NHS: Learning from Mistakes

Jim Shannon Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

We do have a system-wide problem in Leicestershire and we are looking into it urgently. I thank my hon. Friend for raising the issue. He is absolutely right that when we talk about safety and being open about mistakes, that has to apply to the ambulance service as much as to every other part of the NHS.

[Jim Shannon (Strangford) (DUP)]

May I also welcome the Secretary of State’s statement to the House? In particular, I welcome the commitment to building a safer, seven-day NHS. In Northern Ireland, we have just announced 1,200 new nurses, 300 new professionals, extra money for autism and mental health care and, just this week, extra money to address waiting lists to build a safer, seven-day NHS—that is what we want.

The Secretary of State referred to learning from mistakes, the need for an extension of trusts’ disciplinary procedures, openness to learning and a charter for openness and transparency. What discussions has he had with the Northern Ireland Assembly Minister, Simon Hamilton, about ensuring that that system can be replicated in Northern Ireland and by regional Assemblies and Administrations across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Mr Hunt]

My colleague, the hospitals Minister, will have those discussions with the Northern Ireland Health Minister. However, the hon. Gentleman is right that if we are going to have a learning culture, it needs to be across the UK, not just in England. That is why I welcome the discussions we have with the Scottish NHS and the Welsh NHS. There are things that we can learn from each other, and we should be very open-minded in doing so.

Autism Diagnosis Waiting Times

Jim Shannon Excerpts

Tuesday 8th March 2016 Westminster Hall

[Jo Cox]

I agree entirely, and one of the worrying things that became apparent to me in my research for this speech is the growing regional disparity in autism diagnosis waiting times, as well as in the service someone gets once they have a diagnosis. Let us hope that the Minister addresses that point.

My constituent from Batley has given up his job so that his son can attend school every day. As I have said, the problem exists not just in my constituency, but up and down the country, and stories from the NAS highlight that. There is Mel from Watford, whose son waited nine years. Noah, who is four, waited two years for his diagnosis—that is half his life. Meanwhile, data from Public Health England from the latest adult autism strategy show huge regional variation in adult services, with waiting times between referral and first appointment —not even the whole diagnosis journey—in the south-west reaching 95 weeks. In my region of Yorkshire and the Humber, it is 84 weeks. The NICE quality standard on autism is clear: once referred, people should wait no longer than three months before having their first diagnostic appointment. For this to happen, the Government, local authorities and NHS England need to act.

In my own local authority, Kirklees, despite strong leadership and a clear commitment to protect and safeguard vulnerable children and adults, there is an acknowledged crisis in children’s mental health and autism services. Some families have been waiting more than two years for a diagnosis, often longer. I have been encouraging Kirklees and its clinical commissioning groups to clear the backlog and redesign their services, and I am pleased to announce that, starting last Friday, a plan to clear the backlog within 12 months is now being rolled out regionally. This will quadruple the number of diagnoses that can take place in my constituency.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. Autism diagnosis across the whole of the United Kingdom of Great Britain and Northern Ireland is a big issue. In Northern Ireland, some 2,000 young people are waiting for a diagnosis, although the Minister has set some money aside. There is a need not only for early diagnosis, but for further stages of the education programme as well. Does the hon. Lady agree that the Minister should consider what has been done regionally—in Northern Ireland, Scotland and Wales—because there are lessons to be learnt that would benefit all of us?

[Jo Cox]

I agree entirely. It is time for the Government to bring a wider discussion about autism services to the Floor of the House.

My local authority’s announcement last Friday now means that we will quadruple the number of diagnoses that can take place in my constituency. It still needs to redesign the service in a way that prevents future backlogs, but this is good news for Batley and Spen and for people across Kirklees. However, it should not go unacknowledged that local authorities such as mine are working hard to reform services in an environment of severe and disproportionate budget constraint, imposed on them by Government. Of course, this is just one local authority; what about the hundreds of others and the desperate families in their care?

We also now have to accept that this failure to diagnose autism early ends up costing taxpayers much more. When developing its guidance for health services, NICE stated:

“Investment in local autism services also contributes to: a reduction in GP appointments, fewer emergency admissions and less use of mental health services in times of crisis, including the use of inpatient psychiatric services.”

Medical Centre (Brownsover)

Jim Shannon Excerpts

Monday 7th March 2016 Commons Chamber

[Mark Pawsey (Rugby) (Con)]

I am grateful to have secured the debate, which gives me the opportunity to raise an important issue in my constituency. I will speak about the delays that have occurred, over several years, in the provision of a new medical facility in the area of Brownsover, in the town of Rugby.

Rugby is one of the fastest growing towns in the country, and we have a positive attitude towards new development. There has been a great deal of new housing development in recent years, mostly in the north of the borough in and around the area known as Brownsover. Historically, Brownsover has faced a number of complex challenges, which the community and the local authority, Rugby Borough Council, have not shied away from. A lot of investment has been put into overcoming those challenges. The area comprises a mix of social, sheltered and affordable housing as well as privately owned homes, with a population made up of a broad range of different age groups. A large number of young families live in the area, as well as a substantial elderly population. Despite the much-welcomed investment in Brownsover, with additional retail outlets and new housing, and the significant increase in population that has come with it, we have yet to see significant investment in the vital area of local health provision.

The original doctors’ surgery, which dates back 50 years or so, was established as the area developed. Despite the growth of the area and of the population, there is no evidence that the surgery was extended or that there was any recognition of the need for a bigger surgery. Plans for a new medical facility in Brownsover were first proposed back in 2002. The local authority, conscious of the specific needs of the area, began working on plans, under which it would supply land it owned, free of charge, to a developer willing to provide a community centre, alongside an all-encompassing modern medical facility, as part of the wider plan to revitalise the area.

The years passed, and for many years there was no progress, but plans for a new medical centre resurfaced in 2011. A planning application was submitted to the local authority and was approved that year. At the time, there was a real expectation that work would begin the following year, but, once again, local residents were left exasperated as the months and years passed and no works were begun. The community, which had been so optimistic when plans were first revealed in 2002, was once more left angry and frustrated—even more so when they were forced to watch from the sidelines as plans for new medical facilities elsewhere in our growing town were approved, particularly a very smart new development on the old cattle market site.

I hope the picture I am painting shows that, for many years, my constituents in Brownsover have suffered disappointment after disappointment, and false promises and false dawns about getting their new medical centre. I must say that the anger in the community reached a tipping point in February 2015, when the news broke that NHS England had withdrawn the contract for the existing local GP practice in Brownsover and that the practice was to close in April—just three months later—which left little time to arrange alternative facilities within the community. The announcement was met with considerable fury within the community, which, as I have said, has complex needs and challenges.

The news of the closure of the GP surgery caused real disquiet within the community. A GP, who was held in high regard, had practised there for 30 years, and this much-valued and much-needed facility—as I have said, the only one in the urban area in the north of Rugby—was serving over 6,600 patients in partnership with its sister surgery in the town centre. Residents felt at ease with the local GPs, who in turn knew the residents’ medical history. There was real concern at the sudden nature of the news. I will come on to the actions taken by NHS England to deal with that concern.

To its credit, one of the first things NHS England did was to provide an opportunity for local residents to pose questions in a series of public meetings. The community expressed real anger at those meetings. They took place on 2 and 9 March, while Parliament was sitting, and on Friday 13 March 2015, when, as I was in my constituency, I was able to attend the one in Brownsover scout hut. The concerns of some pretty angry residents revolved around three issues: first, the lack of notice they had received; secondly, the interim arrangements that would be made; and, thirdly, whether the new surgery they had been promised would actually be delivered, given that they had been given such promises many times before. At the meeting I attended, residents were assured that the new surgery would be provided, and that it would open in the late summer or autumn of 2016.

The news that the new surgery was coming was intended to be the light at the end of the tunnel to appease an incensed community, but there was concern over whether the assurances would be fulfilled. When I attended the meetings, it seemed to me that a delivery time of 18 months was rather optimistic. It seems that that caution was justified, because we are yet to see evidence of any activity to supply the new surgery. There is absolutely no evidence of a spade getting anywhere near the ground. I have recently described the delays in delivering this provision as completely unacceptable. The original opening date of autumn 2016, which was promised by NHS England in the public meetings and to me in meetings in my office, will definitely not be realised.

It is a matter of regret that NHS England has not covered itself in glory in this matter. The news of the closure first came out in February 2015 and patients were informed by letter that the practice would close its doors on 17 April that year. I was notified by NHS England by email on 16 February. That led to a flurry—an avalanche, in fact—of emails from concerned constituents. There was concern about the method by which the news was communicated. One resident showed me a two-page letter that had details on only one side of the piece of paper, leaving them to guess what the other information might be.

The intention was that the surgery would close within three months and that residents would be able to register at a new temporary surgery some 2 miles away in Rugby town centre while the new surgery was built. The distance of 2 miles to the site in Lower Hillmorton Road was a concern for many of the residents for whom it would cause difficulties. Many of those with young children or with particular health needs felt that travelling to the temporary practice would be too much to bear, despite an offer from NHS England to provide transport for residents.

It is easy to understand why people were concerned when the facility in their community had been taken away and a new one had been promised for a number of years. Within the community, we managed to convey the message that there would be some temporary pain in order to achieve a long-term gain. Regrettably, that long-term gain seems to be some distance away.

[Jim Shannon (Strangford) (DUP)]

This debate is not about my area, but I am curious to know whether any consideration has been given to the increasing population? In Belfast, the population will double in the next 20 years, so Northern Ireland has to look forward strategically and have a long-term vision. Has consideration been given to population growth in planning the new surgery? Is it not time for the Government to look to the long term and create the provision for the next 20 or 30 years?

[Mark Pawsey]

The hon. Gentleman raises an interesting point. To a certain extent, that involves chasing a moving target. The surgery that was in the community was completely inadequate for the needs and size of the population. I fear that some of the delays in the delivery of the new surgery are happening because we are trying to anticipate what will be needed in the future. The sense in my community is that we do not have anything now, so let us get on with delivering what has been promised for many years.

I met NHS England in February last year and learned about the temporary arrangements for transferring patients to Lower Hillmorton Road and the cost involved in modifying those premises, which had been deemed inadequate for use as a surgery. Money was therefore spent on that building. I also heard about the plans for delivering the new surgery. Again, I was told that it would be delivered in the late summer or autumn of 2016. I was keen to do all that I could to ensure that those commitments were met. I kept in contact with NHS England and representatives of the Brownsover patients action group, which came together under the capable leadership of Jake Stevenson.

In the second half of 2015, some of us perhaps took our eye off the ball and thought that plans were being worked up and that work would start imminently—we simply waited for things to happen. Things came to a head in early 2016 when, after visit after visit to the site, nothing seemed to be happening and I thought that it was probably time to arrange a further meeting with NHS England, and to invite representatives from the Brownsover patients action group. We also invited NHS Property Services, which had come to take over the project. At that meeting in January or February this year I became increasingly concerned about the lack of progress, and it became clear that the opening of the surgery would be put back for one, two or three years—it was not clear exactly when it would be, because a new business plan needed to be put in place and that was still being worked on, despite previous assurances that the work was going out to tender.

It was equally alarming when we were told at that meeting that it was now possible for a practice to be put into the original buildings on the Brownsover site, which we had originally been told was unsuitable. We learned that that site was to be brought back into operation on a temporary basis, having closed for a year and with 6,600 patients relocated to new practices in the town. For many of my constituents, being told that the old site would once again be available might have been good news, but it meant that the new surgery that the community had been waiting for would be delayed. We now hear that the old site will be made available as a temporary site for three to five years, and we do not believe that that is temporary—it is getting close to being permanent once again.

There are no issues with the availability of land because the local authority will make the land available, and no issues of planning consent because that has already been granted. It seemed that bureaucracy and red tape within the system was going to cause a significant and unacceptable delay, and the light at the end of the tunnel that was promised to my constituents was fading fast. At that point I contacted the Minister, who I am delighted is in his place, and I alerted him to the situation. I am grateful to him for meeting me so swiftly after we made contact.

A couple of weeks ago on 22 February, I and Jake Stevenson from the Brownsover patients action group met the Minister, together with representatives from NHS England and the Department of Health, to outline our concerns. One outcome of that meeting has been that NHS England has become a lot more communicative. It was kind enough to email me on 1 March to update me and advise me that it has awarded a contract to a company to assist it with the business case for the medical centre. That is not a contract for building or delivering the surgery, just to assist with the business case. It is disappointing that in the past 12 months we have got absolutely nowhere. We are no further forward than we were this time last year, and clearly the promises that were made will not be realised.

One key reason why I have brought this matter to the attention of the House is the long history of disappointments that my constituents in Brownsover have gone through over the years. We are now looking for firm assurances that whatever date we are given for the delivery of the new service, it will finally be delivered.



I am very grateful to the Minister for the attention he has given to this matter so far, for the understanding he displayed to members of the patients action group when he met them, and for his sympathy. It is clear that the Minister gets it. He understands why the delivery of the surgery is so important. I was very impressed by his willingness to bring parties together, to talk around the table and to bring about a solution to the challenges in getting this very important provision delivered at the earliest opportunity. I very much hope that in his response to my remarks he will be able to provide the assurances my constituents in Brownsover are looking for.

End of Life Care

Jim Shannon Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Deputy Speaker, for giving me the chance to speak on this issue. According to the End of Life Care Coalition, in the 12 months since the “Choice” review was published, almost 50,000 people experienced poor care during the last three months of their lives.

Some right hon. and hon. Members have clearly said that they are speaking from a family point of view, and I heard some of their speeches in the Chamber. Twelve months ago today my father passed away. My dad always wanted to die at home, but that was not possible. He had fallen out of bed and broken his femur. It was quite impossible for my mum to give him the care that he had to have, so he passed away in hospital. I have some experience of end-of-life care in hospitals, and I must say that I commend those involved: first, my mother, who was very loyally and religiously attentive to him, but also the nurses, who particularly helped and were very attentive and caring.

The 2015 report from the Parliamentary and Health Service Ombudsman, “Dying without dignity”, demonstrated the consequences of people dying without access to high-quality care and support. It highlighted cases where people had died in distressing circumstances, which had a lasting impact on their friends and families. That is what we are focusing on today. Unfortunately, research by the London School of Economics suggests that such situations are not as rare as they should be. The people who tend to miss out on palliative care are those with conditions other than cancer, those over the age of 85, single people and people from black and minority ethnic communities. Quite clearly, those are issues.

Research conducted by Ipsos MORI and Marie Curie—many of us met those from Marie Curie in Parliament yesterday—have found that seven out of 10 carers thought that people with a terminal illness were not getting all the care and support that they need. I commend the Marie Curie nurses for the hard and very attentive work that they do. Again, I have experienced that personally because a good friend of mine, Irene Brown, passed away just last week. Marie Curie helped her and her family greatly near the end of her life.

We have had ongoing worries and troubles about care homes in my constituency, with the threat of closures compounding the misery for people who need help the most and who already have to deal with an over-pressed and strained health service. I have to say, with respect, that the fact that such issues are not at the top of the priority list only serves to strengthen the disillusionment with the Government.

[Alison Thewliss (Glasgow Central) (SNP)]

Does the hon. Gentleman share my concern, which was highlighted by some of the Marie Curie nurses I met, that while they very much want to do an excellent job in looking after they people they serve, they cannot do so all week but only on a couple of days, with less experienced staff coming in to fill in the gaps?

[Jim Shannon]

I obviously agree with the hon. Lady. I understand exactly what she says, as I think does everyone in the House. The Marie Curie nurses are special nurses and they do a grand job.

The issue of state-assisted suicide has been mentioned. We have had a debate in the House and a clear decision has been made, by an outstanding majority, that there is no need for it, and we will keep that going. We do not need to discuss the matter, because it has already been decided.

I want to refer quickly to the significant improvements to end-of-life care in Northern Ireland with the ambitious “Transforming your care” plan. Although there is still a long way to go, I ask the Minister sitting on the Front Bench, who is always very responsive, to look at what all the devolved regions have been doing, not least Northern Ireland, to ensure that the best strategy known and available nationwide is being implemented so that the figures I led with are reduced as much as possible and as fast as possible. We all know people or have known people going through this period of their life and, young or old, it is a reality that all of us will face some day. The UK Government and the devolved Governments need to do better on this issue to give ordinary, everyday, hard-working people the treatment they deserve at such a distressing time.

I will conclude on this point because I am conscious that other Members wish to speak. If the Government have been taking action on this issue, they need to make that clear and publicise it, despite the obvious delay. In other words, are the Government giving end-of-life care the focus and money it needs, and are they working with charities and hospices to ensure that it is delivered? It is true that there should be no timescale for coming up with the best solution, but it is equally true that there has been insufficient explanation as to why the timescale has been delayed. I know that the Minister will respond to that. That delay is compounding the misery for people who are affected by this issue and their families. When it comes to end-of-life care, let us ensure that we deliver for our constituents.

Junior Doctors Contracts

Jim Shannon Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

The Welsh and Scottish Governments may have avoided the difficult decision that we are taking in the NHS in England, but the longer they go on avoiding the issue, the longer they will have higher mortality rates at weekends, which we are determined to do something about.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. If we do not have enough junior doctors, patient safety cannot be guaranteed. In his statement, he referred to reducing the number of hours, nights, days and rostered weekends for doctors. Does he believe that that will ensure that there will be no strike? What safeguards are in place for patients, nurses and senior doctors if an agreement cannot be reached?

[Mr Hunt]

It is because an agreement cannot be reached that we have to take the measures that we are taking today. The bits of the new contract to which the hon. Gentleman draws attention are the bits that will have the biggest impact on the morale of junior doctors, because we are saying that we do not think it is right for hospitals to ask them to work five nights in a row or to work six or seven long days in a row. We are putting that right in the new contract. That will lead to less tired doctors and better care for patients.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 9th February 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Northern Ireland has the lowest number of GPs per capita across the United Kingdom. In order to access GPs, we need to have GPs. In the whole of the United Kingdom of Great Britain and Northern Ireland 25% of GPs are aged over 55, and that is going to get worse. What steps have been taken to train more GPs and to ensure that they stay in the NHS and do not go overseas, where there are better wages and conditions?

[Mr Hunt]

We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.

Child Dental Health

Jim Shannon Excerpts

Wednesday 3rd February 2016 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

I have a well-known interest to declare as a very part-time, or occasional, dentist. I am a member of a number of dental organisations that have applied considerable pressure on me to seek this debate.

On 27 May, the Minister will give the opening address and take questions at the British Dental Association’s annual conference in Manchester. There are 39,000 dentists and 63,000 dental care professionals in the United Kingdom, spread over the four nations, with the majority of them in England. They will wish to hear about the national health service and contracts, but as professionals their biggest concern will probably be child dental health. Perhaps the Minister’s reply could be secret practice for opening the meeting, bearing in mind that, I suspect, very few dentists will be watching us.

Dentists feel that their small branch of general health is seen as a “Cinderella” service and a sideline within the national health service. Increasingly, the biggest problem they face is child dental health in the form of caries. This disease is almost entirely preventable, but it is not being prevented. As the Minister is aware, the biggest single factor in dental caries is sugar. The raw statistics on child dental health are pitiful. Deciduous teeth, or baby teeth, are particularly susceptible to decay as they have thinner enamel compared with permanent dentition, and this obviously contributes to children having dental decay. Dental decay is the No. 1 reason for children aged five to nine being admitted to hospital in the United Kingdom.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland, tooth decay among under-15s has fallen consistently since 2000, and specific education has been done by our health and education Departments to make that happen. The hon. Gentleman referred to those aged between five and 10 consuming sugar. Every child will eat their weight in sugar in a year. Does he agree that we need a tax on sugar, because if we address this at the early stages, we will go a long way towards addressing the problem of tooth decay?

[Sir Paul Beresford]

I wish it were that simple. I personally believe that that would not make one iota of difference after a few months. One need only stand in the supermarket watching the kids pushing the mothers for sweets and the mothers feeding them to realise that, as I say, it will not make one iota of difference unless it is prohibited, in which case we would have other difficulties that I will not go into.

As I have said, the No. 1 reason for children aged five to nine being admitted to hospital in the United Kingdom is dental decay. The NHS spent £30 million on hospital-based extractions for children aged 18 and under in the year 2012-13. That is 900 children a week, who are being admitted primarily for tooth extraction—often under a general anaesthetic, which carries a slight risk in itself.

I am sure that the Minister is aware of the results of the 2013 child dental health survey. For the sake of those who have not read the statistics and who may glance tomorrow at the debate, I will touch on some of the figures. For example, 31% of five-year-olds had obvious decay in their primary teeth. That figure was higher in more deprived areas, where 41% of those eligible for free school meals had decayed primary teeth, in comparison with 29% of other children of the same age. Of five-year-olds who were eligible for free school meals, 21% had severe or extensive tooth decay, compared with only 11% of those who were not eligible.

By the age of 15, 46% of our children have tooth decay. Of the 15 year-olds, 59% of those eligible for free school meals had decay, compared with 43% of other children of the same age; 45% reported that their daily life had been affected by problems with their teeth and their mouth in the previous three months; and 28% reported being embarrassed to smile or laugh because of the condition of their teeth. Those are 15-year-olds, who are suddenly taking notice of the world and hoping to be taken notice of themselves.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford) and his excellent speech. The House has been fortunate to benefit from his professional knowledge on a number of occasions. As a new Minister coming into office some nine months ago, I had an early meeting with him, from which I benefited hugely and continue to benefit. I am grateful for the way in which he put his case and for the heads-up in respect of what I might do and the speech that I might make to the British Dental Association in due course.

I am grateful that the usual suspects have been here to listen because of their interest in these matters, namely the hon. Members for Strangford (Jim Shannon) and for Nottingham North (Mr Allen). I thank my hon. Friend the Member for Battersea (Jane Ellison), who is the public health Minister, for being here, together with the Whip and the Parliamentary Private Secretary. I also saw the hon. Member for Dewsbury (Paula Sherriff), who has been to see me to talk about dental matters and who clearly cares very much about these issues.

I congratulate my hon. Friend the Member for Mole Valley on securing this very important debate about children’s dental health. Poor oral health in children and young people can affect their ability to sleep, eat, speak, play and socialise with other children. Other impacts include pain, infections, poor diet and impaired nutrition and growth. When children are not healthy, it affects their ability to learn, thrive and develop. To benefit fully from education, children need to enter school ready to learn and to be healthy, and they must be prepared emotionally, behaviourally and socially. Poor oral health may also result in children being absent from school to seek treatment or because they are in pain. Parents may also have to take time off work to take their children to the dentist. This is not simply a health issue; it impacts on children’s development and the economy.

It is a fact that the two main dental diseases, dental decay and gum disease, can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examination by a dentist. Despite that, as my hon. Friend has set out, their prevalence rates in England are still too high. Dental epidemiological surveys have been carried out for the past 30 years in England and give a helpful picture of the prevalence and trends in oral health. Public Health England is due to report on the most recent five-year-olds survey in the late spring.

There is a mixture of news, as the House might expect. The good news is that the data we have at present show that oral health in five-year-olds is better than it has ever been, with 72% of five-year-old children in England decay free. Between 2008 and 2012, the number of five-year-old children who showed signs of decay fell by approximately 10%. The mean number of decayed, missing or filled teeth was less than one, at 0.94. Indeed, the data suggest that, notwithstanding the All Blacks’ rugby success and their bone-crushing efforts on the field, oral health in children is currently better in England than in New Zealand. New Zealand’s data for children aged five in 2013 showed that the proportion who were disease free was 57.5% and that the mean number of decayed, missing or filled teeth was 1.88.

[Jim Shannon]

We have had a marked reduction in dental decay in children since the year 2000, as I said earlier in an intervention. With respect, Minister, I would say that we are doing some good work in Northern Ireland. The Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) knows that I always say, “Let’s exchange ideas and information.” We are doing good work in Northern Ireland and we want to tell Ministers about it.

[Alistair Burt]

This is possibly the fourth or fifth invitation that I have received from my hon. Friend to come to see different things in Northern Ireland, and he is right about every one. He finds in me a willing ear, and we will make a visit because there are several different things to see. Where devolved Administrations and the Department can learn from each other, that matters, and I will certainly take up my hon. Friend’s offer.

In older children there are challenges when comparing different countries, because of how the surveys are carried out. The available data still show that we have among the lowest rates of dental decay in Europe, but despite that solid progress we must do more. There is disparity of experience between the majority of children who suffer little or no tooth decay, and the minority who suffer decay that is sometimes considerable and can start in early life. In this House, we know the children who I am talking about—it is a depressingly familiar case. We can picture those children as we speak, as my hon. Friend the Member for Mole Valley described in the sometimes horrific parts of what he told the House. The fact that we know that such decay affects children in particular circumstances makes us weep.

Public Health England’s 2013 dental survey of three-year-olds found that of the children in England whose parents gave consent for their participation in the survey, 12% had already experienced dental decay. On average, those children had three teeth that were decayed, missing or filled. Their primary, or baby, teeth will only have just developed at that age, so it is highly distressing for the child, parents, and dental teams who need to treat them. Dental decay is the top cause of childhood admissions to hospitals in seven to nine-year-olds. In 2013-14, the total number of children admitted to hospital for extraction of decayed teeth in England was 63,196. Of those, 10,001 were nought to four-year-olds, and so would start school with missing teeth.

From April 2016, a new oral health indicator will be published in the NHS outcome framework based on the extraction of teeth in hospital in children aged 10 and under. That indicator will allow us to monitor the level of extractions, with the aim of reducing the number of children who need to be referred for extractions in the medium term. Extractions are a symptom of poor oral health, and the key is to tackle the cause of that. Today I commit that my officials will work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment.

The good news is that the transfer of public health responsibilities to local authorities provides new opportunities for the improvement of children’s oral health. Local authorities are now statutorily obliged to provide or commission oral health promotion programmes to improve the health of the local population, to an extent that they consider appropriate in their areas. In order to support local authorities in exercising those responsibilities, Public Health England published “Local Authorities improving oral health: commissioning better oral health for children” in 2014. That document gives local authorities the latest evidence on what works to improve children’s oral health.

The commitment of the hon. Member for Nottingham North to early intervention and the improvement of children’s chances is noteworthy and well recognised in this House and beyond, and of course he can come to see me. I would be happy to discuss with him what he wants to promote in Nottingham, which sounds just the sort of initiative we need.

Public Health England is also addressing oral health in children as a priority as part of its “Best Start in Life” programme. That includes working with and learning from others, such as the “Childsmile” initiative in Scotland, to which my hon. Friend the Member for Mole Valley referred. It is important that health visitors—I know that the Public Health Minister takes a particular interest in their work—midwives, and the wider early years workforce have access to evidence-based oral health improvement training to enable them to support families to improve oral health.

Public Health England and the Royal College of Surgeons Faculty of Dental Practice are working with the Royal College of Paediatrics and Child Health to review the dental content of the red book—the personal child health record—to provide the most up-to-date evidence-based advice and support for parents and carers. The National Institute for Health and Care Excellence has also produced recent oral health guidance that makes recommendations on undertaking oral health needs assessments, developing a local strategy on oral health, and delivering community-based interventions and activities for all age groups, including children. Community initiatives to improve oral health include supervised fluoride tooth-brushing schemes, fluoride varnish schemes and water fluoridation.

I agree with my hon. Friend that water fluoridation is an effective way of reducing dental decay. However, as the House knows, the matter is not in my hands. Decisions on water fluoridation are best taken locally and local authorities now have responsibility for making proposals regarding any new fluoridation schemes. I am personally in favour. I think I am the only Member in the Chamber who remembers Ivan Lawrence and the spectacular debates we had on fluoridation in the 1980s. He made one of the longest speeches ever. Fluoridation was bitterly and hard-fought-for and I do not think there is any prospect of pushing the matter through the House at present. I am perfectly convinced by the science and that is my personal view, but this is a matter that must be taken on locally.

Diet is also key to improving children’s teeth and Public Health England published “Sugar reduction: the evidence for action” in October 2015. Studies indicate that higher consumption of sugar and sugar-containing foods and drinks is associated with a greater risk of dental caries in children—no surprise there. Evidence from the report showed that a number of levers could be successful, although I agree with my hon. Friend that it is unlikely that a single action alone would be effective in reducing sugar intake.

The evidence suggests that a broad, structured approach involving restrictions on price promotions and marketing, product reformulation, portion size reduction and price increases on unhealthy products, implemented in parallel, is likely to have the biggest impact. Positive changes to the food environment, such as the public sector procuring, providing and selling healthier foods, as well as information and education, are also needed to help to support people in making healthier choices.

Dentists have a key role to play. “Delivering Better Oral Health” is an evidence-based guide to prevention in dental practice. It provides clear advice for dental teams on preventive care and interventions that could be delivered in dental practice and school settings. Regular fluoride varnish is now advised by Public Health England for all children at risk of tooth decay.

For instance, the evidence shows that twice yearly application of fluoride varnish to children’s teeth—more often for children at risk—can have a positive impact on reducing dental decay. In 2014-15, for children, courses of treatment that included a fluoride varnish increased by 24.6% on the previous year to 3.4 million. Fluoride varnishes now equate to 30.9% of all child treatments, compared with 25.2% last year. This is encouraging progress.

There are many measures that can and should be taken in order to reduce the prevalence of decay in children, but we recognise it is unlikely that we will be able to eradicate entirely the causes or the effects of poor oral health in children. This means that the continued provision of high quality NHS primary dental services will continue to be an important part of ensuring that every child in England enjoys as high a standard of oral health as possible. NHS England has a duty to commission services to improve the health of the population and reduce inequalities—this is surely an issue of inequality—and also a statutory duty to commission primary dental services to meet local need. NHS England is committed to improving commissioning of primary care dentistry within the overall vision of the “Five Year Forward View”.

Huddersfield Royal Infirmary

Jim Shannon Excerpts

Tuesday 2nd February 2016 Westminster Hall

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Colne Valley (Jason McCartney) and my hon. Friend the Member for Dewsbury (Paula Sherriff), who have eloquently made the case and saved me from spending an awful lot of time going into the detail. However, I must repeat some of the narrative. Mr Speaker often, I think, verges a little on ageism when he points out how long I have been in the House of Commons, but it does mean that I have a long memory and I know the narrative of what has happened in health provision in my part of the world. That is always difficult for Ministers.

I noticed that this Minister, when asked whether he had visited Huddersfield, looked down at his papers rather intently. I do not blame him for that—there are parts of England that I have yet to visit—but Huddersfield is an absolute gem of a place. It nestles in the Pennines. I once had an American student who said, “I’ve found out the difference between Lancashire and Yorkshire—you’ve got the Pyrenees between you.” I said, “A lot of people in Yorkshire wish it was the Pyrenees; actually, it’s the Pennines.” That is a slightly humorous remark, but the fact is that it is a very hilly area; conditions can be very difficult. We see the special signs up in bad weather. Can we go over the tops? Often the conditions are such that we cannot. Very close to us, it is very hilly, with very difficult road networks. There is not much flat land. We were looking for industrial investment. You and I, Mr Pritchard, care very much about the manufacturing sector, and when people are trying to attract new businesses, they are all the time looking for flat land. We do not have any flat land; that is the truth. It is very difficult to find a flat space in our part of the world. It is difficult terrain.

What is nice about this debate is that from both sides of the Chamber we are making it clear that we do not want to beggar our neighbour. We want good health provision throughout our area. Good health provision is what motivates all of us. We want the highest-quality health provision. However, we do want accountable delivery of health provision. Many of us feel that the old system had its imperfections and the new system has its imperfections. Both the hon. Member for Colne Valley and my hon. Friend the Member for Dewsbury talked about the PFI. I have a long knowledge of PFIs. When I was chairing the Select Committee on Education, PFIs were used, as you know, Mr Pritchard, for much school building. I learnt over many years of controversy over PFIs that one cannot dislike PFIs on principle, but one can be against bad PFIs and in favour of good PFIs. I think that that is the truth of the matter.

There is a lot of evidence that some of the health PFIs were entered into with a rather amateur group of people representing the health trusts. That is the only explanation if we are to be kind to those people who made the arrangements. They were dealing with some pretty clever people—leading consultancies and people who really knew their stuff from the City of London. A senior professor said to me that some of the people sitting on the other side of the table were not as sharp as they could have been. They may have been local accountants and solicitors or the local management team, and perhaps they did not see quite how much the PFI was going to cost them over the number of years for which it was to run. That is the context.

A particularly worrying PFI was agreed for the Calderdale hospital in Halifax. There were two trusts in those days: the Halifax trust and the Huddersfield trust. The Huddersfield trust was always very well managed and had plenty of reserves, but when Halifax and Calderdale ran into trouble, we were pushed by the then Department to merge with the trust that was limping rather. People may remember this. We did merge, because we did believe in a good health service for all the people in our part of Kirklees and in Calderdale. That is the history; now we have to bring ourselves up to date.

There is a new dilemma, and I do not want to make it party political, but the urgent question on national health service finances yesterday did point to the fact that up and down the country a number of trusts are in serious financial trouble. Until comparatively recently, our health trust was in pretty good shape. Only comparatively recently did we suddenly have some real financial challenges. The Minister will be very familiar with this dilemma. On the one hand, we are being asked to make savings, efficiencies—4% every year—in order to maintain a good record with all the organisations that look at our health provision. On the one hand, there is that pressure for greater efficiency and saving money, but at the same time on our patch we have this PFI that is a great drain. On the other hand, we have what is a pretty old hospital in modern terms. I was once with Harold Wilson in the hospital when I was a very young MP. He had come up, and we were waiting for the top brass to come down and guide us. He said, “Barry, I don’t think I’ve ever been here before,” and behind him was a great marble stone that said, “Opened by Harold Wilson in 1965”.

The hospital is a classic early 1960s building. Some of us love some of the 1960s buildings. There are some that we cherish, such as the Barbican. Many people hate the hospital; I quite like it. There is a kind of brutalism that one likes. However, a lot of 1960s building was a little bit below par. We have on the one hand a hospital PFI that is very expensive and on the other a local hospital that is getting old. It has been invested in over the years. A great deal of investment has gone in, but I am told that a conservative estimate is that at least £200 million would be needed really to get it back on track. That is a great pressure on local health provision.

All of us across the parties in our area—local councillors have also been very active in the campaign—understand that we want the best possible healthcare for all the people on our patch. I know that the Minister is not so familiar with our part of the world. Not only is it hilly but it has a very mixed population. A lot of wealthy people live on our patch. There are a lot of middle-class people and a lot of people who are more challenged in terms of their income. It is a very mixed area, and that is the beauty of it. It is not boring; it is in every sense a vibrant area. I recently challenged the Secretary of State for Business, Innovation and Skills to come to Huddersfield and have a decent suit made of fine Huddersfield worsted; we still make the finest worsted in the world. Indeed, Mr Speaker is now also coming to Huddersfield to have a fine worsted suit made. I see you looking interested, Mr Pritchard—the invitation could be extended.

The fact is that, were there not so much contest between the smaller towns, the area might have had the name “Greater Huddersfield”. It is a city—one of the biggest urban conglomerations in the country—but people, especially outsiders, do not realise that because we have broken it up into different names. Kirklees is vast, which means that there are great healthcare challenges. Put that together with our difficult geography and an interesting history, and we face real challenges. We want the Minister to be open-minded and to enter into a discussion to find a way to get the very best result for the people of our area.

I shall be quite blunt about my resistance to CCGs. I wanted to be independent in assessing PFIs, and I said that there had been good PFIs and poor PFIs. There are also good CCGs and not so good CCGs, and I am not impressed by the quality and leadership of my local CCG. Although I have some resistance to CCGs, the general model is not a difficult one. I chair the all-party parliamentary group on management, so I am keen on good management in the health service and outside. Sometimes I see doctors managing CCGs; management is not part of any medical course I know of. We would not expect it to be. We train doctors to be good clinicians and good GPs, not to be managers. Some CCGs have real difficulties because they lack quality management.

There has been a failure of management in our local CCG when it comes to a proper, rational assessment of where we are now and how we can get the best possible healthcare in our area, taking into account all the difficult pieces of information that I have mentioned, including an ageing hospital that needs investment, a newish hospital that was built under a PFI, and difficult communications. I ask the Minister to look very carefully at what has been going on in our locality and to get the whole situation appraised carefully, independently and objectively.

[Jim Shannon (Strangford) (DUP)]

I understand that this is an issue for the A&E in Huddersfield, but the hon. Gentleman mentioned getting other advice. In Northern Ireland, the Minister has set up a new panel to look at the whole health service and how best to take it forward in an area of financial restraint. Does he agree—I suspect that he does—that it is time to share those ideas across the whole United Kingdom of Great Britain and Northern Ireland? Thereby, we can all learn together.

[Mr Sheerman]

I very much welcome that information, which relates to the point made by my hon. Friend the Member for Batley and Spen (Jo Cox). She said that there was no clear, strategic plan for the broader area of West Yorkshire. West Yorkshire is very close to Barnsley on one boundary. On another, it goes a long way right up the valley to where a very large number of people live in places such as Todmorden, where a bridge was recently affected by floods. Those places are in strong Manchester commuting territory. The area is vast and complex, and I cannot remember a proper evaluation across the piece, rather than an assessment that just carved out one bit of territory and looked into that very carefully.

I do not want to go through how many people are enraged, but they include—I read in the Huddersfield Examiner—Sir Patrick Stewart. Until recently, he was the chancellor of Huddersfield University, which was university of the year last year. He sends, from Hollywood, his solidarity with the people of Huddersfield on the issue of keeping the A&E department open.

On 11 March this year, we celebrate the centenary of the birth of Harold Wilson—a great man and a great Prime Minister—who was born in Huddersfield. When I used to drive him around Huddersfield, we would pass the old further education college, which was the old, old Huddersfield hospital, and he always said, “My appendix is in there.” The area has a great history. Please, in this special year, let us listen to the voices of the people of Huddersfield and Halifax, and get this right. At the moment, the suggestion of closing A&E in Huddersfield is not right, nor is the suggestion that Halifax is the only alternative. Personally, I think that there is a scheme by which we could keep both A&E departments open. My request to the Minister is: get that rigorous, independent, thoughtful appraisal of what the hell is going on, and get it right.

NHS and Social Care Commission

Jim Shannon Excerpts

Thursday 28th January 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to participate in this debate, which I thank the right hon. Member for North Norfolk (Norman Lamb) for securing. We know he has a passion for this subject—in our many debates, we always take great account of what he says—so it was good to have him leading the debate. I think that other Members who have spoken—the hon. Members for Totnes (Dr Wollaston), for Leicester West (Liz Kendall) and for Bracknell (Dr Lee)—sat on a social care Bill Committee I sat on in the last Parliament, so we have some knowledge of the subject. I also thank the right hon. Member for Sheffield, Hallam (Mr Clegg) for kindly letting me go before him. I have a plane to catch, and sometimes these debates can go on.

Those who have spoken have brought a wealth of knowledge and experience to this debate, as will those who have not yet spoken, and I want to add a wee bit of that in relation to Northern Ireland, while commenting on the mainland as well. This year marks the 10th anniversary of the Wanless review of social care for older people. Since the review, there have been attempts, first by the coalition Government and now by the Conservative majority Government, to shift the policy direction and introduce new legislation to optimise healthcare provision and make the system versatile enough to cope with the increasing demand associated with an increasingly elderly population—my constituency has one of the fastest-growing elderly populations. I am going that way myself, but that is by the by.

Despite the welcome efforts by the Government, problems remain. The challenges, not least the financial challenges, are making it more difficult to provide services for the elderly, and these challenges will be around for a while. We will need to learn how to address them as the demographics of the country make service provision for the elderly more challenging. We can foresee these challenges, however, and it is encouraging that the Government recognise that. It is good to see the Minister in his place, and I look forward to reading his contribution. I apologise to him and the shadow spokesperson for being unable to stay for their speeches, as I have already said, but we are always encouraged to see the Minister on his feet, given his interest in this subject.

The importance of an integrated health and social care system is widely accepted. We have seen exciting innovative developments in Northern Ireland, where the former Health Minister, my party colleague Edwin Poots MLA, launched the “Transforming Your Care” programme, which was continued by the next Health Minister, Jim Wells, and now by the present Health Minister, Simon Hamilton. The initiative seeks to move care for elderly people from hospital into their homes wherever possible. That is the focus and goal of the strategy. Not only does this provide care closer to home and a nicer experience all round for the patient, but it has the potential to save the NHS and the social care system a lot of money in the long run. The Minister might like to note that programme as an example of what is possible. If it was replicated nationwide, it could save a lot of money in the long run and make for a more personal social care experience that would benefit the elderly.

With the financial challenges of austerity in our public services, we need to come up with innovative ideas to modernise our health and social care system and offer a first-class service in a financially difficult environment. Whether we like it or not, finance is part of the system we have to work within. The importance of integrated health and social care is widely recognised by health professionals and charities. We now need to turn this into a reality. Adult social care needs to be on a sustainable financial path if we are to maintain a world-class health and social care system, during a time of changing demographics, and we need to make sure that the pressures on the system are properly understood.

The integration of health and social care is crucial to provide a patient-centred service that makes the best use of resources. With care and caution, and with movement in the right direction, it is possible to do more with less. Innovative approaches such as the “Transforming Your Care” initiative are examples of how we can modernise the public sector to deliver real results with a tighter budget. Health and social care need to be seen as equal partners and provided with the necessary resources to deliver high quality services that actually serve the people. “Resources” does not necessarily mean increased funding. We know that we are living in tough times financially, and while funding is always desirable, success should be judged on results rather than the bill for the investment.

Social care is important in its own right. The Local Government Association claims there is a continuing lack of proportionality between additional funding for the NHS and adult social care. While much of the funding for the NHS is front-loaded, additional resources from the better care fund will not be available until 2017. Can the Minister say whether it is possible to consider implementing the better care fund on a shorter timescale? We will not be facing problems down the road in 2017; we are facing them right now, as Members have said and will continue to say. The Government need to make a greater effort to address the issue and ensure that the social care sector is adequately funded and resourced as we seek to make the appropriate reforms to make it a versatile and modern service that delivers for the people that it needs to.

Infected Blood

Jim Shannon Excerpts

Thursday 21st January 2016 Commons Chamber

[Jane Ellison]

In truth, it is a little too early for me to give that level of detail. We want to ask for expert advice on that in order to get it right and, as I said in the statement, we are looking at the impact on people’s health now. We do not want this to be an invasive or onerous process for the people, who have gone through so much already, so we envisage involving people’s own clinicians as well as gathering other evidence. This is something we will ask experts to advise us on and we will come back at the end of the consultation.

[Jim Shannon (Strangford) (DUP)]

I commend the Minister for her work on this and thank her for her statement today. We know her as a compassionate person totally committed to this case; I do not think that anyone in the House has any doubts about what she is trying to deliver, and we thank her for that.

Some 7,500 people have been contaminated by blood. Last year, the Prime Minister gave a commitment of £25 million and this morning the Minister has given a commitment of a further £100 million, which is good news. Some 10 people have passed away. The European Commissioner for Human Rights has recently ruled that Italy must pay compensation immediately to all those who received contaminated blood. I know there is a consultation process, but when will we see the money actually getting to the victims? Is there a timescale? There has not been any commitment, as I understand it, with the Northern Ireland Assembly and the Minister, Simon Hamilton. What, if any, discussions have taken place?

[Jane Ellison]

As I set out earlier, we offered a phone call this morning with the Minister in Northern Ireland, but I am more than happy to pick up on that. Our officials have been working quite closely together for some time on this, so I am more than happy should my opposite number want to have a conversation. The circumstances in Italy are different and, as I said in answer to the last question, other Governments must make decisions for themselves. I am aware of that case, but I think some of the circumstances are quite different. On timescale, our priority is to move forward the individual health assessments, and at the same time we will do some scoping work around reform of the schemes themselves. I cannot yet say how long that will take, but I obviously want to do it as quickly as possible. As I mentioned in my statement, I want to reassure Members that whenever we undertake those assessments, people will not miss out just because they are towards the end of the process. We will backdate all those annual payments, once they are awarded, to April 2016.