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.

Defending Public Services

Jim Shannon Excerpts

Monday 23rd May 2016 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to be called to speak in this debate on the Gracious Speech. There is always a theme in these debates on the Queen’s Speech—a list of goals that are not present, a list of what should have been in there that was not, and what people do not like about it and what they do like about it. What has saddened me is that the common theme from the Opposition is that they do not think that there is much in the Queen’s Speech, and yet, as we have just heard, there are 21 separate Bills. There is quite a lot in there.

It takes me back to 2010, when I first became an MP, because this Queen’s Speech is all about why I wanted to come into politics in the first place. Looking back to 2010, I see that on my website I described myself as the fresh-faced MP for Blackpool North and Cleveleys. That is no longer true—I look in the mirror now and see that the lines are slightly deeper, the eyes slightly more sunken; I am on the wrong side of 40—but one thing has not changed: my belief that I got into politics to stand up for the people who are directly under the state’s care who have no one to stand up for them. They include the patients in hospital, whom we discussed in opening today’s debate; the young people in care waiting to be fostered or adopted, who the Prison Reform Trust told us today are over-represented in the youth justice system, not just by a small amount but by an absolutely massive amount; and the prisoners in our prisons who are not being educated properly or rehabilitated, which has a direct impact on the number of victims there will be if we do not reduce reoffending. Getting that right has to be the right thing to do.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman share my concern about the radicalisation, both Islamist and neo-Nazi, that takes place in prisons? Is there not a need for the Government to tackle that? People are going into prison with some sort of innocence in terms of religious belief and coming out with a radical opinion. There has to be something done.

[Paul Maynard]

I thank the hon. Gentleman for making that point. He tempts me to indulge in a nine-minute disquisition on how we balance the presence of faith in our prison system with the need to safeguard against radicalisation. I agree with him broadly, but I do not want to go down that path, tempting though it may be. I would much rather focus on the fact that what brings all this together—standing up for those who have no one else to stand up for them—is this idea of life chances, which is the theme behind the Queen’s Speech.

The Whip should listen carefully now: although I hate the phrase “life chances”, he should not write that down in his little black book, because to my mind what we are really talking about is social justice. Like Ruth Davidson, I am proud to say I am a John Major Conservative. I believe in equality of opportunity. I do not believe in equality of outcome because it cannot be guaranteed, but I do believe that part of achieving social justice is taking ownership of the consequences of our policies. We have to have some regard for the outcomes.

That can be hard to justify when we look only at globalised national statistics. They do not give us the granular narrative detail of individual lives. Many times in this Chamber we have debated how we measure child poverty, what the best indicators are, what they mean, and how we tackle child poverty. We can disagree constructively on what those indicators are and how we utilise them, but I believe we need to go down another level. A good example is an article I urge everyone to read that appeared in The Atlantic magazine last month about the proportion of Americans who, if landed with an unexpected bill for $400, would not be able to meet it out of their earnings. Shockingly, some 47% of Americans would not be able to pay that bill for $400 without recourse to either borrowing from others or payday lending. I shudder to think what the figure is in this country. No doubt a sociology department somewhere is preparing a research funding request as we speak to find out that information. We need to burrow down so much more into the detail to get a true understanding of how to improve life chances.

Think about the connection between social isolation and ill health—the number of lonely elderly people in my constituency who probably do not speak to anyone day in, day out, and the younger people with serious health conditions who may feel socially isolated. Social isolation is the key predictor of future ill health and therefore future demand on the health service. That has to be taken into account. Think also of children. I visit many primary schools and I know that in the more deprived parts of my constituency there is a major problem with the number of children arriving at school aged four who are untoileted. Think of the burden that places on the staff in toilet training them, taking them away from the educational aspects of their job.

Another wider issue for older children perhaps, those who are eligible for free school meals, is how many of them are not fed properly during the school holidays. I know the hon. Member for Washington and Sunderland West (Mrs Hodgson) is deeply concerned about that. Although all that is difficult to measure, it gives a different dimension to the story of life chances from the national global figures for whether child poverty is going up or down in any particular set of years we all focus on. We need to be much more creative in our approach.

I had hoped that by talking for an extra five minutes, my hon. Friend the Minister for Culture and the Digital Economy would have returned to his seat to hear what I am about to say about Department for Culture, Media and Sport issues. I know he has to wind up the debate and I was hoping to help him. He published an excellent culture White Paper just before the Queen’s Speech—the first since Jenny Lee’s ground-breaking document in the 1960s. The key element of the latest White Paper is about broadening participation. I had not really thought about it in those terms, but I was invited by a constituent, James Nash, to a concert by the National Youth Orchestra at the Liverpool Philharmonic hall a few weeks ago. James plays trumpet at grade 8 —grade 8 is a requirement to play in the National Youth Orchestra. He is very proud of his participation and thoroughly enjoying the experience. He went to a local comprehensive and is very musically talented so this is a fantastic opportunity for him, yet that orchestra is a charity, supported by the Arts Council.

I had the pleasure of hearing Thornton Cleveleys Brass Band the Sunday before last. For the first time ever, it has won a regional division of its national brass band competition at the fourth tier, I gather, of brass bands. It will soon compete in Cheltenham in the national competition. That band is looking for funds and it will be going to the Arts Council, which now supports brass bands thanks, I believe, to the Minister’s intervention. That broadens participation by so many young people who enter music through the local brass band.

There are many ways in which culture is broadening horizons, but unfortunately in Lancashire there is one way in which those horizons are narrowing rapidly—through the very sad decision by Lancashire County Council to close so many of our local libraries. Almost half of Lancashire’s libraries are being shut. I am losing Cleveleys library, which has a children’s centre attached, and Thornton library, which is just over the constituency boundary but I feel I have a share in it with my hon. Friend the Member for Wyre and Preston North (Mr Wallace). We all recognise that councils have to make savings. What I find so frustrating is that when others have come up with solutions to help to keep libraries open and make the savings, Lancashire County Council will not sit down and listen.

Wyre Borough Council wants to convert all Wyre’s libraries into a community interest company, thereby forgoing many of the business rates and other associated costs that make them so expensive to run for the county council. By doing that, it can save the money the county council wants to save and keep every single library open, but shockingly the county council will not even sit down and talk about it. The hon. Member for West Ham (Lyn Brown) rightly praised councils that innovate. Please could she have a word with Lancashire to persuade the council to innovate? Many other councils of all stripes have rethought how they do library provision. Why can Lancashire not do the same? Does it want to make a cheap political point? I desperately hope not, because that would be a tragedy.

I remember back in 2008 the right hon. Member for Leigh (Andy Burnham) taking the visionary step of calling a public inquiry because Wirral Metropolitan Borough Council had chosen to close so many of its libraries. I attended that public inquiry. I know he is not here, but I very much hope that my hon. Friend the Minister for Culture and the Digital Economy will agree to meet me to discuss whether Lancashire’s plans are enough to justify another public inquiry under the terms of the Public Libraries and Museums Act 1964. The council has an obligation to provide a “comprehensive and fair” service. My concern is that what Lancashire is planning is not fair—I know that is a subjective term—and it is certainly not comprehensive.

My constituents, who have been accustomed to going to Thornton and Cleveleys libraries will now have to go further afield, to Fleetwood and Poulton, shortly after seeing all their bus connections to such areas slashed by the county council. That is doubly frustrating. I urge Ministers at least to arrange for me to have a conversation with my hon. Friend the Minister for Culture and the Digital Economy to discuss those issues.

On a wider point, whenever I come here, I desperately try to believe that all of us are here for the right reasons—we all want to make things better for the people we represent in our constituencies. Some of us hide it better than others, perhaps, by our conduct in this place. Some are more bolshie, some are ruder, some cat-call me from a sedentary position and some chunter away, but I always try to find something positive in what the other person is saying, and I urge all Members to try to do that.

Whatever we think of the phrase “life chances”, the issues that it covers are surely the reason why we came here today. I urge all Members to look for the positives in what this Government are trying to do. I know that the Opposition have to scrutinise us, but I hope they will open their hearts occasionally to find the good stuff that we are doing and help us to do it better still, rather than just criticising us for being anti-public sector, anti-everyone and anti-everything.

Junior Doctors Contract

Jim Shannon Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I absolutely agree with that wise comment, and it befits someone who is experienced in working in the Department of Health. We always get further if we sit around the table and talk about such issues. The Government are determined to improve the quality and safety of care for patients, and it is important to recognise that if the Government are successful, it will be better for the morale of doctors. The happiest, most motivated doctors work in the hospitals that are giving the best care to patients. That is why it is a win-win.

I say to Labour Members that it was the refusal of the BMA for many years to talk about the issue that my right hon. Friend referred to that meant we reached a deadlock. The fact that the Government were willing to proceed with important reforms on our own if we had to meant that, in the end, everyone came together and had a sensible negotiation. We got to the right place. I am sure everyone wishes that we had not had to go on the journey we went on to get there, but now that we have got there, I think it is the time for being constructive on all sides.

[Jim Shannon (Strangford) (DUP)]

I also thank the Minister and the BMA for coming to an agreement. The Minister said that it was a win-win for everyone, and so it is. It is always good to talk, and dialogue brings results. That happened in Northern Ireland, and it has happened with the conclusion of this process as well. A good deal has been reached, and some 45,000 junior doctor BMA members will now be asked to vote on it.

We have had eight days of strikes since January, and some 40,000 planned non-urgent operations and 100,000 out-patient appointments have been cancelled. May I ask the Minister what will be done to catch those up, and what discussions he has had with the Northern Ireland Assembly about the agreement?

[Mr Hunt]

I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Specialist nurses are vital for the care and support that they provide for patients and families, not just for the elderly but for the disabled. What is his Department doing to ensure that funding for specialist nurses is maintained and that we do not end up in the situation that we have in Northern Ireland with Four Seasons, which is responsible for 62 homes in Northern Ireland and 450 across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Ben Gummer]

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.