National Health Service Funding

Jim Shannon Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is not often that the people who come last get more time to speak, so thank you very much for that, Madam Deputy Speaker.

The speeches by right hon. and hon. Members from all parts of the Chamber have been exceptional. We should focus on the good things in the NHS, which everyone in this Chamber acknowledges. The passion that we hear in debates like this often comes out of what our constituents tell us.

[Margaret Greenwood]

Does the hon. Gentleman share my concern about the introduction of ACOs through the STPs, which come from America and are often used in insurance-based models of healthcare? Because people here do not pay for healthcare, except through direct taxation, but do pay for social care, there is a lot of concern about the blurring of the boundaries and a worry that we will wind up with people being asked to take out health insurance.

[Jim Shannon]

I agree wholeheartedly with the hon. Lady. Madam Deputy Speaker mentioned how fast she speaks; perhaps she is trying to take away my record. The hon. Member for Vauxhall (Kate Hoey) says that I do more words to the minute than anybody else in the House. Perhaps the hon. Member for Wirral West (Margaret Greenwood) is trying to take that mantle, but we will see.

I am the health spokesperson in the House for the Democratic Unionist party. It is a portfolio that needs to be balanced, and we should look for the greater good at every stage. In my opinion, it is the most difficult portfolio for anybody to hold. I am glad that I am not in the position of the Secretary of State for Health, because I would find it difficult to say to a person, “We cannot supply the drugs that you need to prolong your life, but we are hoping to save the life of the person beside you. We need the money to save, rather than prolong, life.” The hon. Member for Monmouth (David T. C. Davies) referred to sofa-surfing and the lottery for those who need access to drugs. Although I do not envy the Government in having to make such decisions, I cannot sit back and not highlight the difficulties that exist within Government funding and the fact that the NHS must have more designated funding to keep it running.

I read with interest the briefing provided by Macmillan. It sent chills down my spine. By the end of this Parliament, about one in every two people will be diagnosed with cancer in their lifetime. I look around the Chamber today and remember that those statistics include us and our loved ones. Indeed, there are some Members in the Chamber who have experienced cancer and are survivors. My own father battled and won against cancer three times. I am aware of what that battle entails, and how much of it is based on the right diagnosis and treatment, the availability of that treatment, the skill of the surgeon’s knife and the prayers of God’s people—those are all very important. It is clear that improvements in diagnosing and curing the disease mean that more people surviving it are living for longer with it; some 2.5 million people are living with or beyond cancer in the UK today.

In my opinion, more must be done to help those with rare diseases and rare forms of cancer. Will the Minister give us an indication of what funding and resources will be set aside for them? Those rare diseases and cancers are increasing. Put together, those conditions affect a large number of people. I know that funds are not infinite, but we must focus on those with rare diseases and with rare forms of cancer.

I will mention a tremendously courageous lady—I hope she will not mind me mentioning her name in this Chamber—who works in my constituency, called Aundrea Bannatyne. She watched her son battle cancer and triumph, only to be told that she had pancreatic cancer and that there was no treatment for it in Northern Ireland. The help she needs will cost up to £100,000 and the people of the area where she lives, Dundonald, have dug deep to help fund that.

That lady’s story could be replicated in the constituency of every Member in this Chamber, across the whole of the United Kingdom of Great Britain and Northern Ireland, but the postcode lottery says that she cannot have treatment because she lives in Northern Ireland. However, she would be able to access it in other counties on the mainland, which is something that the hon. Member for Monmouth referred to. That lottery is not what is needed. We need treatment in all areas. That must be addressed by additional funding. Aundrea needs more than us wringing our hands and being sympathetic. She needs practical, physical help. That is the only thing that can change her hopes for her future and her son.

Macmillan has said that one in four people living with or beyond cancer face disability or poor health following their treatment. That can remain the case for many years after the treatment ends. It is vital that they can access the best care—the care that is right for them—when they need it. The NHS must be able to meet the changing needs of cancer patients. That would not only increase the quality and experience of survival, but ensure that resources are invested in the most effective way. That is key, given that the five year forward view projections indicate that expenditure on cancer services will need to grow by some 9% a year, to £13 billion, not to get ahead but simply to stand still. That level of spending is likely to yield outcomes that continue to be below average when compared with similar international healthcare systems. We must therefore act now to ensure that the money is spent as effectively as possible, to give England and the United Kingdom of Great Britain and Northern Ireland a better chance to achieve world-class cancer outcomes and deliver the Government’s manifesto commitment.

The health service currently spends more than £500 million a year on emergency care for people with the four most common cancers alone. If we are spending £500 million on emergency treatment for cancer, there is something wrong with the system that we have to address effectively. Emergency care should be a last resort for people living with cancer. Such a vast amount of emergency care spending is symptomatic of a system that is not geared towards helping people take control of their health.

I am conscious that the hon. Member for Bury St Edmunds (Jo Churchill) is waiting to contribute, so I will conclude with this comment. Let us make the right decisions to sustain the NHS as it is—never mind give more, which is what people actually need. If that means taking simple things such as paracetamol off the prescription list, to save £80 million, let us do it.

Let us look at real issues that can make a change. Let us do the simple things for the greater good, and let us determine to be more efficient where possible and cut unnecessary red tape rather than services. Let us ensure that our NHS can withstand not only the surge of cancer diagnoses but the surge of diabetes—other Members have referred to that—heart disease, and all other major illnesses, which are only worsening. I do not envy the Minister’s task, but we have to make hard choices. We have to get the funding in the right place, and make decisions that take away bureaucracy and restore funds where they are needed—to cancer, rare diseases and rare cancers.

Accident and Emergency Services: Merseyside and Cheshire

Jim Shannon Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh]

There is also a petition in Southport, and I am sure there will be petitions wherever in the country this sort of thing happens. As the hon. Gentleman suggests, the ownership of the sustainability and transformation reviews is wholly unclear. No one quite knows who writes the plans, or how they are agreed, and few democratically elected bodies or people, or patients, have any kind of input. In fact, the Liverpool local authorities wrote in some indignation to the authors of the report to ask, “How can we be involved? It alleges in your report that we are involved, but we do not appear to be.” Furthermore, no one quite knows why the hospitals have been grouped as they are.

Southport hospital is in a particularly unfortunate position, because it has changed its chair recently and suspended its chief executive over a period of a year, so it is unclear to me how Southport and Ormskirk’s views could have been represented in any review. Roadshows were organised by the clinical commissioning groups to talk about the financial plight of the local NHS and things that need to be done, and I have attended some of them, but they spend all their time talking about things such as savings on prescriptions and none on the big league stuff that is agreed and discussed in NHS boardrooms. There is absolutely no transparency, and I am sure hon. Members share in my cynicism. We await the real cost-saving proposals—or, in some cases, the empire-building proposals that are often disguised by blather about clinical efficiency and safety, which come almost after the event.

I speak with some cynicism, because I am a veteran of such carryings-on. I regret all the back-stage manoeuvres and, in particular, that no one has been around to champion my local hospital in the review. There is a good case for keeping our A&E—elderly people throughout the country are the major clients of A&E, for obvious reasons.

[Jim Shannon (Strangford) (DUP)]

The debate is clearly about Merseyside, but the issues for accident and emergency are the same everywhere in the United Kingdom, including in Northern Ireland. Does the hon. Gentleman share my concern about A&E being on the frontline of the NHS, so that is where the spend clearly needs to be? Does he also share my concern about Government policies to close some pharmacies, with their role, which will push many minor ailments to A&E, creating even more problems?

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

My hon. Friend is right to say that one of the big issues with ovarian cancer—we talked about this earlier—is that early diagnosis does not happen as quickly as it should. It is true that the cervical cancer test could raise awareness of ovarian cancer. We are looking at the issue and will revert to the House.

[Jim Shannon (Strangford) (DUP)]

Ovarian cancer accounts for some 12% of all new cases, and early diagnosis is critical. What discussions has the Minister had with the devolved Assemblies to co-ordinate and make available better treatment options, to provide a truly UK-wide NHS?

[David Mowat]

This is a reserved matter, but the hon. Gentleman is right to say that early diagnosis is the single most important thing that we need to do better in order to improve our cancer out-turn rates, and that dialogue continues.

Capita Contract (Coventry)

Jim Shannon Excerpts

Tuesday 8th November 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the House. Capita holds the contract for locums for the NHS; no one questions their ability, but does the hon. Gentleman have any concerns about the scheme’s value for money? The Government should look at filling those vacancies from within the NHS, making a saving and keeping that money in the NHS for NHS services.

[Mr Robinson]

Just as I am in favour of a profitable private sector, I am in favour of savings in the NHS. We all know that we have to make savings, but let us make real savings from properly thought-through programmes. The NHS is often the best place to carry them out. We should not have badly planned impositions from the private sector, which does not know what it is going to do or how to do it.

We have to learn the lessons. It is not as if we have not had plenty of examples, as we saw in our debate last week on another private sector company that reviews benefits. That case was an absolute disgrace, but let us not get diverted on to that, because we had a good debate on it last week. Let us stay with the problem before us tonight. I look forward to hearing what the Minister has to tell us, but I must warn her that I have a few things to say yet; I have only just started. Correct me if I am wrong, Madam Deputy Speaker, but I understand that the debate can go longer than half an hour. I do not want to detain the House, but I urge any Member who wishes to contribute to do so, because we have at our disposal at least double the normal time. If I say that to the dismay and disappointment of the Minister, I am sorry, but we will not delay anybody unnecessarily.

Others have been in touch with me on this subject. I am pleased to say that the good old BBC was made aware of an issue and initiated an excellent survey of what is happening in Norfolk, Suffolk and Essex. The survey was carried out by Nikki Fox, who did a good job and presented a programme on this. She discovered that no fewer than 9,000 records had been lost. Some had been found flying loose on the ground in a car park. God knows what happened to the others—nobody knows. Some 9,000 patient records have gone missing in those three counties alone. It is very much to Mr Paul Conroy’s credit that he has written to me issuing a challenge, which I will come to later, to fulfil our public duty to reveal what has happened, which, as is usually the case, others are trying to hide. Capita says that it is unaware of the problems, yet three counties are up in arms and the BBC has conducted an exposé; it beggars belief.

No fewer than 20 practices in Coventry and Warwickshire have been surveyed, and every single one of them has said that there has been a more or less serious deterioration in services. NHS England itself has now stated that patients could be at risk. The whole purpose of tonight’s debate is to reveal that risk and to urge Capita to correct the problem.

Community Pharmacies

Jim Shannon Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

This issue is about a very important cog in the grand scheme of our health service. Some might look at pharmacies as small businesses who get most of their custom from the NHS, but that is not the case. The reason why they are funded is that they are vital organs in the body of the NHS. Local community pharmacies take some of the pressure from GP surgeries. Some 14.2 million people had to wait over a week to see their GP in 2015; without the minor injuries service, how many more people would be waiting that long? How much of the doctor’s time would be taken up with issues that could be handled by a pharmacist?

There are 549 registered pharmacies in Northern Ireland and 2,300 pharmacists. They dispense both medication and advice, and that advice is important. The widespread locations of community pharmacies across Northern Ireland, where people live, shop and work, means that they are readily accessible to the public. Each year community pharmacies in Northern Ireland safely dispense approximately 40 million prescription items, including through the repeat dispensing service. They provide advice to help us look after and care for ourselves and help patients take their medicines more effectively by improving patient knowledge and adherence and use of their medicines. This service has initially been commissioned for patients living with asthma, chronic obstructive pulmonary disease, and diabetes, and it is hoped that it will be extended to other long-term conditions in the future. So the role of pharmacies can be even greater than it is at present.

The minor ailments service supports the use of the community pharmacy as the first point of call for health advice. Pharmacists can use their professional skills to provide advice and if necessary recommend appropriate treatment or refer to another healthcare professional. Other services include the smoking cessation service, which supports nearly 70% of quit attempts every year.

For constituencies such as Strangford which contain rural areas where GP surgeries are few and far between, the provision of a pharmacy is essential. If every mother with a young child takes an appointment with the doctor because the child has a cold and they are rightly worried, our surgeries, which prioritise child appointments, would never have time to check the lady with a small lump under her arm or the man who has had a problem with toileting needs, both of whom are too embarrassed to push for an appointment when everyone is too busy.

These cuts are too harsh. We need community pharmacists to play their vital role in order to allow GPs to focus on what they need to do. I say yes, make savings; yes, trim the fat if there is any; but do not ask for cuts that can only be achieved by cutting vital services. I support the Labour motion.

Social Media and Young People's Mental Health

Jim Shannon Excerpts

Wednesday 2nd November 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Cheltenham (Alex Chalk) on securing it and on setting the scene so well, and I congratulate the other Members who have spoken or who will speak.

This is a pertinent issue. Social media can be a wonderful tool for arranging get-togethers to catch up with old friends and for enjoying updates on the lives of people who live far away. I have seen social media wonderfully used to promote family events, to ask people to pray for a specific need or to provide help through churches and church groups. Social media can do good things.

I saw the part that social media played in spreading information on the dangers of legal highs. I met a young man who organised a peaceful protest outside somewhere that sold legal highs, as they were then known. The protest was well organised, respectful and well attended due to the proper use of social media, and it highlighted the dangers to those using such drugs. Social media brought good from a terrible situation, so they can do good.

I have enjoyed photographs, witty remarks and jokes that have been shared by others, and I can see the benefits of social media when they are used appropriately. However, as the hon. Gentleman said, this debate is sadly not about the good that social media can bring; it is about the bad that social media do to some people’s lives when they are misused. They can become a mistake that will always be there for all to see. They can be a weapon for people to be bullied or mocked in perpetuity. They can be a tool for people to be socially excluded, and they can be the harshest judge and critic that a person will ever have.

How can we protect our children from that? The obvious answer is that we should not allow our children to use social media, which is unrealistic. There is an age limit on most social media sites, but that is not enough. We must step in. We have all seen figures showing that children who spend more than three hours each school day on social media sites such as Facebook and Twitter are more than twice as likely to suffer poor mental health. Whereas 12% of children who spend no time on social networking websites have symptoms of mental ill health, the figure rises to 27% for those who spend three hours or more a day on such websites, so there are health issues. That is not the Minister’s direct responsibility—I am pleased to see her in her place—but we need answers.

How can parents protect their children and how can the Government help that protection? The limitations in place are not working. Enough is Enough, an organisation for internet safety, conducted a survey that found that 95% of teenagers who use social media have witnessed cyber-bullying and 33% have been victims themselves. Too many children are seeing and being part of something that we seek to protect them from.

A study exploring the relationship between teenagers, social media and drug use found that 70% of teenagers aged 12 to 17 use social media and that those who interact with social media on a daily basis are five times more likely to use tobacco, three times more likely to use alcohol and twice as likely to use marijuana. The figures clearly show that there are health and addiction problems related to too much use of social media. In addition, 40% admitted that they had been exposed to pictures of people under the influence via social media, which suggests a correlation between the two factors.

Although all that might not be substantive enough for a court of law, it is jarring enough that the House must consider how we can better regulate things to protect young people. Can we legislate for protection? Can we allocate funding to train schools in dealing with problems caused by social media? Can we ensure that no one can set up profiles until they get older? All those things need to be worked through with healthcare professionals and those who know about social media. The Government, and the Minister in her response, must decide to take action to protect our children. As the hon. Member for Cheltenham said, we are all here to protect children. Action must be taken now.

Coeliac Disease and Prescriptions

Jim Shannon Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Jones]

The hon. Lady raises an interesting point, but I assure her that the products available today are completely different from when I was first diagnosed. The bread then was like cardboard, and today it is very much different.

There is a general duty for GPs to prescribe treatments for health conditions via the FP10 prescribing system where treatment is available, and in the case of coeliac disease that is a gluten-free diet. There is also a duty in legislation for CCGs to reduce inequalities with respect to patient access to services and outcomes, but because of the lack of explicit recommendations on prescribing from NICE, CCGs are being given a fairly free hand to make decisions that run contrary to reducing health inequalities.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate. Prescription of gluten-free food as medication clearly needs to be regulated by the NHS across the United Kingdom. One of my constituents said to me this week:

“The disease is antisocial and can lead to isolation.”

Does the hon. Gentleman agree that the supply of food on prescription can have social benefits, as well as mental, physical and emotional benefits?

NHS Provision (Brighton and Hove)

Jim Shannon Excerpts

Monday 24th October 2016 Commons Chamber

[Caroline Lucas]

I thank the hon. Lady for her intervention—someone who knows a great deal about these issues. I absolutely agree. Once the service has been outsourced, the ability to do a convenient U-turn is taken away. That is failing patients in Brighton and Hove.

The Department has said that allegations of ambulances operating illegally warrant investigation by the CQC. I have written to the Department of Health to demand that that happens and I have written to the CQC as well. Will the Minister go further tonight than admitting the severity of the problem, and let us know what he thinks he can do about it? Specifically, will he provide assurances that the Department of Health is no longer content to leave patient safety in the hands of private companies such as Coperforma, and that it intends to step in, bring the service back in-house and at the very least check that the sub-contractors’ contracts meet the requirements?

[Jim Shannon (Strangford) (DUP)]

On the privatisation of the ambulance service, were there health and safety criteria that the contractor had to meet, in the same way as the NHS does? Were there ever occasions when the contractor’s work fell below the required level of service?

[Caroline Lucas]

That is a good question. When I have asked the CCG that very question, the answer has not been clear. I have been told that the performance of the company was not such that the contract was breached, but one of the difficulties is that so much of the contract is not in the public domain. For example, if the CCG wants to see the sub-contracts between Coperforma and the various companies to which it is subcontracting, the CCG does not have access to those contracts so it cannot assure us what is in them. We have a very opaque system that makes it extremely difficult to say where accountability lies. That is why I say that this is a failed model.

I said earlier that the Coperforma example goes some way to illustrating some of the underlying causes of the NHS crisis that we are experiencing. Trying to get to the bottom of the contracts, sub-contracts and who is responsible for which bit of what is like grappling with a Gordian knot. The CCG admits that one of the biggest challenges is identifying responsibility when things go wrong. When, for example, people providing the service are not being paid, it is not clear where responsibility lies. Was it with Coperforma or with the sub-contracting companies?

That lack of transparency is deeply concerning. It is also a serious example of the problems and risks associated with this outsourcing of so many of our key NHS services.

As we know, the driving force behind all this is commercialisation—commercialisation made worse by the Health and Social Care Act 2012, which has not only exposed patients to unacceptable risks but engendered structures and terms and conditions that appear to protect profit-led companies at all costs. I do not think that is the NHS the public want or deserve; it is not even an NHS that is effective. The model is failing. Contracts such as the one with Coperforma do not work and need to be brought back in-house. I pay tribute to the hon. Member for Bexhill and Battle (Huw Merriman), who has done very good work on this issue, on which I think there is cross-party agreement. He has rightly asserted that, in this instance, private contracting has not worked and the local ambulance service would be better operated within the NHS family.

I would go further still, because it is not just our patient transport services that are in trouble. Coperforma is, as I say, just one example of the fragmentation and marketisation damaging the NHS. Fragmentation matters because the healthcare picture is made up of parts that ought to be interconnected, yet it is hard at the moment for one part to influence the other. For example, ambulance handover times at the Royal Sussex County hospital have apparently risen 16% this year, but that is largely because of the ongoing flow issue caused by a lack of places to discharge people to. The whole system gets blocked when there is no overview. A&E, especially in winter, is all too often the pinch point for failures elsewhere, most notably insufficient capacity in local community social care.

However, fragmentation is an inevitable part of a system that is designed to give private providers as many opportunities as possible to compete for services through a continuous cycle of bidding and contracting out, despite that being hugely inefficient and counterproductive. There are local fears that Brighton and Hove’s children and young people’s community nursing might be taken over by a private company such as Virgin Care. Sussex Community NHS Foundation Trust has preferred bidder status to continue delivering children’s services, but the city council is still forced to undertake a procurement process in the name of market competition. I would argue that that process is a waste of time, effort and money, and increases the risk of a private company stepping in and undercutting a highly valued, effective provider such as Sussex Community NHS Foundation Trust—a risk that is exacerbated by the Government’s mind-bogglingly short-sighted decision to cut public health spending by 3.9% each year until 2021. That equates to £1 million less for our city over the same three years, and it has resulted in some important services being decommissioned. Those include the Family Nurse Partnership, which provides regular visits for teenage mums during pregnancy and until their babies are two years old. That makes no sense, but it is what happens when we do not have a coherent, publicly planned and publicly provided NHS or a model that puts health needs before private profit—one that is based on co-operation, not competition.

That is the model that has been set out in the NHS reinstatement Bill, of which I am a sponsor. I tried to bring it to the House in the last legislative term as a private Member’s Bill, and it is currently before the House in the name of the hon. Member for Wirral West (Margaret Greenwood). That is the kind of NHS I think my constituents want, and it has to go hand in hand, crucially, with adequate levels of funding. According to the King’s Fund chief economist, the annual average real increase in UK NHS spending over the last Parliament was 0.84%. That is the smallest increase in spending for any political party’s period in office since the second world war.

From local ambulance drivers caught up in the Coperforma debacle to junior doctors, NHS staff are universally respected—except, it seems, by this Government. Our nurses should not have to fight for a measly 1% pay rise after years of pay freezes. That does not only have consequences for the individuals involved. Healthwatch Brighton and Hove points out that staff retention is a specific problem in the city, with poor morale and high housing costs as contributory factors. I am particularly worried about the impact of the EU referendum on NHS staffing.

Brighton and Hove is set to benefit hugely from a major new county hospital redevelopment thanks to capital investment secured as a result of a long-standing cross-party campaign, and I am grateful for that. However, I would like to extend the logic of public provision to the services that will be based in the new hospital. In the meantime, as Ministers know well, the big issue is running costs, with the NHS funding settlement during the last Parliament the most austere in its history—that is according to the House of Commons Library.

National Arthritis Week

Jim Shannon Excerpts

Thursday 20th October 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered National Arthritis Week 2016.

It is a pleasure to serve under your chairmanship, Mr Betts. I am delighted that today, for the first time in five years in this House, there is a dedicated debate in Parliament examining the impact of arthritis. It is a privilege to speak in this House; that opportunity is not something we take for granted. It is good to come along to expound and inform on an issue that is so important. I am very pleased to see the Minister in his place. I think he and I will be in this position many times, debating health issues that interest us. It is good to see right hon. and hon. Members here. I know they will all make significant contributions.

Arthritis, along with musculoskeletal conditions, has a massive impact on people’s everyday quality of life. While I am disappointed that we have not spoken sooner in the past five years about this topic, I am pleased that time has been allocated today by the Backbench Business Committee, which I thank, for such an important debate that enjoys cross-party support. Opposition Members seem to be well balanced, and I am pleased to see the hon. Member for Congleton (Fiona Bruce), who is always here; I thank her for that and look forward to her contribution.

I should make it clear at the outset that the title of this debate is a slight misnomer, as the National Arthritis Week campaign has been replaced by the “Share Your Everyday” campaign, led by Arthritis Research UK, which is encouraging the public to share their stories of living with arthritis so that research is better targeted at the issues affecting most people with arthritis. We need to break the stigma of talking about pain and loss of dexterity and mobility, so that we can help to alleviate it. I urge Members to show their support for the campaign by sharing their own stories. I know there are Members here today who will do so, and that will be a very effective way of underlining this issue.

We should begin by discussing arthritis, because the burden on the individual is clear and substantial. It brings pain, isolation and fatigue and stops people doing the things that matter to them, keeping them from the world of work, from enjoying leisure time and from spending time with their families. Those are all key issues. I want to thank Arthritis Research UK—some people from it are in the Gallery—for supplying us all with notes and information to help the debate develop. We thank it for the hard work it does.

Arthritis should not be seen as a by-product of old age. For some it is, but for others it is not. The examples that I, along with others, will give show that arthritis is not only an elderly person’s ailment. It affects thousands of young people and millions of working-age people. One in five people over 50 have osteoarthritis in their knee. There is a young girl in my constituency who I went to appeal with several times. She suffers from chronic inflammation of the bowel—a by-product of severe arthritis, which led to her being medically retired at the age of 28. This is not an elderly person’s disease by any means.

The burden of arthritis on society warrants greater debate. Arthritis has an impact in a number of ways, particularly on our health and care system. Each year, 20% of the population consults a GP about musculoskeletal problems. The NHS spends £5 billion per year on arthritis— its fourth largest programme budget. That puts into perspective the enormity of what we are looking at today. I was struck by the stories shared on the Facebook page set up for this debate, so many of which are genuinely heart-breaking. One that stood out was that of a young girl of 27 who is waiting for a hip replacement, having suffered from arthritis since she was 20. That underlines, again, that this is not an old person’s disease. It knows no barriers, no age restrictions and certainly no class or creed barriers.

There is also the issue of workplace absence, with 30.6 million working days lost to the economy each year. The indirect cost to the economy of arthritic conditions is £25 billion. We do not necessarily want to focus on the financial aspect, but we can look at the figures as an indication of how important it is to address this issue and to raise awareness through this debate.

The scale of the burden is growing, with an ageing and increasingly physically inactive population. The numbers are sure to rise in the coming years. I briefly want to describe some of the characteristics of arthritis. When we talk about arthritis, we are talking about a number of different musculoskeletal conditions within the categories of inflammatory conditions, joint conditions and fragility falls and fractures, which are key factors.

The first group is inflammatory conditions, such as rheumatoid arthritis, where the immune system rapidly begins attacking the joints in the body. Those conditions affect around 1% of the UK population, including people of all ages, and have serious consequences. The second group is a range of conditions that cause musculoskeletal pain, the most common being osteoarthritis. Some 8.75 million people have sought treatment for osteoarthritis, with the true number of sufferers likely to be even higher. As is often the case, we are just scratching at the surface. The gradual onset means the condition mainly affects the elderly, but 2.36 million working-age people in the UK have sought treatment for knee osteoarthritis. Lower back pain, the most common form of disability in the UK, also falls into this group of conditions.

The final group is osteoporosis and fragility fractures. Osteoporosis is a silent and painless disease, but it causes fragility fractures after falls from standing height that afflict mainly but not exclusively elderly patients. The disease causes weakening of the bones and some 300,000 fragility fractures in the UK per year, of which 89,000 are hip fractures. The impact of those fractures on elderly, frail patients can often be severe, taking away their mobility, independence and, in some cases, their lives. We have to consider that.

Arthritis is not inevitable. Preventive measures must be the focus in tackling it. We need to address the risk factors for arthritis and musculoskeletal conditions. Links between being overweight or obese and long-term conditions such as heart disease, cancer and diabetes are well known—I declare an interest, as a diabetic. I am glad to say that I am almost back to the weight I was before I got married, which is quite something. I am trying to keep off all the sweet things, if I can. However, being overweight or obese is also a major risk factor in various forms of arthritis. It is the single biggest avoidable cause of osteoarthritis and increases the likelihood of developing inflammatory conditions such as rheumatoid arthritis.

Every one of us, as an MP, is aware of these issues because our constituents come to see us. In many cases, we deal with related benefit issues, and that is how we come into direct contact with people affected by arthritis.

[Christina Rees (Neath) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this really important debate. These conditions cause not only physical but psychological problems. A girl came to see me, aged 19. She said:

“Arthritis is unpredictable. It flares up suddenly. Medication problems make it difficult for me to manage. It is hard to explain to my friends why I cannot do something I could do last week, because I look so normal.”

Does the hon. Gentleman agree that we have to look at the damage these problems are causing youngsters in their everyday lives, including in how they associate with their friends?

[Jim Shannon]

I thank the hon. Lady for her intervention and for outlining how arthritis can affect people at the age of 19. I am aware of a constituent who is even younger, which really surprises me.

Rising levels of obesity, combined with our ageing society, could lead to a near doubling in the prevalence of osteoarthritis in the UK by 2035. The Government need to make sure that musculoskeletal health is always included in assessment of the population’s health locally and nationally; that the benefits of physical activity for people with musculoskeletal conditions are emphasised in health promotion messages; and that, when programmes targeting lifestyle factors such as obesity and physical inactivity are being designed and delivered, their impact on musculoskeletal health should be explicitly included. So there are many things the Minister could respond to, and I look forward to that.

Above all, the Government need to make sure that effective physical activity services are available locally. This is crucial, and I hope colleagues from all parties will join me in calling for a National Audit Office review of physical activity services for people with osteoarthritis so that services help people across the UK to maintain good musculoskeletal health. We need to address that.

I want to speak about benefits as well. I know about osteoarthritis and rheumatoid arthritis because I have sat across a table from a person helping them fill in disability living allowance forms, now personal independence payment forms. People tell me their story, because we need to know their story when we help them fill in the forms. We need to know what they have done and what they have discussed with their GPs and consultants. The issues are very clear. I know that the Minister is not responsible, but for the record I implore the Department for Work and Pensions to make sure that, when it comes to filling in PIP forms, people have their full medical story told. They need an understanding person at the other end of the phone. I am not being disrespectful to anybody, but sometimes when we phone up about PIP, the person at the other end of the phone does not understand the medical details. I respectfully and gently say to the Government that we need someone on the phone who understands the medical condition and understands the issues and can therefore empathise with the person who does their 10-minute interview at the first stage of their PIP form before they do the full form. I think every MP would recognise that particular issue.

As I mentioned earlier, falls and fractures are a pressing public health issue among older people. Falls are the second greatest contributor to the burden of disability in the UK and a major cause of mortality. Around 300,000 fragility fractures occur each year in the UK, including some 89,000 hip fragility fractures, with 1,865 cases submitted to the national hip fracture database in Northern Ireland. Hip fractures are the most common cause of accident-related death in older people, resulting in some 14,000 deaths in the United Kingdom every year. We know that 20% of hip fracture patients die within four months of their injury and 30% within a year. This is a growing problem. Projections show that by 2036 hip fractures could account for 140,000 hospital admissions in the UK each year, with care and treatment costs rising to £6 billion. Let us put that into perspective and do the sums. Let us address the issue early on and do away with the cost impact further down the line.

We need more joined-up treatment in such cases because, once a first break occurs, it is vital that a second break is avoided. A fracture liaison service, the FLS, which provides targeted assessment and treatment for those with fractures, is widely regarded as the best way to address the problem of preventing future fractures. It is both a clinically effective and a cost-effective solution. Despite this, only 37% of local health services in England have a fracture liaison service. We need local commissioners to ensure that a fracture liaison service is linked to every hospital and held to account for commissioning fracture liaison services that cross the boundaries between health and social care so that the two marry. It is important that it does so. Arthritis may not kill, but it attacks what it means to live. The normality of life will never be the same with arthritis.

The condition limits people in doing the things that matter to them, but with greater personalisation and help in managing their condition, the NHS, care services and our welfare system can help people push back the limits of their condition. Too few people with arthritis currently have a care plan. Many people cannot quickly access physiotherapy without a GP referral, and people with arthritis need more help so that they can be in work, which is where most of them want to be if only that was possible. People with arthritis know how their condition affects them better than anyone else. Personalised and person-centred healthcare is therefore essential to move forward.

Care planning is an approach that people with long-term conditions can use to manage their health and wellbeing. It is based on a two-way conversation with a healthcare professional where goals are shared and actions agreed. If we could arrange that, we could help them. A better system should be in place to make sure that that happens. This can offer important benefits to people with arthritis, yet only 12% of people with arthritis currently have a care plan. If it is only 12%, there is something wrong and we must address that. That number needs to increase if we are to enable more people to manage their condition.

There are other tools that health and care services can use to enable people with arthritis to manage their conditions more effectively. Physiotherapy is a clinically effective therapy that can substantially reduce pain and restore movement for people with arthritis. Again, is it available for everyone? If it is not, it should be. I gently ask the Minister how can we make that happen. I look to the Minister, as I always do, for a sympathetic and understanding response.

Self-referral to physiotherapy is a system that lets people go directly to an NHS physiotherapist without a GP referral. This system is associated with improved health outcomes and patient experience. It is good that it is cost-effective and reduces the burden on GPs. All people with arthritis in Scotland and across much of Wales can already access physiotherapy directly. We have many friends and colleagues here from Scotland, and I know that they will make contributions that I suspect will indicate what is being done in Scotland. I must say I am envious of some of the things being done there. I would love to see those things in place in Northern Ireland and across the whole of the United Kingdom.

In the rest of the UK, for example, only a third of clinical commissioning groups in England offer self-referral and it is still only being piloted in Northern Ireland. That needs to change. When inflammatory conditions such as rheumatoid arthritis strike, delay can be a major risk factor and the clock starts ticking once symptoms develop. Early identification and treatment is needed rapidly to control disease, minimise long-term joint damage and avoid lifelong pain and disability, but the NHS does not currently assess people with rheumatoid and other forms of early inflammatory arthritis—EIA—quickly enough, and national guidelines are not being met. Again, I gently say to the Minister: if the guidelines are not being met, what are we doing to improve that?

A recent clinical audit by the British Society for Rheumatology found that only 20% of people who see a GP with suspected rheumatoid arthritis or EIA are referred to rheumatology specialist services within three days, and only 37% of people referred with suspected rheumatoid arthritis or EIA are seen by a specialist within three weeks. Again, that needs to be addressed and I again look to the Minister for a response on that. Local commissioners across the UK need to achieve earlier diagnosis of inflammatory conditions. Arthritis and other musculoskeletal conditions are the most common diseases in our working population, and as the population gets older, an even greater proportion of workers will have conditions that include osteoarthritis and back pain. Those workers want to keep working, so we have to improve the system of healthcare to enable that.

Many people with arthritis want to work, and they can with the right support. However, only two thirds of working age people with a musculoskeletal condition are currently in work, compared with 74% of those without health problems. What is more, the rate of employment for people with arthritis is 20% lower than for people with no condition. We need better support to enable people with arthritis to work and we need to promote the Access to Work scheme that is in place, which pays for practical support and equipment. It is good that we have such a system, but I want to see better utilisation of it and fiscal incentives for employers to provide health and wellbeing initiatives that promote musculoskeletal health.

It is vital that more is known about people with arthritis so that research can be targeted at what matters most to them, but, worryingly, key data are not being collected. Arthritis Research UK is working to increase the quality and availability of data about the experiences of people with arthritis and about the public services that improve their quality of life. Arthritis Research UK and Imperial College London have developed a model for estimating prevalence using the existing NHS data currently available in England. I encourage all Members for English constituencies to visit the Arthritis Research UK website to get access to the data, which I understand will soon be available in Scotland, and later in Northern Ireland and Wales. We have a lot to do to catch up.

However, not enough data on people with arthritis are being collected, and that limits our understanding of the prevalence of the condition and action that can be taken in response. Moreover, data that are collected are not uniformly classified across the system. Definitions of musculoskeletal conditions used in other national data sets, such as those for benefits, are inconsistent. National survey content may need greater co-ordination. Again, I say gently and with respect that it is a question of how to do things better. I am speaking very quickly, Mr Betts, because I am conscious that other Members want to speak. I am probably rushing faster than usual, but I hope everyone can follow what I am saying.

A pivotal issue is the need to protect and build the UK’s excellence in medical research, so that researchers can continue working on a cure for arthritis. How important it is to find a cure. The centres funded by Arthritis Research UK have been at the forefront of research aimed at improving the lives of people with arthritis in the UK. It is marvellous and encouraging that they have uncovered breakthrough treatments that push back the limits of the condition. In the 1990s, centres supported by Arthritis Research UK—it has given us all the information—discovered that a molecule called tumour necrosis factor was causing the disruptive auto-immune inflammation of joints. The anti-TNF therapy that they developed has freed millions from the pain and disability caused by rheumatoid arthritis; it was also an inspiration for the field of biologics, medicines that use the body’s own molecules to combat diseases. It is crucial that that work, and the work of all medical research charities, should be supported by the Government in the long term with a real-terms increase in science spending. It is not something for the Minister to respond to, but I would seek his assistance and support on that point.

Within the life sciences sector, substantial investment by medical research charities drives improvements in health and generates wider societal and economic benefits. In 2013, medical research charities invested about £1.3 billion in UK medical and health research, which represents more than a third of all publicly-funded medical research in the UK. The Government have recognised that our science base is a vital national asset— a view that I and all Members present, including the Minister, subscribe to—and they have reaffirmed their intention to make Britain the best place in the world for science. We all support that ambition. It is crucial to uphold that commitment, through a real-terms increase in science spending over the long term.

That would include bolstering the charity research support fund, which provides an uplift to support charity-funded research in universities. It is a marvellous asset, investing a lot of money in research. That joint funding of research ensures that charitable donations are invested directly in research that meets the needs of people with medical conditions. In 2013, the Government’s £198 million investment through the CRSF leveraged some £833 million of investment by charities in English universities. That is a significant, marvellous, gigantic sum of money to help to find cures. When the House debates rare diseases—and we do our best in these matters—we often refer to the good work done by charities, universities and the relevant partnerships.

[Christina Rees]

rose—

[Christina Rees]

My arthritis is in many ways self-inflicted; it comes from a lifetime of playing sport. I have no cartilage in my right knee, which is severely arthritic. Then there is my lower back—I do not think anything much works any more. Does the hon. Gentleman think that there should be more research on people who have played sport and become arthritic? In this day and age we advocate participation in sport, without really looking at the long-term consequences.

[Jim Shannon]

The hon. Lady is right and I think many of us recognise what she says. We encourage people who are obese to do more sport. We encourage young people, rather than playing on computers and laptops, as they so often do, to take part in more physical activity. However, we must consider the side-effects of that as well, and ensure that we help with them. I hope that what I have said about responding early has been taken on board. With an early response to signs of deterioration, the hon. Lady might not today be in as much pain; although I can tell hon. Members that I have seen her moving around the House, and she moves at some rate. The hon. Lady is obviously not completely restricted, and I say well done to her.

Without the CRSF there would be less funding to invest in world-class research. The UK’s medical research landscape is currently undergoing major change with the formation of UK Research and Innovation through the Higher Education and Research Bill. I expect that the whole House would agree that is crucial that the CRSF should increase in line with charitable investment, within the new research funding system, to safeguard research in the long term.

I look forward to hearing the remarks that will follow in the debate, including the personal experiences of arthritis of Members’ constituents—and perhaps also those of Members themselves. Much more can be done to improve the quality of life of people with arthritis, and to push back the limits of that worrying condition. We have an opportunity in Parliament to play a huge part in ensuring that our constituents get a better quality of life. I look forward to hearing the speeches of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister.

[Mr Clive Betts (in the Chair)]

The hon. Member for West Ham (Lyn Brown) has apologised in advance for having to leave early on account of new Front-Bench responsibilities. It is normal protocol for hon. Members to stay for the whole debate, but on this occasion I accept her apology.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Foyle on leading the charge—[Hon. Members: “Strangford!”] I beg your pardon; I meant the hon. Member for Strangford (Jim Shannon).

[Jim Shannon]

I have more hair than the hon. Member for Foyle (Mark Durkan), but not much more.

[David Mowat]

Don’t take it as a compliment. It has been a long day.

It seems extraordinary, thinking about some of the subjects we debate, that it has been five years since we have debated this subject in the House of Commons. The debate has been such a pleasure, and I am sure that hon. Members here will see to it that it is not five years before we debate it again. An objective of having a debate in Westminster Hall is to raise awareness. People watch these things, so it is right that we do that and it is important that we do it again next year.

I have been a Minister for about two months, during which time I have met many people, so it has probably been remiss of me not to have met with Arthritis Research UK yet. I am keen to do that. Its representatives are pushing at an open door if they would like to come and see me. As the hon. Member for Coatbridge, Chryston and Bellshill (Philip Boswell) said, it is about action, not words. We will organise that meeting if Arthritis Research UK would like it to happen.

Several hon. Members have mentioned the statistics, but I will repeat them because they are so important. Some 10 million people in the UK—one in six of the population—have an MSK condition. The most common, with 3 million sufferers, is osteoporosis. One in six is an extraordinary figure, and there are 200 variations of MSK conditions. One in 10 people in the UK suffers chronic pain as a consequence of arthritis.

The numbers are mind-boggling. Some 20% of GP consultations are due to MSK conditions, and this at a time when our GP services are stretched in Scotland and in England. MSK conditions account for 30% of GP consultations for the over-55s, and some 7.5 million working days are lost each year. This long-term condition alone costs the NHS between £4 billion and £6 billion, so it is right that we are having this debate.

There have been a number of interesting and useful speeches. Westminster Hall is sometimes a better place to debate such topics. The hon. Member for Strangford talked about lifestyle factors and preventive factors, and he and another Member made an interesting point about DWP and PIP. We need to be more joined up in how we deal with some of these long-term conditions, particularly as they become more prevalent. He also talked extensively and knowledgeably about research—he has clearly been well briefed—and about what we are doing.

The hon. Member for West Ham (Lyn Brown) made an excellent speech about her personal experience, and she emphasised the overlap with mental health. She talked about first suffering from this during her election campaign last year. In fact, it prevented her from canvassing. I note that she got 36,000 votes and her vote went up by 6%. I do not know whether those factors are related. Well done on 36,000. We pass on our congratulations and awe at her performance.

--- Later in debate ---

[Jim Shannon]

I especially thank the right hon. and hon. Members who have made such fantastic contributions —every contribution and intervention has been great. The attendance has also been great. It is genuinely refreshing to have a Minister who understands the issue and is able to respond. We will take him up on his offer to have a meeting with Arthritis Research UK—I thank him for that. I look forward to working on behalf of constituents from across the whole of the United Kingdom of Great Britain and Northern Ireland.

Earlier Cancer Diagnosis: NHS Finances

Jim Shannon Excerpts

Tuesday 18th October 2016 Westminster Hall

[Mr Baron]

I thank my hon. Friend for that intervention.

We have been successful in getting the one-year figures into the DNA of the NHS, but there is no point having the tools in the toolkit if we do not use them, and one thing we are looking carefully at is the lines of accountability. We acknowledge that we are pushing at an open door—the Government have kindly accepted the need for the one-year figures—but there is still a very long way to travel. The latest Ofsted-style ratings have maintained the focus on survival rates, and yet those ratings still found that eight out of 10 CCGs must improve. That shows the scale of the challenge and the extent to which we need to raise our game.

[Jim Shannon (Strangford) (DUP)]

If I could cast the hon. Gentleman’s mind back to the previous intervention, the Be Clear on Cancer campaign identified about 700 more patients with lung cancer, which led to about 300 more patients receiving life-saving surgery. That shows that publicity campaigns work. Does he agree that the Government need to encourage the NHS to have more publicity campaigns to identify the issues and save more lives?

[Mr Baron]

I agree completely. Briefly, the initiatives that could be introduced to promote earlier diagnosis are greater awareness campaigns, better diagnostics at primary care level, better uptake of screening in screening programmes, and better GP awareness—although this is not only about GPs. A whole host of initiatives could be introduced at the primary care level to improve survival rates and awareness generally. So yes, I completely and utterly agree.

Given the limited time available, I will make a little progress on the central point of this debate. We are pushing at an open door, which is fine; we are keeping a watching brief as a cancer community; and, as I have said, the Ofsted-style ratings have shown, among other things, that a big improvement is required. The all-party group on cancer will hold its annual parliamentary reception next summer—the Minister no doubt will be invited to that—at which we will focus on those CCGs that have most improved their one-year survival rates. The Britain Against Cancer conference, which we believe is the largest gathering of the cancer community in this country, will take place at the end of this year and will also focus on that issue.

We are therefore not walking away from the issue of survival rates, but we are saying as part of our watching brief that we wish to bring to the Government’s attention the fact that when it comes to cancer treatment, earlier diagnosis can not only help patients—diagnosing cancers earlier makes for better survival rates—but save a lot of money. The later cancer is diagnosed, the more aggressive the treatments and the higher the cost. That cost is quite significant, and the cost savings from earlier diagnosis could be ploughed back into treatment for patients. At a time when the NHS is under financial pressure, we suggest that too little attention is being paid to those potential cost savings. Too little work has been done by the NHS and too few health economists are looking at how reducing costs to such an extent would benefit both the taxpayer and, most importantly, patients.

Given the NHS’s lack of focus on that area, we have had to go to outside sources to give us some sort of measure of the potential cost savings. A September 2014 report by Incisive Health and Cancer Research UK showed quite a disparity between the cost of treating patients with early stage, or stage 1, cancer and those with late stage, or stages 3 and 4, cancer. For example, the cost per patient per year of treating colon cancer is £3,300 at stage 1 and £12,500 at stage 4—a near fourfold increase. Treating stage 1 rectal cancer costs £4,400; that goes up to nearly £12,000 if it is treated at a late stage. Treating ovarian cancer costs just over £5,000 per patient per year at an early stage, but £15,000 at a late stage. That report focused on four cancers: colon, rectal, lung and ovarian. They amount to only around a fifth of all cancers diagnosed, but if such cost savings were replicated across all cancers, we could be talking about savings of hundreds of millions of pounds, and that is before we even consider the number of patients who would benefit from earlier diagnosis, which Incisive Health cites as something like 52,000.