Ambulatory Care

Jim Shannon Excerpts

Wednesday 27th April 2016 Westminster Hall

[John Howell]

I thank my hon. Friend for allowing me to have a rest and to make the most of that time—as I get older, I need that. I do agree with her; she makes a very valid point. I am concentrating on older people because traditionally that is where the population who have used the hospital in Henley have come from. I think that in the past year only one was under 55. But as I said, my hon. Friend makes a very valid point.

In many cases, the decline that people experience cannot be attributed to the progression of the acute problem for which they were hospitalised in the first place. An example is pneumonia. Even if the disease is cured in a few days or, indeed, if a hip fracture repair is technically perfect and uncomplicated, the patient may never return to the same functional status as they had before they went into hospital.

According to the US study, between 30% and 60% of patients with hip fractures are discharged from the hospital to nursing homes; 20% to 30% of those persons are still residing in nursing homes one year later. Only 20% of one large group of patients returned to their pre-operative functional level after a hip fracture repair.

Many hospitalised patients have difficulty implementing their habitual strategies to avoid incontinence. The environment is unfamiliar. The path to the toilet may not be clear. The high bed may be intimidating. The bed rail becomes an absolute barrier, and the various “tethers”, such as intravenous lines, nasal oxygen lines and catheters, become restraining harnesses. About 40% to 50% of hospitalised persons over the age of 65 are incontinent within a few days of hospitalisation. A high percentage of hospitalised older persons discharged to nursing homes never return to their homes or community. In one study, 55% of persons over the age of 65 who entered nursing homes remained for more than a year. Many of the others were discharged to other hospitals or long-term care facilities, or simply died. The outcome for many hospitalised elders is loss of home and, ultimately, loss of place.

It is most important that relationships among physicians, nurses and other health professionals reflect the interdisciplinary nature of the whole of this process. In particular, I am a great enthusiast for the integration of the NHS with social care. That needs to move ahead very quickly to give the clinicians the responsibility for commissioning the social care that is required. Maintaining wellness and independence in the community prevents conditions deteriorating and therefore results in better health outcomes. Emergency hospital admissions are distressing.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this very important issue to Westminster Hall for consideration. Over the past five years in Northern Ireland, category A ambulance call-outs have increased by 30.9%. It is a devolved matter, but it does indicate a greater dependence on and need for ambulance responses. Does the hon. Gentleman have any thoughts about the best way to ensure that the ambulance service and ambulance staff can do better for elderly people?

[John Howell]

The hon. Gentleman makes a valid point. The costs need to be offset. This is a balancing exercise within the NHS. Costs that are saved by stopping people going into hospital can be spent on the treatments and services they require to get them better. That is a far better way of working.

Emergency hospital admissions are distressing. Better management that keeps people well and out of hospital should lead to a better patient experience. The King’s Fund estimates that emergency admissions for ambulatory care-sensitive conditions could be reduced by between 8% and 18% simply by tackling variations in care and spreading existing good practice. That would result in savings of between £96 million and £238 million, which, as part of the overall management of the NHS budget, could be allocated against the provision of the often quite expensive services that provide the necessary medical investigations on the spot.

A doctor in my constituency, Dr Andrew Burnett of the Sonning Common practice, said:

“Very few of my patients want to be admitted to hospital.”

Most people, if they need to be treated or, indeed, if they are nearing the end of their life, would like that experience to be located at home. I think that probably applies to us all.

There is a particular problem in relation to dementia. I spoke to the Alzheimer’s Society, which said that people are often admitted with an acute physical illness on top of their dementia, and the combination of the two can cause their confusion to become worse. They are then taken out of familiar surroundings and placed on a hospital ward with lots of strange people, noises and smells. That can be terrifying for them and they rapidly deteriorate. The advice from the Alzheimer’s Society is to try to keep people out of hospital for as long as possible. That is why we, and the Oxfordshire medical facilities, are striving hard to develop systems to enable people with physical illnesses to be managed out of hospital.

That is one of the rationales for the new Townlands hospital in Henley, where the clinical commissioning group, along with Oxford University hospitals, Oxford Health and, indeed, the county council, are members of the ambulatory emergency care network, through which organisations can learn from one another to develop robust pathways. Some good case studies are involved in that, but time prevents me from going through them at the moment. I draw the Minister’s attention to those if he needs some examples of how ambulatory care actually works.

Another clinician, Pete McGrane of the CCG, has said:

“Patients who were recently hospitalized are not only recovering from their acute illness; they also experience a period of generalized risk for a range of adverse health events.”

There have been cases in my constituency where the health of elderly people has deteriorated following discharge, or even in hospital, due to other conditions. The relatives have sought to blame the health service for poor care. After following up on those cases, the complaints investigation has shown that it is not poor care that has exacerbated the patients’ distress and symptoms; it is a direct consequence of hospitalisation.

I went to see a hospital in Welwyn Garden City, which has no beds inside. Instead, it has beds in an adjoining care home at the side of the hospital. The place was absolutely heaving with people. I met a gentleman there called Dave. I do not have his surname, nor have I asked his permission to use his name, so we will just keep it as Dave. He could not speak highly enough of the treatment he got. He called in every day for treatment and then got on with his life at home. It revolutionised the treatment he received, which, doctors had confirmed, would otherwise have required a debilitating 56 days of medication, staying in hospital. His experience of hospital stays had shown up their disadvantages, and he pointed out that people were so much more likely to improve, as he had, and to feel better, as he did, if they could stay at home. He was clearly a great enthusiast for this type of service.

In Henley, there is one issue, above all, which I have already touched on and want to emphasise. It was helped by some papers that were forwarded to me by the Health Foundation, which said that it is undertaking

“a joint research programme…monitoring how the quality of health and social care is changing over time.”

I have been very concerned by the way in which we move forward with the integration of social care and health in the county to ensure that it delivers the sort of services that are required in the full context of the patient.

I am pleased and proud that I have helped to deliver a 21st century medical facility for the people not just of Henley, but of the whole of southern Oxfordshire, and that that incorporates ambulatory care. It is clearly the way forward and it is a way forward that I am sure will work.

Lewy Body Dementia

Jim Shannon Excerpts

Tuesday 26th April 2016 Westminster Hall

[Conor McGinn (St Helens North) (Lab)]

I beg to move,

That this House has considered awareness and recognition of dementia with Lewy bodies.

It is a pleasure to have secured this debate, under your chairmanship, Sir Alan, on dementia with Lewy bodies, or DLB as it is known, and as I will refer to it henceforth. May I start by congratulating the Minister on his very significant achievement on Sunday in completing the London marathon? Well done to him for the moneys that he raised for his charities. In the same vein, it is with some pride that I declare that I was recently appointed an ambassador for the Lewy Body Society, a charity whose mission is to raise awareness of DLB among the general public and educate those in the medical profession and decision-making positions about all aspects of the disease, as well as to support and fund research into it. For 10 years, the LBS has raised awareness, provided support and information, and funded research into DLB, which is the second most frequent cause of age-related neurodegenerative dementia. I am delighted that some of those involved in the campaign are in Parliament today.

It might be helpful if I say a little about DLB. Lewy bodies are abnormal aggregates of protein that develop inside nerve cells in Parkinson’s disease, DLB and some other disorders. They were first discovered by Dr Frederick Lewy as far back as 1912, but incredibly, despite that, DLB was virtually unknown until the late 1980s, when advances in techniques made it possible to identify Lewy bodies under a microscope.

Every case of DLB is as individual as the person living with it. Different people show different combinations of symptoms. At present, a diagnosis of DLB can be confirmed only by autopsy, but a careful clinical evaluation of the patient and their symptoms can in many cases form the basis for making a reasonably confident lifetime diagnosis. There are also technological advances in imaging and research into biomarkers that it is hoped will result in earlier and more accurate diagnoses.

The central symptom of DLB is dementia, which is defined as progressive mental decline that is serious enough to interfere with normal daily activities such as eating, washing, dressing, cooking, shopping and managing finances. Significant memory loss may not develop until later. There may also be problems with executive function in respect of attention, problem solving and spatial awareness. This can easily be mistaken for Alzheimer’s disease.

Additional symptoms that may lead to a diagnosis of probable DLB are, first, disturbances in REM—rapid eye movement—sleep. The impact of that on a family carer is terrible. The carer is unable to sleep themselves and therefore becomes unable to support the person with DLB. REM sleep is the deep sleep in which people dream. A certain amount of good, REM sleep is necessary for people to function efficiently. DLB sufferers may talk in their sleep or act out their dreams. Sometimes that is so marked that the sufferer falls off the bed.

Secondly, there is severe sensitivity to neuroleptic drugs. Sometimes people with DLB are prescribed neuroleptic—antipsychotic—drugs to help with their symptoms. That should be done only by someone experienced in the illness, as many of those drugs can be extremely harmful or even fatal to people with DLB. That problem has been recorded.

Despite the importance of correct diagnosis and treatment of DLB, the disease is often not recognised, identified or diagnosed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing a very important issue to the House. The week before last, I had a debate in this Chamber on dementia and Alzheimer’s disease, which a number of hon. Members attended. Dementia has the potential to be the defining condition of this age. Does he think that there should be more research and more partnerships between parts of Government, between universities and between businesses to find a cure for this disease? By finding a cure, we will help to ensure that diagnosis happens earlier, as it should.

[Conor McGinn]

The hon. Gentleman, whom I would feel comfortable referring to as my hon. Friend, makes the point with his usual eloquence, and I could not agree more. I will say a little more later about some of the research being done.

Dementia is not just about memory. The supportive symptoms of DLB are fainting, falls, problems with swallowing and continence, delusions, depression and hallucinations, including hearing, smelling or feeling things. Some people have benign or pleasant hallucinations of, for example, children or animals. A sense of the presence of someone who is not there is common in many patients. Other sufferers see frightening and disturbing things and may react to them by displaying challenging behaviours that prove very difficult for the family to manage.

More than 700,000 people in the UK have dementia. That number is projected to rise to 1 million by 2021 unless significant advances are made; indeed, the figure is expected to double in the next 20 years. As the hon. Gentleman said, the issue now touches the lives of virtually every family in the United Kingdom. It is a big issue for the NHS, but also for all local authorities and, indeed, all public services. In the UK, approximately 100,000 people are thought to suffer from DLB. At least 5% of people aged 85 or older are thought to suffer from this little known, but not uncommon, and devastating disease.

It is important to note that diagnosis rates of dementia across the country are low and incredibly varied. In the UK, less than half of people living with dementia are diagnosed, let alone differentiations being made between the types of dementia.

Antibiotics: Research and Development

Jim Shannon Excerpts

Tuesday 26th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to be called to speak to speak in this debate, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an increasingly important issue that we are more aware of today than ever before. He set out a comprehensive scene, which has been most helpful. He covered many of the issues involved, which will probably take away from other contributions, but he added to the debate, and that is the important thing.

The discovery of antibiotics revolutionised healthcare, allowing for the effective treatment of illnesses, including TB, that had previously been commonplace and frequently deadly. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) referred to the increase in TB in his constituency, which I am aware of because of events that have taken place here in Westminster. The incidence of TB in the United Kingdom has risen sharply in certain areas, and there is a tie-in between how we address TB and HIV. It is important that we look at the bigger picture.

Pathogens have evolved to resist new drugs. Resistance has increasingly become a problem as the pace at which new antibiotics are discovered has slowed and antibiotic use, including misuse and overuse, has risen. Antimicrobial resistance presents arguably the most serious threat to global health security and is threatening to undo major gains in the control of infectious diseases. If it is left unaddressed, 300 million people will die prematurely because of AMR by 2050 and the world’s GDP will be 2% to 3.5% lower. This year, the World Health Organisation and the G20 are considering AMR, providing the UK Government with an opportunity to build on the leadership they have shown to date. The UK Government prioritised tackling drug resistance in their aid strategy published last November. They also created the related Ross fund, which they are to be congratulated on. In addition, they brought the issue to the attention of the international community by commissioning the independent review on AMR in 2014.

The Ross fund is a commitment to spend £1 billion over the next five years on research and development on infectious disease, including £315 million to fight AMR. It is jointly administered by the Department of Health and the Department for International Development. Will the Minister give us some indication of how those Departments are working together to achieve the goals set? Commitments under the Ross fund are yet to be detailed. The all-party group played an instrumental role in securing the Conservative party’s manifesto pledge to create the fund. Given the urgency of tackling the TB epidemic, it is important that TB is prioritised within the Ross fund. Will the Minister tell us— I am sure he will—how that will happen? Although the Government’s steps are welcome, we must ask when the funding provided through the Ross fund will be allocated, because many of us are keen to see that happen. The hon. Member for York Outer also asked that question. Investment in TB diagnostics, drugs and vaccines through the fund is critical, and we need to see where the money is being spent and what the feedback is.

TB is the world’s leading infectious killer, killing some 1.5 million people every year, or 4,000 every day. TB is the biggest killer of people with HIV, as I mentioned earlier with reference to London. As the only drug-resistant infections spread through the air, multi-drug-resistant and extensively drug-resistant TB pose a serious threat to global health security. When we think about what is happening in London with TB and HIV, we should also think about what is happening in other parts of the world, where greater numbers are affected and there could be even more deaths.

Multi-drug-resistant TB—MDR-TB—is resistant to certain drugs. It can take more than 4,000 pills over a period of six months to cure someone with TB, and the drugs are often associated with severe side effects that can make treatment unbearable. As a result, patients often do not finish treatment, which increases the likelihood of drug resistance. I do not know whether any research is happening into how to make the drugs more palatable, if that is possible.

As well as treatment failure, inferior treatment and infection with resistant strains are drivers of MDR-TB. The number of cases of drug-resistant TB is increasing. There were nearly half a million new cases of MDR-TB last year and almost 200,000 deaths. One quarter of MDR-TB cases are in the WHO European region. MDR-TB requires patients to take a course of drugs over an 18 to 24-month period, including eight months of daily intravenous injections. That would be quite hard for anybody. Fewer than half of people who start treatment successfully complete the course due to the unbearable side effects, which can include permanent deafness. We have to be aware of not only what is done to treat people medically but the side effects.

The treatment of MDR-TB can cost 450 times the amount usually required to treat TB. In the UK, treatment of MDR-TB costs about £70,000, which is quite a lot of money, but if it addresses the issue, it has to be done. Due to stigma, lack of access to services and poor understanding, 3 million people—more than a third of those who fall ill with TB each year—fail to be diagnosed. MDR-TB already accounts for one third of the 700,000 annual deaths from AMR, and if it is left unaddressed, an additional 2.59 million people will die each year from the disease by 2050. It is imperative that TB is included in the AMR review’s recommendations to be published this year and considered in any international negotiations that follow. The G20 and the WHO will consider AMR this year.

I will finish with one more point—I am conscious of the suggested time for speeches, Mr Evans, but it is important that Members hear this. Although there may be a natural inclination to focus on the impact of increasing resistance to antibiotics on people, there is great work happening within the livestock industry, and particularly the poultry industry. The British Poultry Council has managed to achieve some encouraging results with its antibiotic stewardship scheme. It is the first UK livestock industry to pioneer a data collection mechanism to record antibiotic usage, which covers 90% of production across the chicken, turkey and duck sectors. It is important to record that since the scheme began monitoring overall use, it has demonstrated an encouraging downward trend. Between 2012 and 2015 production increased by 5%, with UK poultry meat accounting for 44% of total UK meat production. The total quantity of antibiotics used by scheme members in the same period decreased by 44%. In 2012, the scheme introduced a voluntary ban on the use of third and fourth-generation cephalosporins and a commitment to reduce the use of fluoroquinolone antibiotics. In 2016, the scheme made a further commitment not to use colistin.

Those encouraging results within the poultry industry should be recognised and encouraged, but as we have seen, when it comes to antibiotics for people, we need to wake up to the issue sooner rather than later. We need the Government to commit to delivering on the Ross fund and to continuing to look for further ways in which they can help address this issue.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Evans. I believe we are expecting a vote, so my speech may be interrupted. I shall crack on, awaiting the bell.

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing the debate and on the tenacity with which he has raised this issue in the House in recent years. It is a great opportunity to have this debate today, when so much is going on this week in London on international health leadership. My hon. Friend’s speech and the informed and constructive comments that he and others have made highlight how seriously this issue is taken throughout the House. Last Monday we had more than 60 Members of Parliament in this Chamber. The fact that we have a dozen today does not suggest that there is any less interest; many Members are tied up in other debates. I know that Members from all parties are concerned about this issue.

The debate is timely, because it coincides with a two-day international summit on antimicrobial resistance convened by the Wellcome Trust in London, which brings together a global gathering of scientists and policy makers to explore key areas for action. I thank the Wellcome Trust and pay tribute to it for its leadership. In so many areas of public policy, it has put its money and expertise to work for us. I also pay tribute to Jim O’Neill and his team, as others have done, for their work on the issue.

I will set out the context of the debate, as a number of other hon. Members have done. Antibiotics play a crucial role not just in human health but in animal health and welfare—my hon. Friend is a doughty campaigner for agricultural causes—and so are of great strategic interest in the wider field of biosecurity. We have seen the impact of diseases in domestic and agricultural poultry and in some of our tree species, and we are trying to view this issue in the wider global context of biosecurity from infectious diseases.

[Jim Shannon]

There have been some marvellous steps forward in addressing the use of antibiotics on poultry, as I indicated in my speech. Many people are trying to move that forward. If we take steps forward with poultry and other animals, we can transfer that work to humans too.

[George Freeman]

The hon. Gentleman makes an excellent point. As ever, Belfast University and the Northern Ireland life sciences cluster are doing good work in agriculture and in the medical space.

For the reasons that I outlined, the growth of resistance presents a genuine strategic global threat, which, as hon. Members from throughout the House have gratifyingly acknowledged, the Government have taken a strategic grip of. Globally, some 700,000 people will die this year because of antimicrobial resistance. In Europe, the healthcare and societal costs of resistance are estimated to be of the order of €1.5 billion per annum. That translates into a verifiable and measurable cost to the NHS of £180 million, but it may well be an awful lot more. Meanwhile, we face an antibiotic discovery void. The golden age of discovery ended in the 1980s. We have had very few new antibiotics since then and no new class since 1987.

I had a 15-year career in the sector and spent one chunk of it starting, financing and managing a small anti-infectives company that was spun out of Hammersmith and Imperial College and used some phenomenally powerful technology to look at the genetics of how microbes reproduce. We spent a lot of money on some elegant science, but we did not produce a new anti-infective. The truth is that these bugs are very difficult targets in biomedicine. It is difficult to go after the cell wall of Gram-positive and Gram-negative bacteria. Their ability to reproduce and develop resistance to drugs—they are moving targets, as it were—makes it particularly difficult to design effective drugs for them.

The good news—if I may put it that way—is that we can do things that will make and are making a real difference. The chief medical officer outlined the scale of the issue and its implications for public health in her 2013 annual report. She called for urgent action at a national and international level. The UK responded by publishing our five-year antimicrobial resistance strategy, the core aims of which were to improve understanding of resistance, to ensure that existing medicines remain effective and to stimulate the development of new antibiotics, diagnostics and therapies. Three years on, we have made considerable progress. We have put the building blocks for success in place, including better data, guidance and a strengthened framework—

Junior Doctors Contracts

Jim Shannon Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend always makes important suggestions that can benefit his constituency, and rightly so. I do not think that there is a need to change the law for that to happen; if military help were needed, I think the military would stand ready to offer it. At the moment, we are making contingency plans by drawing on the consultant workforce, who are not involved in industrial action, and our hope is that A&E departments throughout the country will be covered by that extra support.

[Jim Shannon (Strangford) (DUP)]

If the Health Secretary is unable to impose the original contract, how can people be expected to abide by a new contract that is not legally binding? Does he agree that maintaining a constant approach is absolutely vital, particularly in a fifth walkout, which could involve everyone? What actions is he taking to restore faith in the NHS among both the staff and the general public?

[Mr Hunt]

Just to be absolutely clear, the new contract is legally binding and it will apply to all junior doctors in the NHS. On restoring confidence, obviously morale is low at the height of an industrial relations dispute. I think the real way to restore confidence is to point out to the doctors who work incredibly hard inside the NHS that the Government are this year giving the NHS the sixth biggest funding increase in its history, that we are committed to making the NHS the safest and highest-quality system in the world, and that we believe that if that happens it will also be a better place for them to work. I believe that all those things will come together, but obviously there is a very difficult period that we have to get through first.

Brain Tumours

Jim Shannon Excerpts

Monday 18th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Warrington North (Helen Jones) on her detailed and concise presentation. I am here because my constituents have contacted me. I suspect that is why we are all here: we have poignant personal stories to share.

Brain tumours kill more children and young adults than any other form of cancer. Every day, 10 children and young people in the United Kingdom learn that they have cancer. More than 16,000 people are newly diagnosed with this form of cancer each year in the United Kingdom, yet just 1% of the national spending on cancer research is allocated to this horrendous disease. I am glad to see the Minister in his place; I always look forward to his responses. I am sure that he will respond in a positive fashion and give us the hope for which everyone in this Chamber wishes, along with our constituents.

The allocation of funding is even more alarming when we consider the survival rates for brain tumour patients. Breast and prostate cancer patients, to give two examples, have an 80% five-year survival rate, compared with that of brain tumour patients, which is less than 20%. Clearly, more needs to be done on investment in brain tumour research. Can the Minister indicate what partnerships he is encouraging between universities, Departments and big business to ensure that we can move forward?

[Gavin Robinson (Belfast East) (DUP)]

Our colleague the hon. Member for North Down (Lady Hermon) could not be with us today, but she lost her sister, who was completely asymptomatic, at the age of 37. That reinforces the point that discovery often occurs too late, which is why research and awareness are crucial.

[Jim Shannon]

As always, I thank my hon. Friend for his intervention.

Secondary or metastatic brain tumours are particularly important to consider. Up to 40% of cancers in other parts of the body will eventually spread to the brain. Let us focus on the key issues, such as the blood-brain barrier.

The National Cancer Intelligence Network found that 61% of brain tumour patients were diagnosed in accident and emergency, including 53% of children up to 14 years old, 25% of those aged 15 to 24 and 20% of older adults. Although there are many charities, I will put in a quick plug for CLIC Sargent and its work. Its paper, “The Best Chance from the Start”, found that the rarity of cancer in children and younger people, added to the fact that symptoms can be non-specific, can make it challenging for GPs to recognise the symptoms.

Many constituents have written to me, but I will conclude by quoting two. One is my constituent Mary Patterson, a survivor. She was diagnosed, she had surgery and she is alive today, although her life is restricted. Another story involves a lady in my constituency called Heather, who writes about her late husband George:

“My own interest in this petition and upcoming debate came about because my husband, George Ramsey, died 1 July 2011 from a brain tumour, only nine weeks after diagnosis. He was just 50 years old, and had just retired from the fire service after 32 years of service. Unfortunately my husband received poor management from the neurosurgery department, and his treatment was delayed after the team ran out of time to discuss his case on two separate occasions.”

An ombudsman investigated and reported to the Assembly. I conclude with this comment of hers:

“In his last five years in the fire service, he was the community liaison and youth engagement officer for the Belfast area. The chairman of the Belfast City Council stated that George’s work had ‘made Belfast a safer place’.”

That is a touching and personal testimony. The sad thing is that it is happening to families up and down the country at this moment. Although we have the opportunity to get back on track, it is sad that it took a petition to bring us here.

--- Later in debate ---

[George Freeman]

The hon. Lady, with whom I work closely on a number of issues, makes an excellent point. There are a number of criteria that drive how funding is allocated, and that is one of the things we ought to look at. If I can get to the end of my speech, I will make some recommendations about how we might pick that up and look at it.

I want to announce today that the Government accept that we need to do more in this space, committing to a number of specific actions that reflect the concerns that have been raised, both here and in the Petitions Committee and the all-party group report. I suggest that I should convene in the Department of Health a task and finish group to examine a number of the issues that have been raised here today, and to ask a question. I do not believe that as a Government we are not doing enough. We have put £0.7 billion a year into the Medical Research Council, to do the deep science on the medical frontier. We have put £1 billion a year—ring-fenced—into the National Institute for Health Research’s clinical infrastructure. We are funding the genomics programme and putting £4 billion into digital health and the informatics that go around it. The question we should ask is: surely there is more we can do to help to make that resource and that infrastructure support this particular disease area? I will say a little more about why I think that case has been made and what we might do about it.

I will not repeat all the numbers—hon. Members have heard them—but about 4,000 brain cancer cases are diagnosed each year in this country, resulting in about 3,500 deaths a year. We all know that brain tumours are very complicated—there are about 130 different types of them—and the truth is that we do not know what causes most of these cancers. Old age is a risk factor, but as many hon. Members have said with great passion today, it is those children who are diagnosed who drive us. Four-hundred children a year are diagnosed, and we just do not understand or know exactly what is driving it. There are various hypotheses around genetic conditions and some exposures.

Unlike for most other cancers, brain cancer mortality rates have increased. According to figures from the Office for National Statistics, in the last 30 years the mortality rate for brain cancer has increased by 15% for men and almost 10% for women. Improvements in diagnostics and treatments have helped to improve short-term survival in adults, with around 49% of people diagnosed with brain cancer now surviving for at least a year, compared with around 25% 30 years ago. Long-term survival has also improved, with around 20% of people now surviving for five years or more, compared with around 10% 30 years ago. We have also recently seen an increase of more than 25% in GP referrals for magnetic resonance imaging for potential brain tumours, from about 30,000 to 50,000. Veterans of these issues will know that those are relatively small numbers over quite a long period, compared with the explosive pace of progress in a number of the other disease areas that we often discuss.

A number of Members have talked about early diagnosis, which is clearly absolutely key with this cancer, as with all cancers. Last year, a report by the independent cancer taskforce set out 96 recommendations, broadly covering six strategic priorities, including early diagnosis, and NHS England is working with partners to establish a new cancer programme to implement those recommendations. By the end of this Parliament, everyone referred with a suspected cancer will receive a definitive diagnosis or the all-clear within four weeks.

[Jim Shannon]

rose—

[George Freeman]

I will give way to the hon. Gentleman, because he is a doughty pursuer of mine.

[Jim Shannon]

I thank the Minister for his response. Will he set out the funding or help that he can give to universities? He knows I am very keen on that issue. Universities have put forward some very good medical initiatives and some new medications and medicines as well, and Queen’s University Belfast is one of those universities. Can we do more with universities, business and Government? If we can, we can find the cure, which would be a big step forward.

[George Freeman]

I think we can do more and I welcome this opportunity to praise the role of Queen’s University Belfast in this field; it is a centre of real excellence in cancer science.

The standard treatment by the end of this Parliament will be underpinned by a commitment of an extra £300 million from Government in diagnostics. Last June, the National Institute for Health and Care Excellence published updated guidance on cancer referrals, which will make it easier for GPs to think about the possibility of cancer much sooner and to refer people for tests more quickly. This guidance includes new recommendations about brain cancer in adults, children and young people.

We are investing substantially in research. That is not to say we are doing enough—I will come to that in a moment—but we are investing £1.7 billion every year in health research. I am delighted that in the last autumn statement my right hon. Friend the Chancellor ring-fenced our investment, despite some difficult public spending pressures. We spend £0.7 billion a year on the MRC and £1 billion a year on the NIHR’s clinical infrastructure across the NHS. Cancer research spend by the NIHR rose by over a third during the last Parliament to around £135 million a year. Most of that investment—around £115 million—is on infrastructure. The model is that industry and charity can then run research projects through that infrastructure—I will come back to that point in a moment. That investment supports translating scientific breakthroughs into benefits for patients.

Spend specifically on brain tumour research cannot currently be separated out from total spend data for the cancer research infrastructure. I can, reassuringly, share with colleagues the information that six of our 11 NIHR biomedical research centres are conducting brain tumour research, and that the NIHR clinical research network had 30 brain tumour research studies that were recruiting patients in 2015-16. The NIHR is also funding research programmes and fellowships. For example, the health technology assessment programme is funding a £1.4 million trial involving patients who have received surgery for atypical meningioma.

The other main Government fund for health is the MRC. Over the five years to 2014-15, the MRC spent £10.9 million on research into brain and pituitary tumours, which spans basic discovery science, translational projects and early clinical trials. Both the NIHR and MRC also fund the Clinical Practice Research Datalink—the CPRD —which shares data for research. Four brain tumour studies have been published using CPRD data.

I want to mention the important role of charities. Those that follow my work will know that I have recently opened the door and made what has been described as a bold, generous and comprehensive offer to the Association of Medical Research Charities to come to the top table in the new landscape of life science research co-ordination that I am putting place. Medical research charities in this country raise £1.4 billion every year for research, from the smallest charities on the high street to CRUK, which has now become a major strategic funder and shaper of cancer policy.

I welcome the work that the 18 major charitable and public funders of cancer research are doing in the UK through the National Cancer Research Institute. Through that work and the work that the NIHR is doing with research councils, increased brain tumour research investment by charities drives increased support by the NIHR. Here is the challenge: our system works on the basis of bids and of accelerated funding. Once funding starts to drive clinical and academic results, that generates more funding, which drives more research. The danger in that model is that, unless that initial critical mass can be achieved, things can get squeezed out.

We have invited a number of applications for experimental cancer medicine centre status over this funding period, which are funded by the NIHR and Cancer Research UK. I am delighted to be able to announce that, on behalf of the arm’s-length bodies, NHS England will next month publish an implementation plan for the cancer taskforce strategy, “Achieving world-class cancer outcomes”. As part of one of the specific recommendations in that strategy, Public Health England is investigating how we can use new and existing data sources to identify secondary cancers and cancer progression more generally, including for brain tumours.

I hope I have demonstrated that some progress is being made, but as I have said, I do not think that progress being made is a reason not to do more; I think hon. Members have made a powerful case that we should. We formally accept that more needs to be done. The case has been made that we need to look carefully at what we can do. As the report recommends, I will be asking the NIHR to look at publishing a national register that considers how we spend public funds across research of different disease areas and different organs by therapeutic area, not least because it is a powerful way of helping to draw in co-investment from industry and charities. I shall be raising those issues with the MRC and, having recently convened the NIHR Parliament day, suggesting that at next year’s NIHR Parliament day we come back with that register and that breakdown of information.

We should look at issues around earlier diagnosis. I am prepared to announce today that we should specifically include brain cancer in the Genomics England programme, which is dealing with rare diseases and cancers, to make sure that it is properly picked up, and to talk to NICE about the point made about its guidance procedures. To pull all this together, I want to suggest that I should convene a task and finish working group in the Department of Health to touch on other issues that have been raised, including data collection, trials, off-label drugs, research barriers and skills.

I am conscious that I need to leave the sponsor of the debate a few seconds to close, but I hope that colleagues will see in my response that I have tried both to give patients some hope that we are listening and to strike a blow for good democracy, as well as good medical research.

Contaminated Blood

Jim Shannon Excerpts

Tuesday 12th April 2016 Commons Chamber

[Ms Ritchie]

I am sorry, but I cannot take any interventions because time is limited.

The health problems that thousands face as a result of this tragedy have been exacerbated by the distress and uncertainty around the support arrangements. Irrespective of how bad things have been, I would urge the Minister, having listened to the reasoned demands of Members of all parties, to state clearly that there will be a full and final settlement, that there will be proper transitional arrangements hereafter, and that people so affected will have the right and direct access to the medication required to help them live with their medical conditions, while the families affected by these problems will also be helped. The tragedy of this scandal must be ended and a curtain must be drawn on it.

[Jim Shannon (Strangford) (DUP)]

rose—

[Mr Speaker]

Order. I think three minutes will suffice for the hon. Member for Strangford (Jim Shannon). The hon. Members for Central Ayrshire (Dr Whitford) and for Denton and Reddish (Andrew Gwynne) have still to contribute, and we must try now to get back in time. It falls to the hon. Member for Strangford to exercise Executive leadership in the matter.

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Speaker. It is a pleasure to make a few comments in the debate. Let me first thank the hon. Member for Kingston upon Hull North (Diana Johnson) for setting the scene so well.

Let me start by quoting:

“You can’t give us back our health. But you can give us back our dignity. This tortured road has been too long for many of us. But for the rest of us, please let this be the final road to closure.”

Imagine going to a British hospital in a British city in the middle of one of the richest and most advanced countries in the world for an operation or procedure, and looking forward to getting home, but through no fault of your own, coming out infected with haemophilia or worse. We just cannot imagine what that must be like. For that reason, we must do everything we can to give people back their dignity, as one victim said to the all-party parliamentary group.

The current trusts and systems are not working as well as they could, and they are talking of doing away with aspects of the support for those affected. That is simply outrageous. Of course there are people affected by hepatitis who had nothing to do with the contaminated blood. I understand that we are talking about some 40,000 people across the country, and sadly there is an ever-growing number in Northern Ireland. Scotland has a strong track record through its “Sexual Health and Blood Borne Virus Framework”. It has set an example for the rest of the United Kingdom to follow.

Let me conclude quickly with these five points, because I am conscious of the timescale you have set me, Mr Speaker. The survivors are calling for a full public inquiry to be held under the Inquiries Act 2005 to investigate fully the events that led to thousands of British haemophiliacs and others with bleeding disorders becoming superinfected with a multitude of viruses and pathogens over many years. Full compensation for haemophiliacs and others with bleeding disorders and their families should be awarded in such a way that closure can be achieved for the majority of those infected and affected, including the widows and dependants of those who have died.

The right hon. Member for North Norfolk (Norman Lamb) made an important point about the families. He said we should not forget them, and we are all saying the same thing. We hope that the Minister will respond to that, and we want a full and comprehensive acknowledgement by the Prime Minister. He has apologised, but the apology has been lost in the delays that there have been. There are also lessons to be learned from what happened to the haemophiliacs, and measures should be put in place to protect the patients of the future. There have been missed warnings, failures to pass on test results to patients, procedural errors and non-consensual testing.

Let me conclude. Imagine being one of those innocent people, and imagine the difference that delivery on some of these aspects would make. As the testimony I quoted earlier said:

“You can’t give us back our health. But you can give us back our dignity. This tortured road has been too long for many of us. But for the rest of us, please let this be the final road to closure.”

On such a sensitive matter, we need to be able to give our full empathy and sympathy to those affected. I really believe that the Government need to deliver.

Dementia and Alzheimer’s Disease

Jim Shannon Excerpts

Tuesday 12th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered dementia and Alzheimer’s disease.

I thank all Members who have very energetically turned out in large numbers to support this debate. I am going to keep my speech to 15 minutes to give everybody else a chance to participate. I thank the shadow Minister for being here, and it is good to see the Minister in her place. We always get a good response from her, so I look forward to that.

Yesterday, we had a digital debate in preparation for this debate, and I have got some stats to give hon. Members an idea of how it went. It was organised by Lucinda Blaser and the staff of my office. We reached almost 3 million Twitter accounts, and a total of 1,100 tweets were sent throughout the day. There was an enormous amount of interest outside this House in yesterday’s debate, and the same is true of today’s debate.

I want to speak about the issues that concern me. It is hard to find someone whose life has not been touched in some way by Alzheimer’s or dementia. People up and down the country—unfortunately including many in my constituency—are affected by those indiscriminate diseases. Alzheimer’s and dementia know no class, colour, creed or gender; they can affect any of us. It is extremely important that we have this opportunity in Westminster to discuss advances in ways of tackling the disease. This debate raises awareness and puts the issue of dementia and Alzheimer’s on the agenda for the whole of the United Kingdom. All Members will bring their own knowledge of this subject to the House. We will hear contributions from Members from across the whole of the United Kingdom of Great Britain and Northern Ireland.

According to the Alzheimer’s Society, our ageing population will increase the trends. In 2015, 720,000 of the 856,000 people known to have dementia were in England, 45,000 were in Wales, 70,000 were in Scotland and 21,000 were in my home nation of Northern Ireland. In my trust area, which includes Lisburn, North Down, Down and Ards, the level of dementia is 25% higher than that of England after age standardisations. We have a higher level of dementia and Alzheimer’s in my constituency than anywhere else in Northern Ireland.

[Julian Knight (Solihull) (Con)]

I congratulate the hon. Gentleman on securing this absolutely vital debate. This is not just about the total number of cases of dementia that are now being registered; it is about the increase down the line. In my constituency, we are looking at an estimated increase of 30% over the next five years in reported dementia cases. Will the hon. Gentleman reflect on the increasing incidence of dementia?

[Jim Shannon]

The hon. Gentleman is absolutely on the button on this issue. Very quickly on the figures, because stats can sometimes overawe us, it is estimated that by 2025 1.1 million people will have dementia and Alzheimer’s, and by 2051 2.1 million people will have the diseases. The numbers are enormous.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I congratulate the hon. Gentleman on securing this debate on such an important topic. On the increase in numbers, does he agree that some vital work is being done on mitigating the symptoms of Alzheimer’s, not least in many care homes and residential homes in my constituency? Equally, we have to focus on palliative care for people with Alzheimer’s at the end of their life.

[Jim Shannon]

I was going to come to that issue. I thank the hon. Gentleman for that intervention. It is not just about the diagnosis of dementia and Alzheimer’s, but about the follow-up, the path of care and how we help the whole way through. I will touch on some of those things later in my speech.

We must not abandon or diminish our efforts to find a cure. We have to take into account the reality we face and carefully plan for the future, so that all those with dementia and Alzheimer’s can get the care and support they so desperately need. As the hon. Gentleman said, that is the issue we have to address.

[Maggie Throup (Erewash) (Con)]

We are talking about end-of-life support, but we have to take a practical approach. One of the charities in my constituency—Community Concern Erewash—has a project to dementia-proof houses in Erewash to help people in the early stages of dementia stay in their houses for longer. They are doing things such as labelling drawers and rooms, so that people know exactly know where they are and can navigate their house for longer. Does the hon. Gentleman agree that such practical measures will make a difference?

[Jim Shannon]

The hon. Lady is absolutely right. The simplest things can make a difference. It is about improving quality of life and letting people with dementia and Alzheimer’s have a life with their families.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I congratulate the hon. Gentleman on securing this debate. He makes a very important point, which is that we are concerned not only about those with the condition, but about their carers, of whom there are now 750,000. Does the hon. Gentleman agree—I have been talking to my local Alzheimer’s Society about this—that we have to ensure that we have information and provide access to support and networks so that carers do not feel isolated, as they often do?

[Jim Shannon]

I thank the hon. Gentleman for that contribution. In the digital debate yesterday, there was mention of the clusters for those caring for people with dementia. There are 82 across the UK mainland, including some in our area and in Scotland and Wales. Lots of things are happening, and we need to see them develop.

To be fair—I know the Minister will say this in her response—the Prime Minister made very good comments about the 2020 challenge on dementia, which contains some marvellous things that can pave the way forward. The simple things can really make a difference and change people’s lives easily.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I applaud the hon. Gentleman for securing this very important debate. He is talking about getting the simple things right. In the Medway towns, we have dementia cafés—one is located in Medway—where families and sufferers can be brought together to share their experiences and get the support they need in their local area, which is absolutely vital at that time.

[Jim Shannon]

I thank the hon. Gentleman for that point.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

This is such an important debate, and it is really important that we air all of these issues. It is about the simple things in many cases, but it spreads across a wide network. One of the respite centre residents of Dementia Care—an excellent charity in my constituency—was recently admitted to hospital for a routine procedure but was not released from hospital until 3 am, which threw their entire programme for the next day. More carers were needed to get them back into a routine. Simple things make a huge difference to such people and those who care for them.

[Jim Shannon]

The hon. Lady speaks with knowledge. I thank her for that contribution.

There are ten key indicators of the quality of life of people with dementia: communication difficulties; relationships; environment and surroundings; physical health; a sense of humour; independence; a sense of personal identity; the ability to engage in activities and the opportunity to do so; difficulties with eating, drinking and swallowing; and, of course, their experience of stigma. All of those things are important.

[Mr John Spellar (Warley) (Lab)]

I congratulate the hon. Gentleman on securing this debate. As he draws these strands together, there is one problem that we should focus on. Local authorities have many statutory responsibilities, but as a result of the significant cuts to their budgets, these areas—they are not statutory responsibilities but, as a number of colleagues identified, they play a huge role in enabling people to manage their condition, stay active for longer and provide respite for their carers—are being cut back, which will ultimately have a long-term cost for the health service.

--- Later in debate ---

[Jim Shannon]

Obviously, the right hon. Gentleman has a focus on the issue. We will throw that ball in the Minister’s direction and perhaps she will answer that as well.

Dignity and quality of life are far too easily taken for granted, but simple things are so often lost when someone is diagnosed with Alzheimer’s or dementia. To do what we can to facilitate a better quality of life for those who through no fault of their own are so diagnosed is what I hope we came to this House to do—to make a difference. Yesterday, it was deeply encouraging to see from the digital debate how many bodies are active in the field of dementia and Alzheimer’s.

There are many issues to consider as part of dementia awareness, although one that is often overlooked is sight. I met an optician from Newtownards last week, and what I learned prompted me to mention the subject now. All too often, it is assumed that someone with dementia will gain no benefit from a sight test and vision correction, simply because they have a cognitive impairment or might not work, drive or read. Good eye health and good vision, however, can play an important role in supporting the wellbeing of a person living with dementia. Again, I ask the Minister for a better strategy. I know that opticians’ organisations would be happy to assist. Good vision can greatly increase a person with dementia’s sense of independence, allowing them to continue to participate in daily tasks and activities and in obtaining a good quality of life.

[Bob Stewart (Beckenham) (Con)]

Does the hon. Gentleman intend to cover why there is an increase in dementia? Many of us are dementia friends, but why is there an increase in this awful illness? Do we know?

[Jim Shannon]

I would need to the wisdom of Solomon to answer that question. Personally, I do not know; perhaps it is society or how we live. People are living longer and, by the very nature of living longer, we have such problems. There are probably a number of issues involved and reasons for that. However, early diagnosis, follow-on care and end-of-life care are fundamental.

There is a need to raise awareness among people with dementia and their carers about the disruptions to vision and eye health that might be concurrent with or arise from dementia. We therefore need to emphasise the importance of regular sight tests and eye examinations.

The Mental Health Charter for Sport and Recreation has done some interesting and outside-the-box things for people living with dementia. Along with partners, they have delivered a dementia-friendly swimming initiative, which is steadily expanding across the country. That is an absolutely fantastic way to help improve quality of life. It is amazing how not-for-profits are putting in the hard graft to make heart-warming things such as that happen, often with no funding. It is amazing what a group of dedicated, selfless individuals can do, as has been mentioned.

[Mr Mark Williams (Ceredigion) (LD)]

I thank the hon. Gentleman for giving way and I apologise for missing his opening remarks. Will he take the opportunity to commend the many local communities that have sought dementia-friendly status, meaning that a visit to the shop is not too embarrassing or a stigmatising event for sufferers or their carers?

--- Later in debate ---

[Jim Shannon]

The hon. Gentleman has clearly hit on a very salient point.

In relation to the science and medical sectors, I ask the Minister about the significant spend on and moneys set aside for the investigation into how dementia happens, which the hon. Member for Beckenham (Bob Stewart) asked about in his intervention. That money will help to find a cure—and we need to find a cure, because we have to give hope. To give hope, we have to have medical interventions and the investigations leading to them.

[Maggie Throup]

The hon. Gentleman is talking about a cure. Recently, I visited the department of human genetics at the University of Nottingham, which is working hard on a genomics project to identify the change in the genes that might cause dementia and Alzheimer’s, so there is light at the end of the tunnel, although it is a long way off. Great work is being carried out, however, not only in Nottingham, but in many places in the UK and throughout the world.

[Jim Shannon]

We have to encourage all medical advances.

The number of people living with the condition in the UK is revealed as more startling when we take into account the unsung heroes—the carers.

[Ms Margaret Ritchie (South Down) (SDLP)]

I congratulate the hon. Gentleman on obtaining this debate. He made an important point about the unsung heroes, the carers. Does he agree that often the people who provide the care in the home rely on outside visits, but those are short-term visits, which are not really the answer to support the carer or the person suffering from Alzheimer’s disease or dementia? More work on policy development and resources needs to be invested in by Government in the vital area of caring.

[Jim Shannon]

I thank the hon. Lady for a valuable intervention.

Carers UK estimates that, of the 6.5 million carers in the UK, 670,000 people care for friends or relatives with dementia. It is estimated that the NHS saves some £11.6 billion each year because of those unsung heroes; their contribution as volunteer carers is very valuable. Carers may end up providing more than 100 hours of care per week, and all too often the outside world is completely oblivious to their efforts—even those who know the carers might be oblivious, because they do not know what is happening. Anyone who has lived with someone with dementia or Alzheimer’s, or knows a person who does, knows the problems. People with dementia can often unknowingly become agitated, even violent, and night-time wandering and shouting can have a serious impact on carers’ sleep patterns, let alone sufferers’.

[Danny Kinahan (South Antrim) (UUP)]

I congratulate the hon. Gentleman on securing this debate. Talking about awareness and carers, does he agree with me that a large number of carers might not even be aware of, but need to be taught, how to help and look after? We need an awareness campaign.

[Jim Shannon]

We do need an awareness campaign—perhaps it starts with this debate today, working its way through to our constituencies and the people we represent.

Too often, carers are left to suffer in silence. The existing services on offer are not publicised enough and are not up to standard. The main social security benefit available to carers is the carer’s allowance. Those providing more than 35 hours of care a week are entitled to only £62.10. Further to that, carers may incur sanctions on how much they can earn on top of the allowance. Dementia carers save the NHS more than £11 billion every year, but they get only £62.10 per week for giving up their lives for someone less fortunate. I know the Minister’s Department is not responsible for that but, with respect, it is not a good reflection on Government given the hours spent by carers. Times are tough for the public finances, but it must be highly insulting to carers for them to see some of the things happening in the news when they are getting only £62.10 a week.

[Gavin Robinson (Belfast East) (DUP)]

Familiarity has been mentioned, and that is an important role for carers to play. My own grandmother deteriorated every time she was in hospital, because of the lack of familiarity. Does my hon. Friend support John’s Campaign, which encourages the provision of more time and greater support for carers in the hospital setting, as well as greater flexibility about the hours they can be there with their loved ones?

[Jim Shannon]

My hon. Friend makes a salient point. He always hits on the issues that we should all be aware of.

I welcome the fact that the Government are developing a new carers strategy. I can only hope that this debate will raise awareness of the need for urgent and large-scale reform of the way in which the Government treat carers. I welcome the dementia-friendly communities strategy and the clusters of dementia groups. In my constituency we have a number of homes where patients with dementia and Alzheimer’s are looked after directly. I also have a dementia friends group who come together in the Church of Ireland church in Newtownards. They bring together all the people of Ards and North Down who want to participate. They give them art, they give them music and they give them a chance to interact, and it is marvellous what happens.

Briefly, I want to mention some of the things that happen in Northern Ireland. The Northern Ireland dementia strategy has a list of achievements to its credit in recent times, which I bring before the House to help the debate: £6.25 million in the Dementia Together Northern Ireland project; the appointment of dementia champions—perhaps the Minister will give us some thoughts about dementia champions in the whole of the United Kingdom, because things are happening, but I would like to hear about them.

[Nick Thomas-Symonds]

On dementia champions and dementia friends, will the hon. Gentleman join me in praising the wonderful work that is done by them, especially in providing sufferers with familiarity—the point made by the hon. Member for Belfast East (Gavin Robinson)? One of the ideas is to provide sufferers with things such as memory boxes to trigger the memory, which helps terrifically with this dreadful disease.

[Jim Shannon]

I thank the hon. Gentleman for his intervention.

[Mark Durkan (Foyle) (SDLP)]

I commend the hon. Gentleman for securing the debate. On Northern Ireland, he may be aware that the Joseph Rowntree Foundation supports the Dementia without Walls programme, and one place in which it has done something is in a city with walls—the Derry Engaging and Empowering Dementia project has included: work at the level of schools and everywhere to ensure that everyone is more aware of dementia; and Derry having the first dementia-friendly pantomime in Ireland last December, in the Millennium Forum.

[Jim Shannon]

I thank the hon. Gentleman for his intervention and for giving an example of some of the good things happening throughout the whole country.

I tabled an early-day motion some time ago to highlight what can happen in people’s homes, and I suggested issues such as smoking, drinking, diet, excessive weight, healthy weight and social interaction, which is so important. Many may enjoy a tipple or an alcoholic beverage, but for too long alcohol has been overlooked as a cause of dementia. The hon. Member for Beckenham asked what some of the causes are, and that is one of them. No one is saying to people to go cold turkey or to hang up their dancing shoes, but the facts are there and they need to be heard.

We have alcohol-related dementia, which is formally attributed to alcoholism, and conclusive evidence now shows that heavy drinking over a long period increases the chance not only of dementia in the long term but of early onset dementia. To illustrate that, Alcohol Concern has provided comparative data showing that the brains of men who drank more than four units of alcohol a day—approximately two or three drinks a day—over 10 years age at a higher rate than those of light or non-alcohol drinkers. The brains of men who regularly drank alcohol appeared between 1.5 and 5.7 years older than their healthier counterparts. Those are just some of the things we have got to address.

One other thing we have done in Northern Ireland is provide funding for dementia-specific nurses, new studies into treating dementia—seven studies are taking place in Northern Ireland—and we have clinical leads for research. That is what we need to do. I thank the Minister, the shadow Minister and right hon. and hon. Members for coming to participate in the debate. I hope that my comments and the interventions have helped to focus attention and that we can do a lot more in advancing the race against dementia and Alzheimer’s, supporting the carers better and furthering awareness of the potential causes.

[Several hon. Members rose—]

--- Later in debate ---

[Jim Shannon]

In the very short time that I have, I thank the Minister, the shadow Minister and hon. and right hon. Members for their significant contributions. All political parties have participated, and all regions have taken part. We all want the same things: advances to find a cure to a global problem; more money to be spent on medical research; thanks to the carers, paid and unpaid; and diagnosis, follow-up care and end-of-life care. Make the simple changes. I thank everyone for their personal stories, too.

Motion lapsed (Standing Order No. 10(6)).

Upper Gastrointestinal Haemorrhage

Jim Shannon Excerpts

Monday 11th April 2016 Commons Chamber

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

I am sure we are all very relieved to be having the Adjournment debate at this hour, rather than at two o’clock in the morning, as was previously rumoured.

I must first declare my interest as a doctor. I am grateful for the opportunity to bring forward this extremely important debate—it is certainly important for our constituents—about the management of acute upper gastrointestinal bleeding. I am grateful to the British Society of Gastroenterology, and particularly to its president, Dr Ian Forgacs, for helping me with research in preparing for the debate. The BSG has done a great deal of work over many years to highlight this issue.

Between 50,000 and 70,000 people every year are admitted with acute upper gastrointestinal bleeding, and 10% will, sadly, die. That presents a significant challenge to our national health service.

For the avoidance of doubt, let me say that upper gastrointestinal bleeding is what was so vividly portrayed by Hugh Bonneville, as Lord Grantham, in Julian Fellowes’s “Downton Abbey”. As the New York Post said, the Downton ulcer his lordship had been moaning about for weeks finally erupted all over the dinner table and all over Lady Cora. That is at the extreme end of the spectrum, but when it happens it needs to be dealt with very quickly and proficiently.

I want to start with a little bit of good news. Lord Grantham was lucky to survive in the 1920s, but mortality from upper gastrointestinal bleeding has been falling in the UK, with modest improvements in recent years as new treatments and innovative therapies have emerged, despite an ageing demographic. That is a tribute to our NHS and to some great pioneering work in therapeutics and interventions, much of which has been trialled and researched in the UK.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way; I asked him beforehand for permission to intervene. Northern Ireland has seen some improvements by allowing relatively experimental procedures, provided they are regulated, such as nitrogen treatment systems, to name just one. Does the hon. Gentleman agree that all trusts across the UK need to share such information on any and all new developments, to advance treatments nationwide so that we all gain across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Dr Murrison]

I am grateful to the hon. Gentleman, who takes an interest in these matters. He is right to say that we need to do more networking, to ensure that good practice is understood and inculcated. I will deal with some of that in my remarks.

Two major studies—one by NHS England and the British Society of Gastroenterology in 2013, and the other by the National Confidential Enquiry into Patient Outcome and Death in 2015—highlighted significant shortcomings in provision, confirming earlier studies.

The foreword to the NCEPOD report is starkly entitled “A Bleeding Shame”. NCEPOD found that the clinical care of 45% of acute GI bleed patients was sub-optimal, with a similar number receiving care judged to be good overall. Alarmingly, a quarter of all hospitals treating upper gastrointestinal bleeding were found not to be accredited by the joint advisory group set up 20 years ago to set standards for endoscopy. More hospitals told NCEPOD that they could deliver open surgery of the sort Lord Grantham had in the 1920s than interventional radiology for this particular range of conditions.

Some would say that that is down to inadequate resources. That is the mantra we often hear, particularly from the Labour party, but the situation is far more complicated than that. Alarmingly, NCEPOD reported that organisational issues led to less than satisfactory care in 18% of cases. “Organisational issues” is a polite way of saying poor management, such as failure to organise rotas—the “Bleeding Rota”, as NCEPOD graphically puts it—and I will come back shortly to how that can be addressed with minimal resource implications.

I support the concept of the seven-day NHS, or at least my interpretation of what a seven-day NHS actually means. The management of this range of conditions provides an excellent case study of why seven-day working is important and why Ministers are right to pursue it.

Overall, the evidence does not support the proposition that relatively poor weekend healthcare outcomes for conditions across the board are attributable to a lack of seven-day working. As Professor Matt Sutton’s work, reported by the Office of Health Economics last year, has shown, the quality-adjusted life-year evidence just does not support the cost of translating midweek working to the weekend. Data on increased mortality for those admitted at the weekends are alone insufficient to justify organisational change. The much cited Freemantle paper on weekend deaths does not say that excess weekend deaths are avoidable. Unfortunately, it has been quoted incorrectly by some who have confused association and causation.

Sir Bruce Keogh is right to say, however, that general hospitals are under-resourced at weekends, and the Academy of Medical Royal Colleges is right to point out that junior doctors are, to a certain extent, “winging it” out of hours, because consultants do not tend to be around to the same extent and many support functions are not, either. I remember it very well indeed. Sir Bruce was also right, in his 2013 review of 14 trusts with persistently high mortality rates, to commission Professors Nick Black and Ara Darzi to try to bottom out the relationship between excess mortality rates and avoidable deaths. Sadly, the report published last year did not seem to take us much further forward, other than to call into question the basis of the selection of trusts for the original Keogh review.

In my view, there is a firm argument for a seven-day-a-week NHS, but we need a common understanding of what that actually means beyond the soundbite. Upper GI bleeding is a good case in point, which the Government could perfectly reasonably use to support their proposals for seven-day working without resorting to selective quoting from, for example, the Freemantle paper. Most people are really not bothered about the inability to get an outpatient appointment in dermatology on a Saturday afternoon. That is a luxury bordering on an indulgence. However, if their Downton ulcer erupted on a Friday night, they would not really want to wait until a chaotic Monday morning list before getting endoscoped. They would need to be scoped on a routinely scheduled endoscopy list the following day, and they should not be subjected to delay in investigative and interventional radiology if that is necessary to manage their case optimally.

As far back as 2004, a large study by Sanders published in the European Journal of Gastroenterology and Hepatology showed that dedicated GI bleed units are associated with reduced mortality. NCEPOD asserts that patients with upper gastrointestinal bleeding should only be admitted to units with on-site endoscopy, on-site or networked interventional radiography, on-site surgery and on-site critical care. It promotes the model of comprehensive, dedicated GI bleed units in hospitals on acute medical take. We are far from achieving that.

That highlights some broader issues around right-sizing the NHS estate for optimal acute and critical care outcomes, which is a subject that I have raised before. Because critical care requires multi-specialties, because of the need for increased sub-specialisation and all that implies for populating staff rosters, and because of the better outcomes in large specialist units, not to mention the cost pressures, optimal management of this range of conditions underscores neatly the need for the model hospital concept outlined in February by Lord Carter of Coles. Why are we not moving faster towards having secondary and tertiary care in regional and sub-regional centres, where critical mass, and therefore quality of outcome, can be more readily assured?

I am proud to support a Government who are spending more on the NHS than ever before—spending, let it be remembered, that was opposed by the Labour party at the general election. However, outcomes in the UK routinely compare unfavourably with those in similar countries, with which we can reasonably be compared. I have no specific comparative data for acute upper GI bleeding, but I have no reason to suppose that they run counter to that general trend. The unavoidable truth is that our neighbours spend significantly more on healthcare than we do. The right hon. Member for North Norfolk (Norman Lamb) and I, with colleagues across the House, have called for a commission to achieve consensus on long-term funding. That is despite Simon Stevens’s five-year forward view, which does not come close to addressing what is needed to make progress, given the assumptions on which it is based, which we know we cannot rely on.

It is not just about money, however. The impression given by the studies that I have relied on is that the management of acute upper GI bleeding is a hit-and-miss affair. The BSG blames a

“lack of engagement from senior managers”

for that patchiness. That ties in with the remarks made last week by Dame Julie Moore, who said that there was a “culture of indecision” in the NHS, and that there was “gross incompetence” and a “failure of leadership”. That is pretty hard hitting from a very senior NHS manager, and I wonder how individuals can justify salaries well in excess of the Prime Minister’s if they are failing to get a grip on the sort of shortfalls described as “A Bleeding Shame” by NCEPOD. Dame Julie is right to ask why incredibly expensive senior NHS managers who are managing failure on this scale are still in post.

Last year’s NCEPOD report on acute upper GI bleeding is a wake-up call. Its first and prime recommendation —that patients with any acute GI bleed should be admitted only to hospitals with 24/7 access to on-site endoscopy, on-site or formally networked interventional radiology, on-site GI bleed surgery and on-site critical care—must be implemented without further delay. The answer is dedicated GI bleeding units that are seven-day NHS-compliant, and, with very few exceptions, no unit that cannot match the BSG’s guidelines should take patients with acute upper GI bleeding.

I look forward to hearing how the Minister will make this so. I invite him to return to the House after 12 months, if I am fortunate enough to secure another Adjournment debate of this sort, to tell us how the position has improved.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friend the Member for South West Wiltshire (Dr Murrison) for his wide-ranging introduction to this important matter, and for his ability to make this difficult medical subject relevant using the important context of “Downton Abbey”. Lord Grantham’s ulcer is, indeed, a filmic representation of a dangerous clinical event that can happen to people. Mercifully, its incidence in this country is relatively low when compared with that of our European partners and colleagues, although the mortality rates associated with GI bleeding are higher than we would wish. The data are not as robust as I would like them to be, and comparisons can therefore not be nice ones, but none the less mortality rates are not as low as they should be when compared with European comparators.

My hon. Friend points out a number of reasons why that should not be the case. He speaks wisely about the need for on-site site endoscopy, on-site radiology, on-site surgery and on-site critical care, all of which were recommended by the NCEPOD report. That tallies closely with the most recent National Institute for Health and Care Excellence guidelines. The guidelines specify that endoscopy should be offered to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and offered within 24 hours of admission to all other patients with upper GI bleeding.

Reports from NHS Improving Quality and the National Confidential Enquiry into Patient Outcome and Death, to which my hon. Friend referred, go further and state that that will require the appropriate structures to be in place at all hours of the day and on all days of the week. As he reflected, that tallies well with the aims of the Government in producing a seven-day NHS, although I will, if I may, take issue with certain aspects of his comments in a few moments.

The audit of endoscopy services for acute upper gastrointestinal bleeding in 2007 found that only half of all acute trusts in England were compliant with NICE guidelines in this area. The most recent survey has shown some improvement. In 2013, 62% of services are able to provide a formal 24/7 rota for endoscopy specialists, and 56% of services can offer acute admissions for endoscopy within 24 hours of admission. While this is an improvement, there is clearly a long way to go if only 62% and 56% of services respectively provide the kind of provision we expect. Our aim, therefore, is to ensure that every patient has 24/7 access to safe, high-quality GI endoscopy services with facilities to perform an interventional procedure linked to other essential interventions, such as interventional radiology and surgery. High-quality care will not only reduce mortality and complications but increase early discharge, through the use of formal risk assessment scores, and reduce lengths of stays.

It is therefore important that those services are available to those patients at all hours of the day, and on all days of the week. That is why we have made clear our commitment that, by the end of this Parliament, patients with urgent and emergency hospital care needs will have access to the same level of consultant review, diagnostic tests and treatment seven days a week; patients with upper GI bleeds will be one of many cohorts of patients to benefit from that.

At this point I should be very clear in my response to my hon. Friend. He restated the position, often quoted by Opposition Members, that somehow there is a lack of definition about our intentions for 24/7 services. I say to him gently that we have been very clear indeed about how we believe the seven-day NHS will be delivered. In secondary and tertiary care, it will be based entirely on the needs of urgent and emergency care pathways. Those pathways have been outlined in 10 clinical standards brought together by the Academy of Royal Medical Colleges, under the chairmanship of Sir Bruce Keogh. Those 10 clinical standards have informed the policy we have developed on urgent emergency care, which will be announced and rolled out in the weeks and months to come.

We could not have been more clear, both in this place—I believe we have been clear to my hon. Friend—and to the public at large, that our intentions for a seven-day NHS are rooted in the provision of a consistent urgent and emergency care pathway for patients. We have never intended to mandate from the centre non-acute dermatological services, as he suggested, or any other service like that.

Clearly, to support good 24/7 services in hospitals we have to be able to provide exceptional diagnostic services. Whatever the lacunae in the current evidence base around particular specialties in the NHS—we are never going to have a full picture in the way we might wish—we can draw general conclusions. One, which my hon. Friend rightly drew, is that the quality of diagnostics needs to be consistent, people need to have access to those diagnostic services on a regular, rigorous, robust and consistent basis, and those services need to be available on a Saturday night much as they would be on a Monday morning. That is why the Government’s intentions on 24/7 services involve consistent diagnostic services, as we have made clear since the beginning of the policy.

It is important to explain how those services will become priorities for trusts. In the roll-out of a consistent 24/7 service in diagnostics, we want to be clear to trusts about exactly what is expected of them. Patients admitted as an emergency should be seen as soon as possible by a consultant for review, but at least within 14 hours of arrival at hospital. In-patients must have scheduled seven-day access to the full range of diagnostic services, including endoscopy, with reporting of results within one hour for critical patients and 12 hours for urgent patients. In-patients must also have timely 24-hour in-patient access to consultant-directed interventions such as critical care, interventional radiology, interventional endoscopy and emergency general surgery, either on-site or through formally agreed network arrangements. Finally, all acutely ill patients in high dependency hospital areas, such as the acute medical unit and the intensive care unit, must be seen and reviewed by a consultant twice daily.

I hope my hon. Friend will see that we are already encapsulating his principal demands about upper gastrointestinal bleeding in the general outline of the clinical standards that we plan to roll out to ensure consistent quality of care for urgent and emergency care pathways.

We will monitor the implementation of those clinical standards through transparent metrics, and I hope that in a year, if my hon. Friend is successful in securing a further Adjournment debate—I would happy to brief him privately on this issue both then and in the interim—he will see that through the transparent metrics that we will publish on mortality, length of stay, emergency readmissions and whole series of other measures, there will be trust compliance across clinical standards.

[Jim Shannon]

I understand that mortality rates for hospitalised conditions can be as much as 35%. That worries me, and I am not sure whether the Minister has addressed that issue. He referred to 10% mortality, but some hospitalised conditions have a 35% mortality rate. We must address that.

[Ben Gummer]

There is variation in mortality, and I hope we will make progress in that area over the next period. We must understand comparisons of mortality across the country, and as the hon. Gentleman knows, the Secretary of State is interested in discovering and understanding that issue. We must also understand variations across the European Union, and in the United Kingdom where there are apparent variations between practice in England and that in Scotland, Wales and Northern Ireland. Some of that comes down to data collection, but we must understand where it comes down to practice and consider how we can improve in accordance with our most neighbourly health systems.

Junior Doctors: Industrial Action

Jim Shannon Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

The new trade union legislation does not apply to doctors in the way my hon. Friend suggests, but I appeal to them and their consciences not to withdraw emergency cover and put patients at an increased risk of harm.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland, we have become experts in compromise and reaching agreement. We have had to come to terms with difficult issues and compromise on many things. The Northern Ireland Assembly Health Minister is in talks with the BMA and junior doctors to find a tailored solution for Northern Ireland that is affordable and has patient safety at its heart. Does the Minister not agree that it is time to get round the table, meet the BMA and junior doctors and realise that compromise between all parties can and often does reach a fair solution for all?

[Ben Gummer]

The contract is a compromise. We have compromised in a series of areas to try and reach a settlement, and 90% of it has been agreed with the BMA, but in the absence of talks—one party refuses to discuss the remaining items on a point of principle—we have to move ahead with implementation. That train has now left the station, and we will be bringing in the new contract later this year.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

What discussions has the Minister had with her counterpart in Northern Ireland regarding the reduction and eventual eradication of hepatitis C? Does she agree that it is important to have a strategy that encompasses the whole United Kingdom of Great Britain and Northern Ireland?

[Jane Ellison]

Absolutely. The consideration of all aspects of how we eliminate hepatitis C over time is important, but we should not underestimate what a difficult job that is, largely because an awful lot of people are not aware that they have it—they are asymptomatic and therefore much of the burden of the disease is not visible to us. However, there is always more we can do, and we continue to make this issue a priority.