Blood Cancers

Jim Shannon Excerpts

Thursday 7th July 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered blood cancers and the Cancer Drugs Fund.

It is always a pleasure to come to this Chamber and have the opportunity to expound on the subjects that we bring here for consideration. I am pleased that so many hon. Members have made the effort to attend on a Thursday afternoon—often referred to as the graveyard shift. I am not sure that is entirely accurate or fair, but we thank very much those who have made the effort to be here. It is also a pleasure to see in her place the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), and I look forward to hearing the Minister. He and I always seem to be in these debates—if he is here I am here, and if I am here so is he—but it is always a pleasure to see him. We look forward to his response to the points that we make during the debate.

Cancer is a massive issue. It will affect one in every two people we meet, and many of us here have a personal interest in the subject. More and more people are surviving cancer because of the incredible work that has been done by the pharmaceutical industry and private enterprise, and also because of the work done in partnership with universities. Queen’s University Belfast is involved in finding new drugs and working with private enterprise, the Government and the education system to find ways of doing more.

The fact that more people are surviving and living longer is to be celebrated, but unfortunately not everyone is living well, which is what this debate is about. That is especially true for people with blood cancers, many of whom will live with the disease and the consequences of its treatment for many years. Some of them are fortunate to do so, but for many that will be time limited. About one in four people living with or beyond cancer face disability or poor health following their treatment. Evidence from Macmillan shows that by 2020 nearly one in every two people will receive a cancer diagnosis in their lifetime. Just look round this Chamber: half the people here today will receive a cancer diagnosis at some time during their life; or, if they are not affected directly, their families certainly will be.

I place on the record my thanks to the cancer charities, Marie Curie Cancer Care, Macmillan Cancer Support and the many others, which do such marvellous work with those who have cancer. Right now, routine follow-up care for people with cancer costs about £250 million a year. It is usually delivered via a one-size-fits-all medical model that is based on repeat out-patient consultations despite a lack of evidence to show that that is effective, so we must also look at that.

I was therefore pleased to see the commissioning guidance released recently to promote the roll-out of a recovery package for everyone with a cancer diagnosis. The recovery package will be especially important for patients with blood cancers, because it will mean that they get the physical, emotional and social support they need to lead as healthy and active a life as possible for as long as possible. Every one of us in this Chamber would wish that to happen. Many people with blood cancers live for a number of years with the consequences of their disease and treatment, so there needs to be a commitment from the Department of Health that everyone with a blood cancer will be offered tailored support.

Let me talk from a personal point of view. My father had cancer on three occasions. He passed away last year. He did not die because of cancer, but he was diagnosed 39 years ago—38 years before he passed away—and my mother was told to go home and prepare and get the estate sorted out. In other words, there was next to no hope, but my dad survived, and he survived for three reasons. He survived, first, because of his faith and the prayers of God’s people; secondly, because of the skill of the surgeon’s knife; and thirdly, because of the care of the nurses. Those three things are vital for all of us. That is an example of how far we have come in those 39 years.

Patients with blood cancers can face significant problems in accessing vital treatment because of the difficulties and complexities of appraising medicines in this area. I thank the charities and others who have given us background information. I will not do this of course, but I could probably speak for three hours on this subject. I am sure that people are thinking, “Well, I hope he doesn’t.” I am not going to, because clearly I want to give everyone an opportunity to participate in the debate.

The appraisal system used by the National Institute for Health and Care Excellence is not suitable for assessing medicines that treat conditions with small patient populations—in other words, cancers that affect a small number of people. Perhaps in the greater scheme of things, they are numerically small, but it is vital that the drugs are available and in place.

At this point, I pay special tribute to the hon. Member for Crawley (Henry Smith), the chair of the newly brought together all-party group. I thank him for going with me to the Backbench Business Committee to ask for this debate. We are both pleased to be able to have the debate so early after the launch of the APPG. The hon. Gentleman will speak himself, but it is a pleasure to work alongside him.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this very important debate. The issue of small populations and finding the right treatments is crucial as the cancer drugs fund goes forward within the NICE context. That is an opportunity as well as a threat. I hope that the hon. Gentleman will reflect that in the rest of his speech.

[Jim Shannon]

It is always a pleasure to have the hon. Gentleman come along to a debate in support. He always does so, and his valuable contributions are always appreciated by us all. I wholeheartedly agree with him.

The way the system fails blood cancer patients can be illustrated via the case of ponatinib, a drug designed to treat chronic myeloid leukaemia patients who are resistant to or intolerant of other treatments. I will elaborate on this point later, for it is very important. I think that the hon. Gentleman has grasped that it is a vital issue as well. The drug is fully available to all CML patients in Scotland and Wales, but in the remainder of the United Kingdom it is provided on the NHS only to a small subset of patients who can benefit from it after NICE refused to appraise it because of the small patient population. One of the questions that we would like answered in this debate if possible—I am not sure whether the Minister is the right person to answer it, but I know that if he is not, he will certainly direct it to the right Department—is how we ensure that there is not a postcode lottery when it comes to the allocation and availability of cancer drugs.

[Peter Dowd (Bootle) (Lab)]

I thank the hon. Gentleman for securing the debate. Does he agree that parents—in my case, the parents of nine-year-old Charlie Fearns—are confused, distressed and dismayed that they are not provided with the medical intervention that they need to treat their child’s illness? Charlie needs chimeric antigen receptor T-cell therapy, but Mr and Mrs Fearns are having to find as much as £150,000-plus to fund the therapy themselves. Does the hon. Gentleman agree with me that that extra burden, in their circumstances, is far too onerous?

[Jim Shannon]

I thank the hon. Gentleman for his intervention and for that personal story. I think that that situation is a disgrace. Any of us in the House would wholeheartedly agree with him. There has to be a system that enables all the people of the United Kingdom of Great Britain and Northern Ireland to partake of, use and access these drugs. The example he gives shows just where the current system falls short. This debate gives us an opportunity to highlight that and to seek the solutions that he and his constituents want.

The situation with ponatinib has resulted in the equivalent of a postcode lottery in patient access across the UK, with some patients having to move to Scotland or Wales to undergo treatment. Why should they have to move? It is not fair that they should. It seems grossly unfair that they should have to either move or travel to the hospital. For these patients, the drug could be an alternative treatment to a stem cell transplant, and a last chance of survival.

The systems of appraisal used to assess blood cancer medicines need to be able to take into account the small patient numbers and the issues that that raises about the amount and maturity of data available, to ensure that all patients who need access to medicines do not miss out because of where they live.

Chronic lymphocytic leukaemia is the most common type of leukaemia, a cancer of the white blood cells. In leukaemia stem cells start to overproduce white blood cells that are not fully developed; in CLL, these are called lymphocytes. Figures from Macmillan and NICE estimate that some 2,700 to 3,200 people in the UK are diagnosed with CLL each year, with most cases occurring in people over 60 and very few in people under 40. Around two thirds of the diagnoses are made by chance through a routine blood test with doctors; people do not know they have it and all of a sudden they find out they do. The other third of diagnoses are made following visits to the doctor for CLL-related symptoms: enlargement of the lymph nodes, liver or spleen, anaemia, bruising or fever, drenching night sweats and/or weight loss of greater than 10%. Someone with any of those symptoms should see their doctor, and do so soon.

CLL is more prevalent in men, with recent studies showing that some of the risk of developing it is inherited from parents. One in 20 CLL patients has a relative with CLL or a very similar condition; however, CLL can and does affect anyone.

[Mr Nigel Dodds (Belfast North) (DUP)]

I commend my hon. Friend for raising this issue today. In Northern Ireland three people every day are diagnosed with blood cancer. I am sure he would agree with commending the work of Leukaemia & Lymphoma NI, the only charity in Northern Ireland dedicated to dealing with this, and the great support it gives to the Centre for Cancer Research and Cell Biology at Queen’s University, which he has already mentioned. Without the dedicated work of people in charities like that across the country, raising money for absolutely vital research, we would be in a much poorer place indeed.

[Jim Shannon]

I am indebted to my right hon. Friend and colleague for that intervention. We have done, and we continue to do, many great things in Northern Ireland in medical research, charitable giving and charitable operations. He has rightly highlighted an organisation in Northern Ireland that does just that. It is worrying that we have so many people with blood cancer. When we take that as a proportion of a nation of 1.8 million, it gives an idea of just how important it is.

CLL tends to develop very slowly with many people not requiring treatment for months or even years, although others need it straight away. For all stages of CLL, more than 40%, of men and more than 50% of women will survive for five years or more after being diagnosed. At stage A, which is the earliest, people survive on average for 10 years or more after diagnosis, those at stage B for five to eight years, and those diagnosed at stage C live for up to three years. From those figures, life expectancy is very clear: people have a diminished lifespan.

Doctors often recommend against immediate treatment for CLL if it is diagnosed at an early stage and opt to watch and wait. I am concerned that sometimes they need to be more proactive and receptive to what the issues are at the time. “Watch and wait” can be stressful for those diagnosed and their families, but early treatment can lead to exposure to the side effects of drugs without achieving significant benefits, as well as to increased life insurance premiums. Sometimes we have to look at the other things that affect us when our health declines, such as work and financial obligations, or how to feed our family. That adds to the stress.

Patients whose CLL relapses early have a more aggressive form of the disease and it is essential that clinicians have a range of treatment options available to suit individual patient need. That is due to factors such as the variable course and nature of the disease, the toxicity profile of the therapies and the comorbidities, which are more prevalent in this situation. There is a general poor understanding of the need for a variety of treatment options. Again, knowledge of the blood cancers among GPs, the NHS, consultants—those who should know—perhaps needs to be improved as well.

Stakeholders including the CLL Support Association, which has done great work collecting much of this information, have two key areas in which they have workable recommendations to make a difference. For post-diagnosis support the CLLSA believes that because CLL behaves in such a diverse way, it is important that patients and their families are provided with accurate information from trusted sources. Each hospital should have a CLL nurse who can provide patients with useful written information that contains links to websites for those who wish to know more.

Let us be honest: people who get this diagnosis want to know as much about the disease and the problems that they have right away; they want to have that knowledge and information right there. As the hon. Member for Bootle (Peter Dowd) said, citing the personal experience of his constituents, they want to know what it means, how to react, what the survival chances are and how long. All those things play upon the mind; they are very important issues.

When it comes to access to new treatments, a second preliminary decision from NICE in June 2016 has provisionally rejected ibrutinib for NICE guidance to treat relapsed refractory and 17p deletion or TP53 mutated CLL. That group of patients have a poor prognosis and very few options available to them. The manufacturer has been requested to submit a proposal for consideration of CDF listing for access to treat adults for the 17p deletion or TP53 mutation only. Again, that is something that perhaps the Minister can reply to. When people see that they can access new treatments, which really could be life-saving, they want to have them right away and want to try them. In many cases, people probably would not mind piloting those things, just to make sure that they can have life expectancy on the timescale they have been given.

The CLLSA feels that ibrutinib should be made available to both groups because both populations share a number of similarities in patient need, including a significant symptom burden, limited alternative treatment options, and subsequently poor survival prospects. As both groups have a similar symptom burden, it is unfair that they will be unable to benefit from access to this treatment. There are also the quality of life benefits. CLLSA argues that the quality of life benefits reported by patients have not been adequately considered by NICE. As such, the cost-effectiveness of ibrutinib is likely to have been underestimated. Many of us believe—in the background information—that it certainly is a drug that could do more if there was the opportunity. We need to make sure that it can be made available and accessible.

Furthermore it should be noted that CLL is a heterogeneous disease, so there is a need for multiple options in every situation. I know that each person’s individual circumstances are different and the GP and consultant who look at that will decide the way forward. Some patients may not respond to, be unable to tolerate or be otherwise unsuitable for alternative treatments such as idelalisib. As such, there is a clear need for access to ibrutinib to enable patient and clinician choice, so that treatment can be tailored to patients’ individual clinical needs. Ultimately the decision will remain a matter for NICE, but this is what the key stakeholder in CLL believes to be the way forward. That is an organisation that has been run by trustees who are all volunteers and either suffer from CLL, are clinicians or are relatives of those with CLL. They do their research, not for glory or riches, but for what is best for those affected.

Some of the background information we had relates to brentuximab—I hope my pronunciation is right. That is hailed as one of the most effective single agents for relapsed anaplastic lymphoma—or Hodgkin’s lymphoma as it is better known. It was delisted after two of its indicators were removed, making it harder for some patients to receive the medicine they need. In November 2015, the Blood Cancers Alliance met the Secretary of State for Health and in a letter to the Prime Minister expressed its concern over the delisting of life-saving drugs from the CDF. There is a drug that was delisted and that seemed to be doing the job; it is concerning that it has been removed when it quite clearly could have made a difference.

It was greatly encouraging to have so many stakeholders engage on this issue and time will not permit me to pay tribute to all of them. Another organization working in the field is Celgene, which has provided some further information that will add to the debate. Five conditions account for almost 70% of the total lives lost to blood cancer: myeloma, diffuse large B-cell lymphoma, acute myeloid leukaemia, myelodysplastic syndromes and the aforementioned chronic lymphocytic leukaemia. New treatments have transformed survival rates for multiple myeloma since the 1970s and there have been great steps forward. I know that when the Minister responds he will tell us some of the good things that have happened, but average life expectancy for a patient diagnosed with multiple myeloma is still only five years. This debate gives us the chance to discuss the issue and get some direction and focus from the Minister on how we move forward and achieve a better, longer life for those with blood cancers.

Continued progress is only possible with continued research and investment. That is critical to achieving progress in the treatment of blood cancers. We have had many debates in Westminster Hall on rare diseases because we acknowledge the need to focus on rare diseases, and today’s debate is an example of that. The numbers of people who fall into the category of having rare diseases are small, but we must not ignore the burden of their despair and what that means.

Many of the molecules in other companies’ pipelines are being studied in combination with Celgene’s treatments. Ceasing access to those treatments will seriously hinder progress in increasing survival rates and limit future innovation. I know that the Minister, like everyone in this Chamber today, is totally committed to finding new drugs that can cure these life-threatening diseases, as I am sure he will make clear in his response. The point is that a balance needs to be struck between regulation protecting people and allowing innovation.

In conclusion, I am pleased to have the opportunity to express in this Chamber my concern on behalf of those with blood cancers. I thank all hon. Members who have come to participate. Our responsibility as elected representatives is to put the case on behalf of our constituents. I believe we have the opportunity to make a difference for those who many years ago would not have a long life, but who today could have a longer life if they had access to the cancer drugs fund. What we have in the United Kingdom of Great Britain and Northern Ireland is people with fantastic brains who have the ability to come up with new medications and who can make these things happen. I look forward very much to the Minister’s response.

--- Later in debate ---

[George Freeman]

I completely agree with my hon. Friend. As she has made clear, and as I repeated earlier, it is tricky because the symptoms are not always straightforward or simple. It is often not a lump or something that is easily detectable, and the symptoms can easily be confused with those of other conditions that many of us might all too easily brush off and dismiss as the result of tiredness, fatigue and the general pressures of modern life. It is important that people recognise the symptoms. The all-party group and this debate will help to underline the importance of being aware of the early symptoms.

So far there have been 11 national Be Clear on Cancer campaigns covering seven types of cancer, and a national respiratory symptoms campaign will run from July to October this year to raise awareness of lung disease. I shall obviously ensure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) is aware of this debate and will make clear to her the cross-party support for greater awareness of blood cancers.

[Jim Shannon]

I am not sure whether this is the Minister’s responsibility, but those of us who have participated in the debate are very aware of the issues relating to the accelerated access review. We are keen to know whether there could be a review of the scheme and of access to drugs. Even if the review were to resolve the many issues surrounding the speed with which new medicines are evaluated by NICE, unless there is meaningful change to the final decision-making process, new medicines will fail to reach patients. I suspect that is the Minister’s responsibility, but he can confirm that. How can we improve the accelerated access review? I know the Minister will have a good answer and I want to give him an opportunity to share it.

[George Freeman]

I am grateful to the hon. Gentleman for reading my mind—not for the first time—because the next paragraph in my speech is about the cancer drugs fund and the accelerated access review. His intervention gives me a moment to highlight some of the important points that colleagues have made. The hon. Gentleman, who is something of a biomedical stalker of mine on these occasions, as he acknowledged—we rarely appear in this House other than together—was right to highlight the great work that Queen’s University Belfast does on blood cancers. He spoke with great passion about his father’s experience.

My hon. Friend the Member for Erewash (Maggie Throup) spoke about her experience as a haematologist in this field and about being involved on the frontline of research. That is another example of the power of having Members with a range of career backgrounds in the House. She brings great expertise to these matters.

The hon. Member for Coventry North East (Colleen Fletcher), who is vice-chair of the all-party group, made some important points about the CDF, to which I will return, and described the experience of her husband Ian. She asked whether I would meet the Anthony Nolan Trust; I will. I have already had several meetings with the trust and will continue to meet it, and when I do, I will pick up on the issues she mentioned relating to post-transplantation care in particular.

My hon. Friend the Member for Crawley spoke powerfully about his mother’s experience and made some really important points, not least about data and the importance of our harnessing it and generating a new model of appraisal. I will pick up on the latter point when I discuss the accelerated access review.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) discussed NICE and how important it is that we tackle the new landscape and make sure we are quicker and better at assessing new medicines. The hon. Member for Hackney North and Stoke Newington raised several important issues in a spirit of cross-party non-partisanship that I hugely welcome and appreciate.

I return to the cancer drugs fund. At the beginning of the previous Parliament, the Government, led by the Prime Minister, made the important commitment that we would put in place a cancer drugs fund to ensure that UK patients got access to the very latest cancer drug treatments. We did that in response to a number of high-profile cases in which NICE, applying its standard, one-size-fits-all quality-adjusted life year, had turned down cancer drugs, and patients were desperate for some hope, wanting the system to be responsive to their needs.

I am proud that we have made a total commitment of more than £1 billion to the cancer drugs fund and that we are continuing to invest each year, with more than £300 million put in this year. However, the system as it was originally set up has not proved to be sustainable, because of the pressure—inevitable pressure, in some ways, given the extraordinary explosion of our medical advances—put on it. If drug companies are turned down by NICE and there is a fund available for a post-NICE approval, the companies simply go to it and it has become over-subscribed.

NHS England has moved in the right direction by taking our funding commitment and repositioning the CDF as an early access and managed-access fund that examines more innovative drugs, ensures that they are provided to patients more quickly and makes sure that the data from that early access is allowed to inform the selection of the drugs that are adopted.

The truth is that breakthroughs in 21st century drug discovery and the rise of better targeted medicines are bringing huge benefits for patients but they also place huge pressure on our traditional models of assessment, adoption and reimbursement. With a rapidly ageing society and an explosion of new treatments, we cannot continue with the old model of one size fits all, with the NHS acting as a late procurer at a retail price of every drug. At the heart of my portfolio is a mission to unleash the power of the NHS as a research partner in bringing new drugs to market and getting a dividend—a discount—in return for that work.

We spend around £14 billion on medicines in the NHS every year and over £5.5 billion of that is spent on cancer drugs. The new generation of cancer therapies are incredibly exciting. The immunotherapies that we are seeing do not just delay death or grant patients a few extra months or years; they are cures for cancer. Those Daily Mail headlines that have been promising cures for cancers for more than 20 years are finally true. We now have cancer cures coming through, which profoundly changes the way that we will have to price drugs.

Let me say something about the accelerated access review, NICE and the CDF. At the heart of the accelerated access review is a commitment from the Government to consider whether and how we can better harness our extraordinary NHS assets as an integrated healthcare system to become a partner in the development of new therapies, so that instead of the industry treating the NHS as an increasingly pressurised retail-based consumer that struggles with this explosion of ever more expensive technology, we become a partner. Then, in return for sharing our clinical assets, for working with charities and the industry around our £1 billion-a-year National Institute for Health Research network, and for our leadership in genomics and informatics, we can pull innovation through more quickly for patients, share a data package and be the first place on Earth that companies want to come to in order to have their innovations assessed.

The accelerated access review has been examining a whole range of complex issues in this field and its report is waiting for a post-referendum slot to be published. I can assure Members that in the time that the review team has been preparing that report for publication, I have not been sitting around waiting for it; along with NHS England, I have been doing the preparatory work to be ready for it. Without in any way wanting to pre-empt the report, let me just share with colleagues some thoughts about where I think there is a huge degree of consensus between the Department of Health and NHS England on how we might be able to make some moves.

There are three key areas. First, in specialist commissioning, which deals with many rare diseases and rare cancers, the drugs are commissioned nationally through the Department of Health and NHS England. We want to see whether we can pull together that commissioning function into a more innovative procurement unit, to pull through and do some more innovative deals with industry in return for discounts—acceleration for discounts.

Secondly, we want to consider the NICE pathways through to NHS England and ask whether we can make it easier for innovators either to go through a series of much clearer NICE pathways or to go straight to NHS England and do pricing, discounting, acceleration and volume deals, as well making sure that we have an transparency and accountability framework so that people can see which parties in the ecosystem are fulfilling their mandate.

[Mr Clive Betts in the Chair]

The evidence from recent NICE approvals is encouraging. Many thousands of people have benefited from blood cancer drugs that NICE has recommended, such as bortezomib, ofatumumab and rituximab, and the evidence is that if we gather the data properly from the drugs that we approve, then we can use that as an intelligent health service to inform which drugs we adopt and pull through more quickly. If we get that right, the CDF in its reformatted position as a managed-access fund operating earlier in the system could become a powerful vehicle for an accelerated-access model of cancer drugs assessment. That will require some careful work on the NICE/NHS England framework, but we are doing that work right now, as we speak.

I will close, Mr Walker, by saying that—ah, Mr Walker has been replaced by you, Mr Betts.

--- Later in debate ---

[Jim Shannon]

It is a privilege to sum up. First, I thank all the right hon. and hon. Members who have made valuable contributions today. In particular, I thank the Minister for his concluding remarks, which gave us lots of hope and comfort for the way forward. I genuinely mean it when I say that we very much appreciate his energy and his commitment to the issues that he is involved with. We know that when he says he will do things he will actually do them, and we very much appreciate that.

I thank all those Members who have made a contribution today. The hon. Members for Scunthorpe (Nic Dakin) and for Bootle (Peter Dowd) and my right hon. Friend the Member for Belfast North (Mr Dodds) told some personal stories to illustrate the issues. In particular, my right hon. Friend referred to the charitable work that is done in England. I think that theme came through in all the contributions that were made today.

The hon. Member for Erewash (Maggie Throup) referred to the stem cell infrastructure that needs to be improved and I thank her for her very helpful contribution. She referred to the suitability of patients for stem cells and drugs, and she also referred—as we all did—to the improvement of NICE, which is very much needed. In addition, she referred to the clinical research that is also needed.

There was a very valuable, detailed and comprehensive contribution from the hon. Member for Coventry North East (Colleen Fletcher). I am so pleased to have listened to the very personal story that she told us, and what a joy it is to know that she can point to the stem cells and to how her husband’s own health has improved, which in turn helps their entire family. I think that each and every one of us here today was particularly touched by that contribution. On behalf of us all, I wish her husband well. It is good to know that the Anthony Nolan trust was very much involved in his treatment, as it is in the treatment of many other people. We thank the trust for its work.

The one key comment by the hon. Lady that I wrote down during the debate was this: “Hope shines out from the darkness”. She also referred to the geographical variations in treatment that exist across the United Kingdom, and to giving a second chance. How true that is.

The hon. Member for Crawley (Henry Smith), who is the chair of the all-party group on blood cancer, also contributed today. First of all, we thank him for his initiative for starting that group. We are very happy to be behind him. He is the general and we are the soldiers; he leads in the direction that we wish to go in. He referred to 130 blood diseases, to the emotional support that is necessary for sufferers, to his concerns over delisting, to the need to improve performance and to how NICE and the pharmaceutical industry can work together, which I mentioned in my introduction, but it is so important it deserves repeating. He also referred to Bloodwise and said that everyone needs access to the drugs that they require now.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) spoke, as he always does; he never misses these debates. He always comes along and makes a very determined and considerable contribution. In many ways Scotland leads the way in what we could do in the rest of the United Kingdom. His contribution outlined what Scotland has done and the regional variations. He made many important points, but one of the ones that I thought was good—the Minister will have noticed this—was on how we can exchange our viewpoints regionally and then use the regional variations to the advantage of us all. In Northern Ireland, we can learn from what they do in Scotland and in England and Wales, and vice versa. That is important.

It is nice to see the shadow Minister in her place. She has certainly grasped her portfolio quickly. She has lots of experience, of course. We thank her for the comments she made. She referred to the evaluation of drug availability, relative costs, the rationale, transparency, the palliative effect and the absolute cost—

[Mr Clive Betts (in the Chair)]

Order. The format is for the mover of the debate to have literally two minutes to finish. I know we have got time, but there is normal procedure with this. Will the hon. Gentleman bear that in mind and come to a conclusion?

[Jim Shannon]

My apologies, Mr Betts. I did not realise that. I thought I had five minutes, and I presumed that was the case. I will bring my comments to an end.

I thank all those who have taken part. I thank the Minister for his concrete proposals and his response. My concluding point is that a single medicine for a cure takes 12 years, 1,600 scientists and 500,000 lab tests to develop. That is the importance of the work that is done. To put it into perspective, that is what we want to work towards: a cure for cancer. If we can get a cure for cancer, we will make lives better. Let us ensure that everyone in the United Kingdom of Great Britain and Northern Ireland can benefit from that.

Question put and agreed to.

Resolved,

That this House has considered blood cancers and the Cancer Drugs Fund.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 5th July 2016 Commons Chamber

[Alistair Burt]

I am sorry to hear about the difficulties of my hon. Friend’s constituents. There is a provision within the regulations to enable patients who have serious difficulty in getting to a pharmacy because of the distance involved or the lack of transport to receive dispensing services from a doctor. Doctors should certainly not be blocking the addition of local pharmacies. If my hon. Friend writes to me, I can look into the matter in greater detail.

[Jim Shannon (Strangford) (DUP)]

Taking into account the immeasurable value that community pharmacies provide for some of the most vulnerable people in sections of our society, does the Minister agree that, when it comes to Government budgets, these dispensing services should be included in any ring-fencing that goes on around front-line services?

[Alistair Burt]

The hon. Gentleman’s support for these services is well known and what he says is right. The regulations do protect the more vulnerable, but when I next look at them, I will make sure that they fulfil his requirements.

Alcohol Consumption Guidelines

Jim Shannon Excerpts

Tuesday 28th June 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Gower (Byron Davies) on securing this debate. I am conscious of the shortness of time, but I will try to bring some balance to the debate. I have great respect for the Minister, but we have to consider the guidelines. The guidelines are based on the recommendations of the advisory group, which asked the Sheffield alcohol research group to publish a report, and they are very clear: men and women should not regularly drink more than 14 units a week and, if they drink as much as 14 units, it should be spread evenly over three or four days. The Royal College of Nursing, Cancer Research UK and the National Institute for Health and Care Excellence support the guidelines. There is a clear link between alcohol and cancer. Those are the medical facts on which the Minister will respond.

The Campaign for Real Ale has raised many concerns, and it alleges that there is overwhelming evidence that moderate alcohol consumption can be part of a healthy lifestyle. The hon. Gentleman made that point clearly in his introduction. It is about balance and people knowing their limits. He also mentioned promoting social wellbeing, and for many people modest alcohol consumption in pubs enables us to build friendships and create a sense of community.

The industry was thought to be dying, with literally dozens of pubs closing each week, but pubs have now become vital community facilities that bring local people together. Pubs have increasingly diversified to provide much-needed services such as village shops, post offices and even housing for defibrillators. We have seen a beer revolution, and there is no constituency anywhere in the United Kingdom that does not have its own local beers and local gins. Alcohol sales are worth some £40 billion, which does not factor in the associated income from activities and events involving alcohol. Wines and spirits directly and indirectly support 512,000 jobs, 69% of which are directly dependent on the industry’s stability and success.

The issue of problem drinking has to be addressed. The industry points to the fact that most people in this country are moderate drinkers. Research shows that 60% of alcohol sales are made either to those who are risking their health or to harmful drinkers who are doing themselves potentially lethal damage. More than 1 million hospital admissions a year are related to alcohol—double the number 10 years ago.

The UK has an alcohol problem, but as with many policy areas, striking a balance, while incredibly difficult, is essential. We cannot harm those who want to enjoy a drink—not to the point that they end up in A&E—but at the same time it is right to warn people of the perils of excessive drinking. The solution lies in education from as early an age as possible. We still have teen drinking; despite existing education and awareness campaigns, the reality is that teen drinking continues. People need to be made aware why they need to watch what they drink, rather than simply being told to do so.

I will conclude, because I am very conscious that other Members want to speak. Recommendations seem to be continually ignored by all age groups, which is regrettable. To see real change—the change we want—there needs to be more awareness, and that awareness needs to be created in a positive manner, so that drinkers manage their own intake because they want to and not because they are being coerced into doing so.

Kentmere Mental Health Ward, Westmorland General Hospital

Jim Shannon Excerpts

Monday 13th June 2016 Commons Chamber

[Tim Farron]

I am extremely grateful to the hon. Lady for her intervention and wish to express great solidarity with her in the campaign that she is running in York. It is of great concern to me that the CQC will make recommendations that will require improvements, and potentially not offer solutions to maintain a plausible and sustainable provision instead. The judgment we have to make is, “Is a good service that is not perfect better than no service?”, and of course the answer is going to be yes.

As I said, the quality of care in Kentmere ward at Westmorland general hospital is excellent, as stated in the report, and the staff are excellent. The ward needs upgrading—that is a given—but its closure would harm the health of some of the most vulnerable people in our community. It is utterly unacceptable that those people will have to be shipped off to Barrow, Whitehaven or Carlisle rather than being treated much closer to home in Kendal. What is more, there is no guarantee that those far distant wards will have the capacity to accommodate them. Already, patients sometimes face the immense journey to Manchester, for example. For many less well-off residents, a round trip to these alternative wards of up to 100 miles, with many hours on the bus or train, will put family and loved ones beyond easy reach. It is the patients who would be harmed if they were cut off from their families and friends and missed out on all-important visits. Instead of the reassurance of familiar faces and surroundings, they would face this dark time alone and in an unknown place.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman know whether any issues have been raised by veterans’ organisations or by veterans themselves? Ex-soldiers and former service personnel are clearly—

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Charlie Elphicke.)

[Jim Shannon]

Does the hon. Gentleman know whether there is a need to address that issue? A lot of veterans in my constituency need help. Does his constituency have the same problems as mine?

[Tim Farron]

The hon. Gentleman draws attention to an extremely important matter, namely the plight of so many veterans. It seems that we are happy for brave women and men to provide loyal service and to put their lives on the line for us, but they are often dropped when they return from duty. There are incidences of mental health concerns for them and their families in the years after their return, and I am not clear that we as a general community provide the support that we should. That support can sometimes be provided by the community, but sometimes it needs to be provided in a physical setting as well. I am grateful to the hon. Gentleman for his intervention.

A recent Government report showed that the closure of this ward in South Lakeland would leave our part of the world with among the worst access to mental health services in the entire United Kingdom. Out of the 6,688 open ward stays in adult acute mental health in-patient care in England alone over the past year, only 263 patients —4% of them—received care 30 miles or more away from where they lived. The closure of the Kentmere ward would leave vast numbers of South Lakes residents—including all of Kendal, as well as many other rural areas—even further away from those services, as the closest alternative in-patient ward is in Barrow, 35 miles away from Westmorland general. The most likely alternatives are further away still: Carlisle is a 45-minute drive, at best, and Whitehaven and Manchester are both more than 70 minutes away, if the traffic is kind.

The provision of replacement community support, which has been offered to compensate for the closure of the ward, would be inadequate. More community support would, of course, be welcomed, but that must be in addition to, not instead of, the 12-bed unit. Increasingly, the majority of patients in the unit are under section, and one cannot section people in the community.

By the way, when people are sectioned, there is an immense impact on our local police force. Closure of the unit in Kendal would mean that our local police force, which is already heavily stretched, under-resourced and under pressure, would have to take patients vast distances across Cumbria to far-off mental health units, taking officers off the beat and threatening the safety and security of our rural communities.

The last time I spent a night out on the beat with our local police force, I was stunned by how much of its time was spent dealing with various kinds of mental health issues. Indeed, that was pretty much all it did on that occasion. Anecdotally, police officers locally tell me that up to half of their workload can involve dealing with people living with mental health conditions. Their dedication and compassion in being the first line of support for incredibly vulnerable and often distressed people and their families is overwhelming, and I am proud of them. However, our police are already working beyond their physical capacity; the closure of Kentmere ward would just add to that pressure. It is unacceptable.

Local people recognise the damage that closure of the ward will have on patient welfare and are once again uniting to make their concerns heard as we stand together to fight to put a stop to the proposed closure. There has been an overwhelming response from local people to the campaign, and as of today our petition has reached 5,500 signatures.

Last week, we were encouraged, in the face of such massive public opposition, as we were able to secure a much welcome but temporary victory: the trust announced that a final decision is to be postponed while it looks at whether the ward can be upgraded and improved to meet CQC standards, which means that it will now stay open and continue to admit patients over the summer. The vulnerable patients I met over the weekend continue to get treatment close to home. If we had not achieved this victory, they would already be being carted off to Barrow or Carlisle—far from home, and far from loved ones. News that new admissions will continue to be made throughout the summer is also welcome.

I am grateful to the trust for listening to our concerns and thinking again. I personally thank every single one of the thousands of local people involved in our campaign. Between us, we forced the trust to hold back on closure. I am especially grateful to volunteers from South Lakeland Mind, and to the local media outlets that have shown such strong support to the campaign. This is only a temporary reprieve for Kentmere ward, and our work is far from complete. My message to the people of South Lakeland is that this is the moment to step up our campaign, energised and encouraged by this success and spurred on by victories in campaigns for our hospital over the last few years. My message to patients and their families is: we will stand with you and we will not give up, because we must not give up.

It has been very clear from my discussions with the trust over the last few days that its default position is still to close the ward. I have one very specific request of the Government this evening. Will the Minister clearly instruct the Cumbria Partnership trust not to close this vital ward? While the trust looks at upgrade options and alternatives, I ask him to make it very clear, right here and right now, that closure is off the table.

I have spoken to many local residents about the matter over the past few weeks, but a conversation I had with one lady struck me particularly hard. She is regularly treated for her mental health condition at the unit, and she was clearly extremely distressed by the thought of having to trek miles from home to receive care if the ward were to close. Her condition has been visibly exacerbated by the tangible threat from this proposal. A decision by the Minister to instruct the trust, tonight, not to go ahead with closure could directly alleviate the worry and anxiety of that lady and many more like her.

The long-term effects of closing the unit would be far greater than the short-term savings. If the Government are serious about mental health, they must put words into action and prove it by stepping in and preventing the closure of this vital ward. The closure of the ward would be a serious backward step for mental health care in South Lakeland, and the Minister has the opportunity to prevent it. On behalf of the people of the South Lakes, I ask him now to take the opportunity to save Kentmere ward.

Carers

Jim Shannon Excerpts

Thursday 9th June 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to contribute to this debate, and to thank the hon. Member for Eastleigh (Mims Davies) for bringing it forward for us all to participate in. This is the second such debate that she has led on this subject, and we look forward to many more on similar subjects in times to come. I also thank all those who have spoken—I understand that I will be the last to speak from the Back Benches before the shadow Minister and the Minister. The hon. Member for Worsley and Eccles South (Barbara Keeley) has just nipped out, but I look forward to her speech, and I very much look forward to the Minister’s. I have honestly found the shadow Minister and the Minister to be compassionate—we have a compassionate shadow Minister and a compassionate Minister—and I am convinced that their responses will both focus on the issues we have raised and those that it is important for us to be involved with.

Carers UK estimates that there are some 6.5 million carers in the UK. Over 1 million people in the UK say that they are supporting or caring for family members who have an illness that is terminal, which is also an issue. To put those figures into perspective, there are two carers for every person who died last year in the United Kingdom. Statistically, that is a massive figure. It is estimated that the NHS saves some £11.6 billion each year because of these unsung heroes. We have used that expression often today, but just because we use it often does not mean that it is any less appropriate. Their contribution as volunteer carers is immeasurably valuable.

Carers may end up providing more than 100 hours of care per week. From my knowledge of those who come to see me and those with whom I have worked in my constituency, I know that 100 hours per week is a low estimate. For some of them, caring is a 24/7 exercise, such are the medical and health difficulties of those for whom they care. All too often the outside world is completely oblivious of their efforts. Even those who know carers may be oblivious, because they do not always know what is happening once the door is closed and the carer is left alone to look after the cared for. We do not know what happens behind those closed doors.

I believe that employers are forcing some workers to forgo promotions. That is clearly stated in the background information that has been provided, on which I congratulate those in the Library. Its staff are not often thanked for what they do, but the background information they have provided—the stats and the paperwork—is very detailed and informative, and they deserve to be congratulated on how well they have prepared us for this debate.

Carers have said that they have had to forgo promotions, reduce working hours or leave work altogether. More than a third of them do not feel comfortable at work talking about caring, just over a third say their employer does not understand their caring role and exactly a third say their employer does not have policies in place to support carers. Some 60% of carers have given up work or reduced their hours to provide care, 25% have been unable to pursue or have had to turn down a promotion, 37% say their work has suffered and 42% say they have struggled financially. These are not just figures; these are people’s lives.

The figures illustrate very clearly what the issues are. Some 55% of carers have struggled financially, as it says in the background information. My colleague, the hon. Member for South Antrim (Danny Kinahan), mentioned that. I suppose all MPs have personal knowledge of this, but we are certainly aware of how carers are struggling in Northern Ireland. Some 72% of carers have given up work or reduced their hours. Again, these figures tell us where the problems are.

As the hon. Member for Eastleigh said, Carers Week is being supported by all the health organisations, including Age UK, the Carers Trust, Independent Age, Macmillan Cancer Support, the Motor Neurone Disease Association, and the Multiple Sclerosis Society. I work with these organisations almost every day of the week. They are household names, unfortunately, because of the level of problems that we have across the whole of Northern Ireland and the United Kingdom.

A subject close to my heart, as is the case for many of those here, is dementia and Alzheimer’s disease. A few months ago, we had a debate on that in Westminster Hall. I have not experienced it personally in my family, but I have certainly experienced it through meeting some of my constituents and their families. It is hard to explain to anyone who has not experienced it. These are very delicate issues to address; they are not just physical but emotional and mental. I have seen people with dementia who can often, unknowingly, become agitated or even violent. Night-time wandering can have a serious impact on carers’ sleep patterns, let alone the sufferer’s. Many people out there require someone close to them to give up much of their lives to provide the care that they need. Sleep patterns are just the tip of the iceberg.

I commend the groups in my area, particularly some of the church groups. For example, a Church of Ireland church, St Mark’s in Newtownards, has a group for the whole of Ards and North Down where people with dementia and Alzheimer’s come together to do painting and crafts. Music is a wonderful thing for helping those with dementia and Alzheimer’s. It helps to relax them, and for some people it takes them back to where they were many years ago—to their youth and their childhood.

[Mike Wood (Dudley South) (Con)]

The hon. Gentleman is speaking movingly about the challenges that dementia sufferers and their carers face. This week the Carers Trust raised with me concerns about patchy levels of support in dementia care around the country. Does he agree that local authorities need to go out and learn from best practice around the country, such as the church groups in his constituency and the successful dementia gateways in Dudley, to make sure that more carers and more dementia sufferers can receive the support they so desperately need?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I wholeheartedly agree; I think we all do. Those of us who are aware of this issue will understand the importance of all these groups. The issue that he touches on was frequently mentioned in the debate in Westminster Hall. Some 38 Members were involved in that debate, and it got a massive response. I thank him for his very important words.

The hon. Member for Eastleigh referred to young carers, as have other hon. Members. Crossroads Young Carers in Newtownards has been around for many years. We have a massive number of young carers in my constituency alone. I was rather shocked to find that they were so numerically strong. That illustrated to me the importance of the role of these schoolchildren, sometimes even primary schoolchildren, who almost become old before their time in looking after parents and family. The Carers Trust says that 80% of young carers miss out childhood experiences. They grow up before their time. They miss out on the leisure, the fun and the nights out with friends because they are looking after their mum, dad, brother, sister, or whoever it may be. They are almost hidden carers in the job that they do. I recognise the good work that Crossroads Young Carers does in my constituency.

We need an awareness campaign about carers so that they are no longer the unsung heroes but become the recognised heroes that they should be, not just in this House but in all our constituencies across the whole of the United Kingdom of Great Britain and Northern Ireland. Too often, carers are left to suffer in silence. The services on offer are not publicised enough and, sadly, too often are not up to standard either. When we read the background material that explains some of the everyday events that carers have to deal with, we get a feeling for and an idea of what they endure each day. I am not sure whether this has been mentioned yet, but, if not, it needs to be put on the record: many carers suffer from bad health themselves as a result of looking after others. In an intense situation, looking after someone 24/7, they need some time to switch off—their brain and their body have to get a bit of rest. It is very important every now and again to get a weekend, or even an hour or two, away from it all.

The main social security benefit available to carers is carer’s allowance. This is for someone who provides more than 35 hours of care a week, and it entitles them to only £62.10. Furthermore, carers may incur sanctions on how much they can earn on top of the allowance. Dementia carers save the NHS more than £11 billion per year, to put a financial cost on it, yet they get only £62.10 per week for giving up their lives for someone less fortunate. I know that the Minister’s Department is not responsible for that, but, with respect, it is not a good reflection on Government, given the hours that carers spend on caring. I recognise that times are tough financially. You cannot produce a high-quality suit if you have low-quality cloth, and the same thing applies to finances. We therefore have to be realistic about what we can do, but it must be highly insulting to carers to see some of the things happening in the news when they are getting only £62.10 per week. Although the Minister is not responsible for benefits, could he give some pointer for carers with regard to benefits advice? I give them benefits advice when they come to my office. To be fair, the benefits system is very responsive. We just have to point people in the right direction and show them the right opportunity. Perhaps there is a role for Government in that. I understand that our colleagues in Scotland have considered upping the carer’s allowance. That was discussed in our debate on dementia and Alzheimer’s.

Carers UK calculates that the value of unpaid care is some £132 billion each year—the equivalent of NHS spending. Although it is hard to calculate how much of this relates to people who care for someone who has a terminal illness, research has found that carers who look after someone with one of the four most prevalent cancers—lung, breast, colorectal or prostate—provide care worth £219 million per year: a third of the total of end-of-life care costs. Providing end-of-life care—that difficult time for people emotionally and physically—saves the NHS a massive amount of money as well. Other people have referred to personal things in families. My mother looked after my dad before he passed away, and that was not always easy. My mum is a fresh 85-year-old, or she will be on 14 July. If it were not for the closeness and the commitment of family, we would face a lot of other serious issues.

According to research by Carers UK’s Northern Ireland subsidiary, Carers NI, 16% of carers cannot afford to pay their utility bills, while nearly 40% cannot afford their bills without struggling financially. I can vouch for that in my constituency, given the numbers of people who come to me who are finding it very difficult to make ends meet financially. The hon. Member for South Antrim (Danny Kinahan) raised the question of heating or eating during the cold spell. That is a reality today as well, perhaps even more so than in the past. A third of carers are using savings to pay everyday living costs, and a third have used up any savings they had and now have nothing to fall back on. Thirty-two per cent. of carers have ended up in debt as a result of caring, and over four in 10 carers—almost half—are cutting back on food or heating. Furthermore, carers experience higher levels of fuel poverty in Northern Ireland than anywhere else in the UK. We have the highest levels of fuel poverty in the whole of the United Kingdom of Great Britain and Northern Ireland.

Information given to us by the Library indicates that 51% of carers

“have let a health problem go untreated…Half of carers (50%) have seen their mental health get worse…Two thirds of carers (66%) have given up work or reduced their hours to care…Almost half of carers (47%) have struggled financially…Almost one third of carers (31%) only get help when it is an emergency.”

That is the reality for carers. Full-time carers are twice as likely as non-carers to be in bad health. Eighty per cent. of carers say that caring has had a negative impact on their health, and half of carers state that they experienced depression after taking on a caring role. Sixty-three per cent. of carers say that they are at breaking point, and one in six carers receive no practical support at all. Despite an ongoing rise in the number of carers in the UK and sharp rises in the number of people caring full time, the number of people who receive carers’ assessments and carers’ services is falling. When we hear all those stats, we need to remember that there are people behind them who have to deal with reality.

It is often said, and we need to say it again, that food banks have been extremely helpful. That is the case in my constituency and, I am sure, in others. Food banks operate out of compassion and heart. They bring together Government bodies, churches and individuals who want to do their bit for the community. The food bank in my area, run by the Trussell Trust, has done exceptional work with carers, those who are under financial pressure and those who are experiencing delays in benefit or not getting all the benefits that they should be getting. The food bank is very much a part of life in my constituency. By the way, I think it is good to have food banks in our constituencies. They bring a lot of good things to my area. I do not see them as a negative; I see them as a positive, because people reach out and want to help each other. That is good, because if we help each other, we do what we are supposed to be doing in this world, which is to make lives better as best we can.

Carers UK estimates that the number of carers will grow to 9 million by 2037. Will any of us in this Chamber be here in 2037? I am not sure. I probably will not be—if I am, I will be the oldest man in the world, but that is by the way. We have to look at the stats, because they take us to where we will be in a few years’ time. I hope that the Government take cognisance of the stats, because it is important to form a strategy.

It is clear already that the support provided to carers does not suffice. Independent analysis demonstrates that the gap in funding for social care is expected to reach between £2.8 billion and £3.5 billion by the end of this Parliament, and that does not even begin to cover what will happen if the Government do not take into account the fact that the number of carers is growing. This should serve as a wake-up call to everyone—the Government, the regional Assemblies in the devolved Administrations and all stakeholders—about the reality ahead. There will be significantly more carers than there are already, and appropriate planning is needed to ensure that support is there.

I conclude with these comments. I welcome the fact that the Government are developing a new carers strategy, and I look forward to the Minister’s response on that. It is important that we, as elected representatives, put forward this debate in a positive fashion to get a strategy and responses to our questions, which we can feed back to our constituents. On the issues that I and others have raised, I impress on the policy makers the need to remember that there are real people behind all the statistics. It is people such as carers whom we are elected to serve. I can only hope that the debate will raise awareness of the need for urgent and large-scale reform of the way in which the Government treat carers.

A number of carer support groups come together in the churches and the community centres of Strangford. They are wonderful people who do great work, and they deserve to be supported and helped by us, as MPs through our Government and through the regional Assemblies, in whatever way we can. Those groups bring together all the people of the Ards and North Down Council area who want to participate. They give carers much needed opportunities for rest and socialisation. The opportunity to socialise and interact with others, or to get a moment or two to themselves, can make a world of difference to carers.

Comparative Healthcare Economics/NHS Finance

Jim Shannon Excerpts

Tuesday 7th June 2016 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I need to start by confessing an interest as a doctor. We are now 18 months into the five year forward view, and the big question really is: what next? “What next?” really means bringing English healthcare outcomes up to the standard enjoyed in peer group European nations, and I am afraid that means much more money. I hope that, in the next few minutes, I can suggest how we might go about achieving that.

The average age of Members of Parliament is 51. That means that most Members of this House have tipped, or are tipping, into the demographic twilight zone in which the incidence of common and chronic diseases begins to accelerate—it is sad but true. That focuses the mind on what a successful healthcare economy looks like and what it delivers for patients.

When those 51-year-olds enter the danger zone in a few years’ time, what will success look like? Success will mean accommodating the great advances in medicine that we believe we are on the cusp of achieving, and that we hope will add years to life and life to years, and I know that my hon. Friend the Minister is particularly exercised about those matters. Success will mean dealing with the healthcare needs of an ageing demographic, an expanding population, and more chronic diseases of lifestyle, which will amount to a 3% per annum uplift in demand, according to NHS England and the Nuffield Trust. Success will mean satisfying the legitimate demands of a less deferential, consumerist, better educated society that will not be content with second best. Success will mean closing the gap between healthcare outcomes here and in northern European countries with which we can reasonably be compared, and therein lies the “What next?”

In July 2010, the Government White Paper “Equity and excellence” exposed relatively poor health outcomes in the UK, compared with other countries. Our healthcare system was delivering poorer results in terms of mortality and morbidity. The most recent OECD statistics, published last year, have confirmed Britain’s relatively poor performance across pretty well the complete spectrum of common diseases—common cancers, ischaemic heart disease, cerebrovascular disease and the rest. Crucially, the number of unnecessary deaths—mortality amenable to healthcare—is substantially higher in the UK than in neighbouring countries.

However, healthcare is not just about reducing deaths. What about other measures of quality? Measures such as post-operative sepsis, pulmonary embolism, deep vein thrombosis, obstetric trauma and diabetic complications are worryingly unimpressive in the UK, compared with countries we would consider to be in our peer group. Although the teenage pregnancy rate has improved in recent years, the UK bumps along the bottom of the EU league table with recent accession states. The list goes on.

The Swedish-based and well-respected, if drug firm-funded, Health Consumer Powerhouse has been reporting on the performance of Europe’s healthcare economies since 2005. The UK’s position in its Euro Health Consumer Index has always been mediocre, but in January the UK was ranked 14th out of 35—just above Slovenia, Croatia and Estonia, and below European countries that most Britons would regard as peers.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter forward. This may seem a bit like politicking, but it none the less needs to be said. There is no doubt that the Transatlantic Trade and Investment Partnership has the potential to threaten the very nature of our NHS. What is even clearer is that we are sending millions of pounds every week to the EU that could be invested in our NHS, where that money is much needed. Does the hon. Gentleman agree that there is great potential to properly resource and liberate our great NHS, were we to vote to leave the EU?

[Dr Murrison]

I think the hon. Gentleman and I are on the same side of the Brexit debate, and I certainly would welcome the extra money that would be spent on the NHS in the event that we leave the European Union, so fingers crossed for 23 June.

The Health Consumer Powerhouse report highlights poor accessibility and an “autocratic top-down management culture” here, in contrast to top-performing Holland’s removal of what Health Consumer Powerhouse calls “healthcare amateurs”—that is to say, politicians and bureaucrats—from decision making. Unhappily, that sounds rather familiar. Earlier this year, Dame Julie Moore slated fellow senior NHS managers for “gross incompetence” and poor leadership.

The question is, what, apart from its management, accounts for the UK’s lacklustre ranking? Despite the UK’s innovative cancer drugs fund, Health Consumer Powerhouse found, for example, relatively poor availability of the latest oncology interventions and therapeutics, including radiotherapy. Sadly, that rings true, and we remember the high-profile case of Ashya King, the five-year-old with medulloblastoma, who was taken by his parents in 2014 from Southampton general hospital to Spain and then the Czech Republic for proton beam therapy, which was not available here.

The much-vaunted Commonwealth Fund report that some use to claim that the NHS is super-efficient and effective actually contains just one element that deals directly with health outcomes—a composite of deaths amenable to medical care, of infant mortality and of life expectancy at 60, it puts the UK 10th out of 11, the US being bottom. Tenth out of 11 sophisticated healthcare economies is not where I want the UK to be, and not where the Minister wants the UK to be either. The British public would expect us to be doing rather better against a raft of healthcare outcomes where the UK is firmly in the wake of our immediate northern-European neighbours France, Germany, Holland, Belgium and Denmark.

Can we explain why UK healthcare outcomes are not as good as those of peer group nations through differences in the level of healthcare funding? We can expect an opinion from the House of Lords, which last week set up a Select Committee under Lord Patel to examine the sustainability of the NHS—that is, the “what next?” question. I would be very surprised if it did not conclude that the answer is to bring spend up to the level enjoyed in countries such as France, Germany and Holland. After all, closing the gap with the EU15 in health spending as a proportion of GDP was a goal explicitly set in 2000. However, Conservative Members tend to be somewhat wary of making spend a proxy for outcome. It is not enough just to write big cheques and consider the job done. Can we do better with what we have? There are apologists for our low spending on health who cite the supposed efficiency of the NHS, but simply asserting that the NHS is more efficient than health services in other countries does not make it true.

I do not know what is in the Minister’s speaking notes, but there is a very good chance that he will use the New York-based Commonwealth Fund analysis on comparative healthcare to support a contention that the NHS is very efficient and thus ameliorates the relatively low UK spend on healthcare. The report’s methodology rewards close examination. I am sure he will have read it thoroughly, but if not, I commend it to him. In my opinion, its methodology renders the sorts of deductions that have been made unsafe. The only reliable element of the analysis that is used to claim that the NHS is relatively efficient is the percentage of national expenditure spent on administration and insurance, meaning that the UK comes in at fifth out of 11. Given that the nature of our system means that insurance and transactional costs are very low, that is hardly something to crow about. Other markers of efficiency rely on patient and practitioner surveys and include items such as time spent filling out financial transaction forms. UK-relevant metrics, such as rehospitalisation rates, were found to be comparatively poor. I conclude that it would be unsafe to make claims about the relative efficiency of the NHS based on contestable reports like that of New York’s Commonwealth Fund.

Let us suppose for one moment that the NHS is fairly efficient—not very efficient, because Carter and others suggest that that would be unwise, but fairly efficient. Indeed, I have no reason to suppose that it is institutionally profligate. If it is fairly efficient, we will not be able to squeeze many more efficiencies from it beyond the Stevens assumptions, but we will still be left with relatively poor outcomes and still needing to know “what next?” Simon Stevens still believes that we can squeeze £22 billion in efficiencies from the NHS. Much of this, presumably, is predicated on productivity gains that are contingent on holding down salaries and wages—a challenge if incomes in the economy rise. This is what I think he means by “strong performance”—strong indeed, because the implied productivity gains of 2.4% are well in excess of anything that has been achieved by the NHS historically and well beyond expectations for the wider economy. It also depends on sustained spending on social services and public and preventive health. Both, in the event, have been impacted by cuts to local government funding—cuts that I supported and accept were entirely necessary to repair the public finances, but cuts nevertheless.

So “what next?” will inevitably mean a step change in input—in money—if not by the end of the five year forward view period, then without doubt during the next decade and beyond. Here again, it is instructive to look across the channel, where we find some good news for Ministers. The Office for National Statistics has just tweaked its approach to health accounting to comply more closely with that of the OECD, and obligingly, this increases the UK’s spend on public and private healthcare combined from 8.7% of GDP to 9.9%. Most of this is due to re-badging a slice of publicly funded social care as healthcare spend. Of course, none of this accountancy changes by one penny the amount spent on care, but it impacts on the international spending league table. It means that we overtake southern European countries such as Spain, Portugal, Italy and Greece. However, we still lag well behind Germany, France and the Netherlands—my chosen basket of similar European countries.

So what next? Data from the Kings Fund and the Institute for Fiscal Studies suggest that income tax must rise by at least 3p in the pound simply to offset the fall in NHS spending as a proportion of GDP predicted over the rest of the decade. But all that will do is arrest the UK’s relative downward trajectory towards being the sick man of Europe. To bring spend up to the EU15 average would now involve an 8p increase. That eye-watering sum may be toned down a little bit by the new Office for National Statistics method for calculating healthcare spend, but probably not greatly if the comparison we actually want to make is with our closest European neighbours France, Germany and the Netherlands.

So, if we accept that big fistfuls of money are needed, the question becomes, “How are we to get it?” The Labour party does not know. It has yet to say how much it thinks the NHS budget should be, despite every encouragement from me and others to do so. All we know is that the party opposed the Stevens uplift at the general election. Maybe the unaccustomed reticence about pledging money from the party of fiscal incontinence is an indication of the sheer scale of the spending challenge that even Labour has perceived in a rare lucid moment.

Although I have every confidence in my right hon. Friend the Chancellor, a precipitous growth in the economy seems unlikely, and further borrowing should not be an option. In fact, half the £350 million per week that we send to the EU—a figure, net of rebate and subsidy, that I personally rely on—would, by my reckoning, halve the difference. I fervently hope that it will be in play after 23 June, but it would still leave a gap. How will that gap be closed? It is said that if we want a social healthcare system, we must choose between Bismarck and Beveridge. For my part, I cannot see how the transaction costs implicit in insurance-based models or large-scale schemes of co-payment would improve productivity or efficiency in our NHS—this despite the fact that the UK healthcare economy is distinguished from others by the small scale of its private provision.

For me, the Bismarck versus Beveridge debate is pretty much settled. However, I would expect a commission to examine all possible funding streams, drawing on experience from other countries. I would expect it to look closer to home at incentives that can be given to encourage subscription to mutuals, such as the Benenden Healthcare Society, formed in 1905 by and for Post Office workers, whose headquarters in York I visited recently.

But affirming that the great bulk of healthcare in the UK should continue to be funded through general taxation does not just mean more of the same. A variable hypothecated tax would be an easier sell to the public than a general tax hike. Treasury officials, or course, hate hypothecation, but the Treasury has been softening its approach in recent years and we are now, of course, wedded to the far less economically literate practice of hypothecated spend as a proportion of GDP for selected areas of public expenditure. Despite the Treasury’s reluctance, if we are talking about several pence in the pound to bring UK health spending up to the average of neighbouring similar countries, we have to find a politically acceptable and publicly palatable way of doing so. Either way, gathering a consensus on this most sensitive and complex of public policy areas, using a vehicle on a spectrum from royal commission to non-departmental public body, surely makes sense. As a model, may I suggest the influential Pensions Commission, chaired by Adair Turner, during the last Labour Government?

If the NHS is the closest we have to a national religion, its critical friends are often seen as heretics. We saw that even at the height of the Mid Staffs scandal. How, then, are we to uphold this rallying point for national morality, decency and righteousness with the more prosaic imperatives to save and lengthen life, make sick people better, prevent ill health and match health outcomes in comparable countries? I hope that the Minister will agree that the proposal for a commission and associated national conversation—made by me and others in this House, in the other place and elsewhere—has merit. I warmly congratulate Ministers on successfully arguing the NHS’s corner at a time of austerity. However, I urge the Government to give serious thought to establishing a commission that will examine how we can properly and sustainably fund healthcare and close the widening gap that exists between us and our European neighbours.

Support for Life-shortening Conditions

Jim Shannon Excerpts

Tuesday 7th June 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Pudsey (Stuart Andrew) on clearly outlining the case and how we all feel about this important subject. I apologise in advance for not being here to hear the shadow Minister and the Minister—I have apologised to them both. I have to attend the Select Committee on Defence, otherwise I would look forward to hearing what they have to say.

This issue is important to me, as it is to the hon. Member for Pudsey and others in the Chamber, which is why we are here. We are here to represent our people and their viewpoints on issues that they want to be debated. There are Members here with personal stories, some of which we have heard before, and I look forward to hearing some of those stories again.

Life-shortening conditions are those for which there is no reasonable hope of cure and from which children are expected to die, or for which curative treatment may be feasible but can fail. Children with life-shortening conditions need continuing palliative care throughout the trajectory of their illness. As I always do in Westminster Hall and in the House, I will give a Northern Ireland perspective. The Minister knows that health is a devolved matter in Northern Ireland, and I will therefore add to the debate and the knowledge we all have by addressing some of the positive things we are doing in Northern Ireland. By sharing knowledge from across the United Kingdom of Great Britain and Northern Ireland we have an opportunity to enhance and enrich our lives and to help ourselves to do things.

In Northern Ireland alone there are currently estimated to be some 1,300 children and young people living with life-shortening conditions. Many of those children have extremely complex and unpredictable conditions, and they are under the pressure of requiring round-the-clock care seven days a week. Due to medical advances and improved care, that prevalence is growing and more of those children are living into adulthood.

The hon. Member for Pudsey and my hon. Friend the Member for Upper Bann (David Simpson) referred to families and how important it is for children under pressure and in need of medical assistance to have family support. It is about their parents, their siblings, their grandparents, their family circle and their friends coming together to give support and help at the right time. Because the proportion of young people and children in the Province with life-shortening conditions is less than 1%, people might be inclined to believe that they are an underfunded and perhaps neglected section of the population, but fortunately they would be wrong. More can always be done, but in Northern Ireland the work to support young people and children affected by life-shortening conditions has been positive and is ongoing.

Health may be a devolved matter, and this debate may be most pertinent to NHS England, but such conditions affect British children across the whole United Kingdom of Great Britain and Northern Ireland, and it is therefore important to make such points. It is important to link the work of Government institutions across the United Kingdom to determine what is best practice and what is not, and to share ideas on the way forward. Hopefully this debate will give us an opportunity to do just that.

[David Simpson]

We have discussed palliative care. Does my hon. Friend agree that it is important that complete, wrap-around palliative care is given to those affected? What happens to children with life-shortening illnesses post-19 has been an issue across the whole United Kingdom for far too long, and we need to address it.

[Jim Shannon]

My hon. Friend has hit on the kernel of the issue.

We need to exchange medical advances among all regions of the United Kingdom. We want to ensure that we in Northern Ireland have information about what is happening in London, Scotland, Cardiff or wherever it may be. I also want to put on the record my thanks to all the doctors, nurses and consultants involved, and to all the other people who genuinely, consistently, honestly and energetically give their time for the children affected. I have some constituents who have attended Great Ormond Street children’s hospital, not only for life-threatening conditions but for life-changing ones, and we thank everyone for what they do.

[Mr Robin Walker]

May I add to that list hospital chaplains, who play an important role in supporting bereaved relatives of all religions and of none?

--- Later in debate ---

[Jim Shannon]

That is absolutely right. It is so important in a time of physical, emotional and spiritual need.

Although it is critical for the Government to provide appropriate support, non-profit organisations and charities are often the most innovative and forward-thinking, because they are made up of people who are motivated and dedicated to making a difference. The Government need to resource those people properly so that their efforts can bear fruit and those affected by their work can receive the benefits of such support.

The hon. Member for Pudsey referred to the changes in disability living allowance. I will not repeat his words, but I wholeheartedly support what he said. How important it would be if we had a realistic disability living allowance system in place for those from nought to three, as well as from three onwards. It would only be a small change. The Minister knows that I respect him greatly—he is responsible and positive, and others want to hear from him today—and I say respectfully to him that he could use his position to make that change. It would make a hands-on difference, as my colleague the hon. Member for Foyle (Mark Durkan) said earlier.

Northern Ireland Children’s Hospice and Together for Short Lives are just two of the many organisations that make a difference in Northern Ireland. I commend them for their efforts not only to provide support for young people and children with life-shortening conditions but to research and produce realistic and helpful ways forward. They make a positive contribution.

I will quote testimony from an anonymous parent who went through palliative care for their young child in Northern Ireland. It sheds some light on what the experience can be like for normal, everyday people in the unfortunate position of having to live through such circumstances:

“Having had a child born with very complex needs, we found ourselves in the horrendous position of spending the first and last seven months of our child’s life in a neonatal unit and children’s ward. Our daughter was only able to come home for two separate days during this period. This involved ambulance transportation and two nurses. The process of getting her home for good was so complex and arduous it could not be completed before she died. Although hospital staff were brilliant, a busy general ward is not appropriate for end of life care.”

That puts things into perspective and reminds us that we are dealing with real people’s lives in this House. What we do and say has an impact on people across the country.

The same charities that I mentioned earlier have published a set of recommendations for the Northern Ireland Assembly—it has responsibility for the issue, and the Minister has recently changed—that will, in their view, transform the lives of children and young people with life-shortening conditions. Among the seven recommendations are calls for a dedicated children’s palliative care consultant in Northern Ireland, improved access to multidisciplinary services for children who need palliative care and high-quality planning to support young people as they transition to adult services. Although we are doing those three things in Northern Ireland, if they were in place here on the mainland as well, it would be a step in the right direction to improve things.

Critically, the recommendations also call for a fully funded children’s palliative care strategy for Northern Ireland, which would address many of the core gaps and provide a framework for appropriate and consistent children’s palliative care services for every family who needs them in Northern Ireland in the future. In Northern Ireland at present, a growing number of doctors, paediatricians and GPs are interested in children’s palliative care and are gaining vital knowledge and experience every day. However, the number of senior paediatricians with the necessary qualifications to be considered expert remains in the single figures.

The recommendation for Northern Ireland—again, I hope it will happen on the mainland as well—is to have a regional consultant. That is vital, but just one consultant for Northern Ireland would not be enough. A better option would be to have two part-time consultants who could overlap in looking after patients. It would mean that someone would always be available, 52 weeks of the year.

Mr Percy, I realise that I have overstepped my time, and I apologise. I will end with these two paragraphs. We know all too well that the purse strings have been tightened, but those are just a few of the ideas put forward by people working on the front line. They are the ones who know best, the ones closest to the reality of palliative care for young people and the ones who must live and work with the medical and financial implications of Government policy. They are the ones we need to listen to if we wish to make the difference that I think everyone in this Chamber, this House and across the whole United Kingdom of Great Britain and Northern Ireland wants.

No child should have to suffer as a result of being diagnosed with a condition through no fault of their own, and no family should have to live through such suffering. We are in a position to make a difference. If national Government liaise constantly with charities and those affected, surely progress is possible.

Diabetes-related Complications

Jim Shannon Excerpts

Tuesday 7th June 2016 Westminster Hall

[Paula Sherriff]

I thank hon. Members for their contributions, and I will now try to make a little progress.

Earlier this year, the Public Accounts Committee said that

“the costs of diabetes to the NHS will continue to rise. In order to control these costs, the Department and NHS must take significant action to improve prevention and treatment for diabetes patients in the next couple of years.”

The wider impact on people’s health is significant. One in five hospital admissions for heart failure, heart attack and stroke are among people with diabetes. The condition is responsible for more than 135 amputations per week. It is the leading cause of preventable sight loss in people of working age and the single most common cause of kidney failure.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing the debate. I declare an interest as a type 2 diabetic. I lost almost 4 stone and I am still a type 2 diabetic. I still need tablets to keep me right, and many type 2 diabetics are the same. Experts at Queen’s University Belfast are spearheading a new major research project aimed at ascertaining why thousands of diabetics around the world suffer kidney failure, which she referred to. They have examined DNA samples from 20,000 diabetics to help identify the genetic factors in diabetic kidney disease. The project could enable personalised procedures for those at risk. Does she agree that such research is the key to unlocking life-changing advances for diabetics?

[Paula Sherriff]

I absolutely agree, and it is encouraging to learn that such research and development is being carried out. I will later share details of a visit that my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and I undertook recently, which proved very interesting.

HPV Vaccinations for MSM

Jim Shannon Excerpts

Tuesday 7th June 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Hollobone, and it is a pleasure to be able to speak in the debate.

I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing a debate on such an important issue. He has been a stalwart speaker on the issue in this Parliament and the previous one. He never lets his subject matter fall, and I thank him for his commitment and his energy.

It is good to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place again. It is also especially nice to see the Minister in her place again—she is spending a great deal of her afternoon in Westminster Hall, but it is always a pleasure to have her here. I look forward to her response to this debate.

For years, often due to stigma and attitudes, the issue was ignored, so it is welcome that we can now give it the attention that it deserves, not only in Parliament, as today and in the past, but in all walks of life, because it is now part of national conversations on advancing healthcare. As the Democratic Unionist party health spokesperson at Westminster, I am pleased to participate in the debate, to encourage and support the hon. Member for Finchley and Golders Green in what he is talking about today, and to comment on what we have done in Northern Ireland, as I always do in such debates, hopefully adding to our general knowledge of the subject.

Genital warts are the most common viral sexually transmitted infection and are caused by the human papilloma virus. In September 2008, Northern Ireland introduced an HPV vaccination programme targeting 12 and 13-year-old girls in schools. It primarily vaccinated against HPV 16 and 18, which are associated with more than 70% of cervical cancers. From September 2012, 12 and 13-year-old girls were offered the quadrivalent vaccine, which protects against not only types 16 and 18, but types 6 and 11, which are mainly associated with the majority of genital wart viruses. It is expected that rates of first episodes of genital warts will be positively impacted by the introduction of the HPV vaccination programme.

In men, there is no reliable test for HPV infection. As the hon. Gentleman said, it is often difficult to diagnose, and there are no symptoms for high-risk HPV. People who are known to be at a high risk of having anal HPV and of developing anal cancer may be offered an anal smear, but nothing goes beyond that. It is frustrating to have some steps in the health process, but no steps to take things to the next stage and to do what the hon. Gentleman said. That is why we are having the debate today and why it is critical for men to start receiving equality with women in terms of the protection offered against HPV by the health service. Given the higher risk of HPV infection associated with men who have sex with men, surely the provision of a vaccine is a no-brainer.

In November 2015, following a review of the evidence, the Joint Committee on Vaccination and Immunisation published a position statement recommending the introduction of a vaccination programme for men who have sex with men, are aged up to 45, and attend genitourinary and HIV clinics. Some steps forward have been taken, but larger steps are needed, with more ground being covered.

Since the JCVI recommendations, and in line with them, the Welsh and Scottish Governments have announced that they will roll out vaccination programmes. I hope that the Department of Health in Northern Ireland will follow suit—the matter is devolved, as the Minister knows—and that men throughout the United Kingdom will get the long-overdue support that they deserve. It is about fairness, and when there is clear evidence that a section of the population might be at particular risk of something, appropriate action should and must be taken.

Continued monitoring of results is also necessary to ensure that the recommendations, when implemented, have the desired results, and that any changes or extensions to the plans can be made to ensure the most full and proper protection available is afforded to all those affected. To conclude, developments are long overdue. The debate has been welcome and an opportunity to highlight the issue—I congratulate the hon. Gentleman again. The fact that a goodly number of Members are participating is an indication that we, too, want to see change. It is about seeing the plans implemented and ensuring that the proposals work well in practice.

Excess Winter Deaths

Jim Shannon Excerpts

Monday 6th June 2016 Commons Chamber

[Dan Jarvis (Barnsley Central) (Lab)]

I am grateful to have secured this opportunity to raise the important subject of excess winter deaths again in this House. I first raised the issue with the Prime Minister some four years ago. Since then, tragically, 117,000 people have died unnecessarily because of the cold—43,000 in the winter of 2014-15 alone. I think we can all agree that it is simply unacceptable that each year tens of thousands of people are dying unnecessarily. I am not going to pretend that this is an easy problem to solve or that any one Government are to blame. Tonight I intend to outline where I believe the Government’s approach can be improved and, in a constructive manner, offer suggestions of steps that I believe should be taken to address this national scandal, because while today was a very warm day, now—during the summer months—is precisely the time when we should be preparing for the winter.

The majority of those who are dying are elderly. We know that the demographic group most affected by excess winter deaths is women aged over 85, yet we also know from the evidence across Europe that more people are dying unnecessarily here than is the case elsewhere. Scandinavian countries including Norway, Denmark, Finland and Sweden all have significantly lower rates of excess winter deaths than the UK, despite all of those countries being considerably colder. One of the reasons for that is that, in policy terms, Scandinavian countries tend to be better prepared. As former director general of Age UK Michelle Mitchell put it,

“excess winter deaths are much lower because they take staying warm seriously and prepare for the cold weather.”

We know that that preparation is key, and I will outline several areas where preparation in our country could be improved.

The first is public health. The Office for National Statistics analysis of the most recent excess winter deaths figures highlights flu as an important factor in mortality levels, so I have to say to the Minister that I was concerned to be left waiting this spring for the Government’s flu plan for the upcoming winter. It was published just before recess, but that was some two months later than last year. Will the Minister say why the Government’s flu preparations are behind compared with a year ago?

Secondly, we know that cold homes are a major cause of excess winter deaths. They are also a burden on our public finances. Former chief medical officer Liam Donaldson has estimated that cold homes cost the NHS £850 million each year. Unfortunately, many elderly people live in fuel poverty—people like Lynne from Cumbria, who to keep warm in winter has to put on several layers of clothing and heat a hot water bottle, because she cannot afford to have the heating on when she needs to. For people like Lynne energy prices are a big issue. I welcome the fact that energy prices are falling, but they are not falling in line with wholesale prices, and too many energy customers find themselves on tariffs that lead to them paying more than they should. What discussions has the Minister had with her colleagues at the Department of Energy and Climate Change about alleviating fuel poverty to help to prevent excess winter deaths?

In addition, more can and should be done about home insulation. Although neither programme was perfect, I thought the green deal and energy company obligation were steps in the right direction. However, the green deal has now expired and the energy company obligation expires next year. We have been told that it will be reformed and renewed but, as yet, no timeline has been set out by the Government for doing so. May I ask the Minister what discussions she has had with fellow Ministers at the Department of Energy and Climate Change about ensuring that home insulation is increased?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing an important issue to the House in this Adjournment debate. In the period from July 2014 to August 2015, there were 870 excess winter deaths in Northern Ireland—the highest figure since 2009-10. It is unbelievable that the figure is so high in a developed nation such as ours. Does he agree that we need to do more to eradicate winter deaths, not just reduce them? In other words, it should be target zero.

[Dan Jarvis]

I am grateful to the hon. Gentleman for his intervention. He is absolutely right to draw attention to the heavy costs that his part of the world has borne. He is right to point out that in a prosperous, wealthy nation—yes, of course we have challenges—it is simply unacceptable that anyone should die as a result of the cold. The numbers that he has outlined in Northern Ireland and the national numbers that I outlined are simply unacceptable. As I said, this not the fault of any single Government—this is an issue that has challenged successive Governments. The Prime Minister recently said to me that these figures act as a standing rebuke to all Governments. The issue for us in the House tonight is what practical measures and action the Government can take to reduce the numbers and get to the point, as the hon. Gentleman suggested, where no one dies in this country as a result of the cold.

I was outlining some of those practical measures and was asking the Minister about the conversations that I hoped she would have with her colleagues at DECC on home insulation. Any measures that the Government seek to take should be targeted at those groups such as the elderly who are the most vulnerable to the cold. That brings me to a crucial point about the importance of cross-government working. Excess winter deaths are clearly an issue that requires a cross-government approach, but despite the fact that nearly 44,000 people died unnecessarily in the most recent winter for which we have figures, there is not a joined-up cross-government plan to reduce excess winter deaths.

A number of Departments, including the Department of Health, the Department of Energy and Climate Change, the Department for Work and Pensions, the Cabinet Office and the Department for Communities and Local Government, have policies which could contribute to reducing excess winter deaths. As yet, there is no overarching cross-government strategy to join up those policies and ensure that they contribute in the best possible way to reducing excess winter deaths. It is often left to local authorities to develop their own approach to reducing excess winter deaths. In Barnsley, we are fortunate that our local authority takes this issue very seriously. The council is making a concerted effort to ensure that vulnerable and elderly people live in heated homes.

--- Later in debate ---

[Jim Shannon]

The hon. Gentleman is outlining a plan of action. Does he feel that there is a role that the Salvation Army and church groups, whose congregations are normally elderly people, could play in the Government’s strategy?

[Dan Jarvis]

I absolutely do believe that there is a role for the charitable sector and for a range of organisations that make hugely significant contributions. However, the point I am trying to make concerns the means by which we draw those contributions together—the practical co-ordination measures that can be taken at a local level, led by directors of public health, to ensure that we have the most effective response and bring together all the different agencies locally, including the local authority, the clinical commissioning group, the local hospital, the GPs practices and the organisations the hon. Gentleman rightly referred to.

Before drawing to a conclusion, I want to take the opportunity to tell the House that I have started a petition today on Parliament’s petition website so that people across the country can join me in calling for a national strategy. I am pleased to say that, despite the fact that the petition launched only a few hours ago, it has already received a signature from one of the Minister’s own constituents—I hope she will welcome that contribution.

To conclude, the way in which a society cares for the most vulnerable is an important metric by which any society should seek to be judged. At the moment, given the numbers of people who are dying each year, we as a country are failing that test. Reducing excess winter deaths is an issue Members on both sides of the House can work together on. I look forward to the Minister’s response. I know she treats these matters with the concern they rightly deserve. I hope that tonight will not be the end of the discussion but the beginning and that she will go away and consult colleagues across the Government to see what more can be done so that, this winter and in winters to come, we can prevent people from dying unnecessarily.