate could have been fatal. The key issue for me is that many physician associates do not know or have the self-awareness to understand the limits of their knowledge and practice, but this is perhaps understandable in a health system that fails to adequately regulate and indeed define its scope of practice.

There are many other areas of concern that have been highlighted in a recent British Medical Association survey of 18,000 doctors, an overwhelming majority of whom work with physician associates. In November 2023, due to severe concerns around patient safety, the BMA called a halt to the recruitment of medical associate professionals to allow proper time for the extent of patient safety claims to be investigated and the scope of the role to be considered.

When the physician associate role was introduced, it was clearly seen as part of the solution to a shortage of doctors, which currently stands at in excess of 8,500. By freeing up doctors from administrative tasks and minor clinical roles, it allowed them to see more complex patients and get the training required to become excellent consultants or GPs.

Unfortunately, physician associates and anaesthesia assistants have been employed in the NHS in roles that stretch far beyond that original remit, and in many cases that were reported in the recent BMA survey that I mentioned, they appear to be working well beyond their competence. That has raised serious patient safety concerns—I gave some examples earlier—and led to calls to review the role, limit the scope of practice, and protect training for the doctors that the NHS desperately needs. When consultant time is taken by supervising physician associates, that is to the detriment of training and supervising junior doctors. That has not yet been addressed or even considered in the NHS England workforce plan.

Internationally Recruited Health and Social Care Staff: Employment Practices

Jim Shannon Excerpts

Wednesday 31st January 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate.

I thank the right hon. Member for Spelthorne (Kwasi Kwarteng) for leading the debate and setting the scene so very well. I have to put on record our thanks to all the wonderful health and social care staff, who, as we all know, go above and beyond the terms of looking after us and our constituents; they give a wealth of ability, energy and time, and regardless of where we are, the job they do is undeniably challenging. We thank them dearly, and we mean that.

It is also always great to be here in Westminster Hall to give a Northern Ireland perspective, as I always do in these debates. Health is devolved back home, so the processes there are slightly different. I will also make a couple of important points—everybody’s points are important—to remind hon. Members that although we are discussing internationally recruited health and social care staff, some of our own people here who wish to do the same job are restricted from doing so.

In November 2022, Northern Ireland welcomed 133 new international nurses, mostly from India and Zimbabwe, who took up permanent posts across Craigavon, Lurgan and South Tyrone hospitals. At such a challenging time for the health and social care sector—with ongoing demand for services, issues within the workforce, and lots of developments—ensuring sustainable care for others should be at the forefront of our priorities.

I am keen to say that there are clearly issues in terms of entry requirements and placements for those wanting to study nursing, medicine and so on in Northern Ireland universities. I suspect that the same problems occur in other parts of the United Kingdom. I am aware of so many people who wanted to be a nurse or in medicine, and wanted to stay in their own country to do so, but did not gain the entry requirements needed or there were no places for them. Whenever the Minister responds to the debate, perhaps she could tell us what discussions have taken place with those universities to ensure that the opportunities and number of places are increased—in Northern Ireland and across the whole United Kingdom.

For example, I have a constituent who attained 10 A* grades in her GCSEs—my goodness, this is a smart lady! She also completed her gold Duke of Edinburgh award and went to on to help with healthcare in small communities in Africa; that is very commendable. By the way, I know this lovely young lady well, and she will go far and do well. In her A-levels, she got 3 A* grades and one A, and she attended interviews but did not receive a place in university in Northern Ireland. If she had, she would have stayed in Northern Ireland. Whenever we talk about recruiting internationally—we should be doing so, and highlighting that issue—we also have to highlight the fact that we have talented people at home who wish to stay, but there is not an opportunity for them to do so.

Ultimately, that young girl went to Wales to study, with a further £5,000 of debt for each year of her degree. She is now a junior doctor in Cardiff, but the point is that she should have been given that opportunity in the place where she wanted to live, work and serve. The question for me is: will she ever come home to Northern Ireland? While Wales has gained her, Northern Ireland has lost her. I am all for securing our health and social care workforce, and if that means going international, let us do that; but there is also a source of talent back home.

There seems to be an issue with those who want to study nursing in their own country but are unable to do that because of placement issues, so will the Minister tell us whether that is one reason why we are struggling to maintain a steady workforce? If we can train them back home and keep them, we will not have to source them internationally. It all comes down to funding, which comes from Westminster. We need to increase the number of spaces that universities can facilitate. With great respect, I ask the Minister whether it is possible to engage with the Department for the Economy back home in Northern Ireland. Hon. Members have heard the news today: the Northern Ireland Assembly will be up and running, hopefully shortly. What can be done to give local students more opportunities to study in their own country?

Northern Ireland offers wonderful opportunities for international recruitment. We recruit internationally all the time. The number of people on the permanent register in Northern Ireland who were initially registered outside of the UK increased to 3,794 in 2022-23 from 3,399 the previous year—an increase of 400 international nurses. We recruit internationally and are pleased with the contribution, ability and talent they bring to Northern Ireland. I welcome the wealth of experience they bring, but I want also to be a voice for those students from Northern Ireland who cannot get a place and therefore have no choice but to leave Northern Ireland and study, work and live elsewhere.

Will the Minister engage with the Department for the Economy back home in the Northern Ireland, with the Assembly, and with local universities such as Queen’s University Belfast, Ulster University and Magee university, to see what more can be done to facilitate greater placement opportunities for Northern Irish students in our local universities and, ultimately, to ensure that they take up nursing and medicine opportunities in Northern Ireland? The health service can only gain from that, and it would reduce the numbers of people we have to source internationally.

Pharmacy First

Jim Shannon Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

Absolutely, and I am always happy to discuss that further with my right hon. Friend.

[Jim Shannon (Strangford) (DUP)]

Northern Ireland’s minor ailments scheme, and this Pharmacy First initiative, are acknowledgments that GPs can spend up to 40% of their working day on minor ailments, but the scale in Northern Ireland is different from what has been proposed for England. Is there capacity for a UK-wide roll-out of Pharmacy First to take pressure off our GP services? If there is, that would be the right thing to do.