Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Speaker]

Extreme brevity is now required. I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

A recent study suggests that the NHS is starting diabetics on insulin much later than in other countries. What will the Department do to address that issue?

[Jane Ellison]

I thank the hon. Gentleman for his interest in this important subject. As he knows, we are looking at care right across the diabetes pathway, with a view to building on the first ever at-scale national diabetes prevention programme. I will take up the issue he raises and look at it in the context of all the other aspects of diabetes care we are examining.

Fibromyalgia

Jim Shannon Excerpts

Wednesday 1st July 2015 Westminster Hall

[Alok Sharma]

Yes, of course; the hon. Gentleman is absolutely right. I shall go on to provide more details of what is going on locally and perhaps what we ought to be doing nationally.

I first learnt about the condition almost by accident a few years ago, through a chance conversation with some constituents. Since then, through the work of the excellent Reading fibromyalgia support group, which meets regularly in my constituency, I have been able to learn more about fibromyalgia and meet many of the people locally who are trying to cope with the condition, as well as medical practitioners who are focused on helping sufferers.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue to Westminster Hall for consideration. In my constituency, many people have come to me with disability living allowance claims, which is where my interest in and knowledge of fibromyalgia comes from. What concerns me greatly as a result of the correspondence and communication that I have had with my constituents is that GPs seem not always to be aware of the symptoms of fibromyalgia. That means that the figure for diagnosis in Northern Ireland is only 3%, yet we have a significantly larger number of people who have the disease. Does he think we need greater awareness among GPs to start with and then we can address the issue?

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

I congratulate my hon. Friend the Member for Reading West (Alok Sharma) on securing a debate on this important issue. In his constituency, he has shown great support for his local fibromyalgia patient group by advocating on its behalf, raising money and raising the profile of the disease, which is so debilitating for its sufferers. He has helped the group to continue its important work of improving awareness of the condition and providing advice to patients and their families. I pay tribute to the work of FMA UK, other fibromyalgia charities and the many patient support groups around the country who work tirelessly to raise the profile of the disease and support those who are affected by it. I welcome today’s merger of FMA UK and FibroAction, which will help to give a stronger patient voice to those who are affected.

Fibromyalgia is an incurable musculoskeletal condition of unknown cause that can have a debilitating impact on those who are affected. Although no exact figures are available, research suggests that fibromyalgia affects around 2.5 million patients in the UK, the majority of whom are women over the age of 40. Fibromyalgia symptoms affect the soft tissues, muscles, tendons and ligaments of the body and result in widespread and variable pain throughout the body. Poor-quality, non-refreshing sleep contributes to an ongoing cycle of chronic pain and fatigue, and, in some cases, poor concentration and short-term memory problems. Irritable bowel syndrome, restless legs, head and neck pain and sensitivity to temperature change are also associated symptoms of fibromyalgia. The symptoms and their severity differ from patient to patient.

Diagnosing the symptoms of fibromyalgia can be challenging for GPs. Some 20% of the general population consult their GP about a musculoskeletal problem each year, which amounts to more than 100,000 consultations a day. The symptoms of fibromyalgia are common to other conditions such as rheumatoid arthritis, lupus and chronic fatigue syndrome. In addition, patients with fibromyalgia can often visibly appear well, despite their symptoms. GPs face a further obstacle because there is no diagnostic test that accurately identifies the condition. A diagnosis is usually made via a process of diagnostic investigation to exclude other potential causes of the patient’s ill health. It is, therefore, important that clinicians have the training, tools and resources to help them identify fibromyalgia symptoms when a patient presents.

Musculoskeletal conditions are a key part of the generalist undergraduate MBBS medical curriculum. The General Medical Council requires that the MBBS curriculum provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including musculoskeletal health. Musculoskeletal health is also a key component of GP training, and the Royal College of General Practitioners’ curriculum statement on musculoskeletal conditions sets it out that GPs should be able to diagnose and manage common regional pain syndromes such as fibromyalgia.

In addition to clinical training and experience, GPs have at their disposal a number of tools and resources. They include: the Map of Medicine, an online evidence-based guide and clinical decision support tool available to GPs and other healthcare professionals in the NHS, which has a fibromyalgia and chronic pain pathway, and helps clinicians to identify the symptoms and make the right referral; a free e-learning course on musculoskeletal care, including fibromyalgia, developed by the RCGP and Arthritis Research UK, which aims to improve skills in diagnosing and managing musculoskeletal conditions; NHS evidence services, which provide access to a vast online repository of clinical knowledge and guidance covering a wide range of conditions, including fibromyalgia; and a fibromyalgia medical guide for health professionals developed by FMA UK.

Once a patient is diagnosed with fibromyalgia, a number of treatment options are available to them. In the absence of a cure, relieving pain and restoring quality of life are the primary clinical goals. Treatment options include pain relieving medication, physiotherapy, dietary and exercise advice, counselling or cognitive behavioural therapy, and self-management programmes to give patients the skills and confidence to manage their condition. The routine assessment and management of pain is a required competency of all health professionals. Many patients can have their fibromyalgia successfully managed through routine access to locally commissioned services via GPs, and community and secondary care services. I will turn to my hon. Friend’s point about specialist clinics in a moment.

[Jim Shannon]

The hon. Member for Reading West (Alok Sharma) and I asked how we can raise awareness within the GP profession to ensure that GPs understand the symptoms of fibromyalgia and diagnose it earlier. As I pointed out in my intervention, only 3% of people in Northern Ireland have been diagnosed with the condition, but the number of people who suffer from it is far larger. There seems to be a gap between those who have been diagnosed and those who have not. Is that because GPs are not really aware of the condition? How can we make them more aware?

[George Freeman]

The hon. Gentleman makes an excellent point, and he is helping to raise awareness today. I will pass on the points made today to the team at NHS England with responsibility for this issue. The answer to the question on awareness is to support debates such as this, and to promote the work of the charity and the patient advocacy groups.

The routine assessment of pain is a required competency for all healthcare professionals. However, patients who remain in high levels of pain after conventional approaches to treatment have failed are able to access specialised pain services, which are nationally commissioned by NHS England. Patients referred to such services receive multidisciplinary team care from clinicians with expertise in pain management.

Operational Productivity in NHS Providers

Jim Shannon Excerpts

Wednesday 1st July 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Pritchard. I apologise for having had to step out of the Chamber for a minute or two. I expected the speech of the hon. Member for Bristol South (Karin Smyth) to be a wee bit longer. It is always a pleasure to speak on these issues, and I thank the hon. Member for Hendon (Dr Offord) for bringing this subject to the House for our consideration.

The Carter report is important. Members will know that health is a devolved matter in Northern Ireland, and the responsibility for health falls clearly on the Northern Ireland Assembly and my party colleague Simon Hamilton, but it is important that we consider the issues and the recommendations in the report. I will speak to that in a few minutes, but first I pay tribute to all those who, despite the numerous difficulties facing us, make our NHS one of the premier care services in the world.

The tireless work of the doctors, nurses, surgeons, technicians, pharmacists, auxiliaries, cleaners, cooks, porters and those who work in admin behind the scenes has not gone unnoticed. I am sure everyone here would start by thanking them for their contributions, their efforts and the exhausting work they do. I thank them for their smiles to the patients and families, sometimes when the workers are so exhausted they can barely stand. I thank them for staying those extra 10 and 15 minutes beyond what they are paid for to make a patient comfortable. I thank them for choosing to come to work and sometimes having to face abuse from tired and perhaps frightened people. I thank them for retaining their dignity and helpful nature. In this debate, we do not stand in judgment on the NHS or the workers; rather, we look at the procedures in place and how we as Members of Parliament can help to make the NHS, which we are fortunate to have across all the regions, more effective for everyone.

[Mr Jim Cunningham]

The hon. Gentleman mentioned long hours. Some of the young trainee doctors are doing a 12-hour day, seven days a week. That can go on for months. That is not exactly conducive to good morale in the national health service, is it?

[Jim Shannon]

None of us here said that it was. It is important that our doctors and the staff are not over-tired.

The Carter report sets out how efficiencies can be delivered. The hon. Member for Angus (Mike Weir) who spoke before me clearly outlined the issues. The title of the debate refers to Lord Carter’s review of productivity in hospitals, and the interim report of that review, “Review of operational productivity in NHS providers”, which was published on 11 June. We all know that Lord Carter of Coles was appointed by the Health Secretary to chair the NHS procurement and efficiency board in June 2014, to review the operational productivity of NHS hospitals and to establish the opportunities for efficiency savings across the NHS. To do that, Lord Carter and the review board worked with a group of 22 NHS providers across England, and I think that what they have found in England will be replicated for us in Northern Ireland and for our colleagues in Scotland and Wales. There are lessons to learn, so we should take note of what the report says.

As I said, an interim report was published on 11 June outlining the work that has been carried out and the interim recommendations and next steps. The full report is to come in the autumn, and I look forward to seeing what it says. Back home, people are sick to death of the term “efficiency savings”, the idiotic behaviour of Sinn Féin and the Social Democratic and Labour party and others and the funding penalties we are facing. Our NHS is being asked to do the impossible and be more efficient than it is, but when I look at the findings of the interim report, I see things that may extend to our running of the NHS in Northern Ireland. That is what the Carter report is about, and I am sure the Minister will give his thoughts on that shortly. The report sets out ways we could ease the pressure off front-line services and enable the functioning of our country while we wait for action to cease the penalties and see Northern Ireland receiving what she is entitled to—what we would be getting, were it not for the inability of Sinn Féin to do what its Members were elected to do and work for the people. That, however, is a different debate for another day, and I accept that.

The interim report suggests that the NHS in England could look to make savings of some £5 billion per annum by 2019-20 and reports three major areas of opportunity. The first is hospitals getting a stronger grip on the utilisation of resources, particularly in four areas: workforce, hospital pharmacy and medicines, estates management and procurement. The second is achieving greater productivity in hospital workflow—how patients move through the system—and the subsequent use of assets such as operating theatres. I have always felt we could look at that, and the Carter report has examined it and offered some ideas on how it could work. The final area is gaining a better understanding of the need for hospitals to develop sub-acute services, either on their own or in collaboration with others, to facilitate the discharge of patients. It is about making it work better together.

We need a way of ensuring the highest quality of patient care, delivered at the lowest price possible to ensure that more funding can be diverted to cancer drugs. Members will know that I have advocated ensuring the availability of cancer drugs across the whole United Kingdom, rather than that being down to postcode. In Northern Ireland, we would like to use prescription charges to put some money towards cancer drugs. I know that the Government have given a commitment and that there is some help for the devolved Administrations when it comes to cancer drugs, but not to the extent that we would like. We also need more funding diverted to research and other areas.

I was surprised to see in the report that one hospital could save up to £750,000 a year by improving the way it deals with staff rosters, annual leave, sickness and flexible working. That was just one example, which would regain the £10,000 a month the hospital was losing due to people claiming too much annual leave. That is an easy way of getting money back into hospitals. Ensuring every hospital pays the best price for medicines and supplies would save money that could be invested in front-line care. One hospital with 23 operating theatres improved the way it tracks the products used during surgery and saved £230,000 in the first year alone. I am not saying that every hospital could do that, but it is an example of what can be done, and it would be unwise to ignore it.

When the Hansard report of this debate becomes available, I will send a copy to my colleague, the Health Minister in Northern Ireland, Simon Hamilton, to make him aware of the Carter report and this debate. Helpful lessons may emerge that we could use. For example, a hospital was using the soluble version of a steroid for multiple illnesses and paying £1.50 a tablet when the solid version costs just 2p a tablet. Using the soluble version only for children and patients who have trouble swallowing saved £40,000 every year. Those may be small examples, but they collectively show how something could happen. I have some concerns. Cheap is not always best, and we have many examples of the copying of tablets in China and elsewhere. Those tablets are not as effective and may be harmful, so we have to monitor how we best ensure that cheaper drugs are effective and tackle the diseases they are designed to tackle.

We must take these issues in hand if we are to see the best possible use of funding. With the publication of the full report in the autumn, we will have a better idea of where we are. I hope that that report will be seen not as a stick to beat the NHS with—if it is, that will be for the wrong reasons—but as a ray of light that will help make things better. I very much look forward to seeing what it says about how we can improve things here in England, because we will then, I hope, be able to use that example to improve things across the water in Northern Ireland and perhaps in Scotland, for my colleague and friend, the hon. Member for Angus.

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[Ben Gummer]

I do not want to ruin the hon. Lady’s nascent reputation by agreeing with her again—happily, there are very few Opposition Members present to notice, although that is not an implied criticism—but she is absolutely right. We are lucky that nursing places are quite significantly over-subscribed. The position is popular, but she is absolutely right that we need to not only make far greater use of apprenticeships but widen the skills base in nursing full stop. We are actively working on that in the Department—I have spent much of the day on it, and I am sure there will be more to come.

To help chief executives in this interim period, we have forced all agencies that want to offer their services to ensure that they are doing so through framework contracts, and we are ensuring that there is an hourly cap on the rate that can be charged. We have also taken additional measures on managerial salaries, along with a few other measures, to ensure that managers have the opportunity to be able to manage costs as they wish. We understand, however, that this is the first stage of a much deeper programme of reform that is needed. Lord Carter’s report points in that direction by suggesting that we use our existing workforce far better, so that people are doing the job that they are suited to and qualified for and that their time is not wasted. That is the great win, not only for efficiency and patient care, but for staff enjoyment of their jobs.

The hon. Member for Coventry South (Mr Cunningham) made some helpful interventions about NHS workers’ quality of life. It has been a sad but persistent truth of the NHS for many years—decades, in fact—that staff-reported incidents of harassment and bullying have been higher than the national average and that workforce stress and illness is higher than average. Some of that is to be expected—parts of the NHS are extremely stressful working environments—but we can do much more. Part of that is about ensuring, when people turn up to work, that they are doing the job they wanted to do, with a suitable but not excessive degree of pressure, and that the system is not wasting their time. If we make them happier in their jobs, their patient care will improve and their commitment to the service will be even greater. I am therefore aware of the prize, not just in pounds, shillings and pence, but in an improvement to staff morale and therefore patient care.

[Jim Shannon]

One of the things that concerns me from a Northern Ireland perspective—this has also been raised in discussions with other Members in the Chamber today and outside—is that the NHS greatly relies on, in our case, Filipino workers, which is an immigration issue. Has the Minister had any discussions with the Minister for Immigration, the right hon. Member for Old Bexley and Sidcup (James Brokenshire), to ensure that there will be no shortfall when the gaps left by those who are here on work visas need to be filled and that the quality service in the NHS will not be lost? The hon. Member for Bristol South (Karin Smyth) referred to training people to ensure that keen, interested and able replacements are available. Has the Minister given any thought to that?

[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.

Post Office Horizon System

Jim Shannon Excerpts

Monday 29th June 2015 Commons Chamber

[Andrew Bridgen (North West Leicestershire) (Con)]

I pay tribute to the work carried out on this issue by James Arbuthnot, the former Member for North East Hampshire, and Mike Wood, the former Member for Batley and Spen, both of whom I worked with for more than two years in a working party in search of a fair settlement on this matter. Unfortunately, throughout the process we all lost faith and trust in the Post Office’s willingness to investigate the issue properly and thoroughly.

To give some background on how the Post Office has let down sub-postmasters and Members of this House throughout this process, let us consider how it has dealt with the matter from the outset. The Horizon accounting system used by sub-postmasters was introduced some 15 years ago. Almost immediately, a spate of discrepancies began to appear as sub-postmasters attempted to balance their accounts at the end of the day. From that time forward, there has been failing after failing on the part of the Post Office.

The Post Office has finally acknowledged that its help system for the Horizon software was completely inadequate, but even with that admission the Post Office continues in its failure to demonstrate any appetite to deal with issues arising from the Horizon system in a fair and transparent way.

[Jim Shannon (Strangford) (DUP)]

Is there not something disgraceful in the fact that criminal charges were pressed against these sub-postmasters and sub-postmistresses when the fault lay with the Post Office, yet nearly two years after the investigations those charges have not been lifted? The shadow hanging over their heads has not been lifted either. Does the hon. Gentleman not feel that it is time to bring that to an end?

[Andrew Bridgen]

The hon. Gentleman tells a tale which has been told too long to the working group. We need to bring matters to a head and I hope the debate tonight will give us an opportunity to do so.

The mediation scheme that was set up to handle disputes about the software system has not delivered what Members of this House had understood was agreed at its inception. It was flawed in a number of ways, the most significant being that it excluded those who had pleaded guilty.

Drugs: Ultra-rare Diseases

Jim Shannon Excerpts

Tuesday 16th June 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Member for Leeds North West (Greg Mulholland) on bringing this matter to Westminster Hall for consideration. Westminster Hall is well filled today because we all have constituents who are suffering and do not have access to the drugs needed to combat these rare diseases. I also congratulate the hon. Gentleman on his hard work on this issue, for which he is well renowned; we have all said that, but it is the truth, and we all want him to know that we know it.

I am glad this debate has occurred, because it is on a subject that affects many people in my constituency. We have heard some stories and we will hear more before this debate is over.

The diseases we are considering may be rare, but collectively they affect the lives of 3 million people across the United Kingdom. That emphasises that everything must be done to create a comprehensive initiative for providing care to those affected by these difficult and challenging diseases.

Rare diseases tend to be life-threatening or chronically debilitating. There are between 6,000 and 8,000 rare diseases. Each one affects less than 0.1% of the UK’s population, but Rare Disease UK calculates that 75% of these illnesses affect children.

We are here today on behalf of our constituents, but we are also focusing very much on young people across the United Kingdom of Great Britain and Northern Ireland who have these problems.

The ultra-rare diseases that have been mentioned include Morquio disease, Duchenne muscular dystrophy and tuberous sclerosis. I would also add Prader-Willi syndrome, which some of my constituents suffer from.

The chance of improving people’s quality of life depends very much on a narrow timescale. It requires quick diagnosis, treatment and drug provision, so that drugs can be accessed when they are proven to be most effective. In other words, as every Member who has spoken has said, time is of the essence—the people who are suffering need help now, not in six or 12 months. It is our duty to make that timeline as transparent and effective as possible within the finite resources we have, and I understand the problems the Minister has. There must be adequate assistance for practitioners, to allow for timely diagnosis and the timely provision of drugs and treatment.

[Mr Anderson]

The hon. Gentleman has been very consistent on this issue, and he is right: as those of us in the all-party group on muscular dystrophy have found, one of the main reasons for delays is that clinicians—particularly GPs—do not see these diseases very often, and when they do, they are sometimes lost as to where to go. Once a disease is diagnosed, the people suffering from it should have no worse access to treatment than people with much more common diseases—surely that is the issue that has to be addressed. Once a disease is identified, we have to get to grips with it, and people have to get the medication and the support they need, so that they can get on and live the best life they can.

[Jim Shannon]

I agree wholeheartedly. I am sure the Minister has heard us all say that time is of the essence and that we should strike right away. That is what we are about.

The health and social care professionals involved in the diagnosis, treatment and care of these patients face difficult tasks. As I was saying, there must be adequate assistance for them, to allow for timely diagnosis and the timely provision of drugs and treatment. There also needs to be sufficient funding UK-wide.

In Adjournment debates and other debates about these issues, I have always referred to Queen’s University in Belfast and to the importance of research and development. Queen’s University is one of the universities that do research, and it works in conjunction with the Health Department. Perhaps the Minister could therefore give us some idea what the Government are doing on research and development to ensure that new drugs are found.

[David Simpson (Upper Bann) (DUP)]

My hon. Friend mentions research. As he will know, I am involved in a campaign in Northern Ireland and across the United Kingdom on complex regional pain syndrome. The condition affects children, but it mostly affects adults from the age of 50 onwards, and people can lose limbs to it. One in every 3,000 people is affected, and many lives have been destroyed. We need more research to find a drug to cure this condition, and research funding needs to be put in place so that that research can be done.

[Jim Shannon]

I thank my hon. Friend for his intervention. That is a message that I, too, believe in, and I am sure the Minister will respond positively.

Leaving aside all the statistics we have heard today, we need to imagine the emotional strain these things put on people and their families, and we have had examples of that. Only 35% of patients are aware of a licensed treatment for their condition. There is something wrong when that is the case. How come only 35% of people know there is something there for them? How are the Government addressing that? I am not attacking the Minister—that is not how I work—but how do we move things forward in a positive fashion? Of that 35%, 89% are able to access the treatment, but 11% are not. Therefore, 65% of people are not aware of the drugs, and of the 35% who are, a proportion are not able to get them.

Like others, I want now to touch on Duchenne muscular dystrophy. If Translarna is given at the correct time, we can prolong the sufferer’s mobility. My constituents deserve to have access to that drug as soon as possible, and that is what I would like to see happen. The effects of long waiting times and uncertainty are widespread, and although ultra-rare diseases affect the few, their effects for those who suffer from them are an inescapable reality and should be treated with the utmost seriousness.

Families deserve a solution to the continual failure to establish a lawful, robust and transparent commissioning service that enables the rare disease community to access new drugs in an equitable and timely manner and to avoid situations such as those we have spoken about, where crucial windows of opportunity pass by. This is a crisis—it cannot be described as anything else. People are in trouble, and they need our help now.

Let me quickly pay tribute to the lady who looks after the Northern Ireland Rare Disease Partnership, Christine Collins. Last year, we met the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), to discuss these matters. We were clearly moving forward, and the Minister was very responsive. The background information for the debate says that, in November 2013, the UK Department of Health and the devolved Governments published the UK strategy for rare diseases. In June 2014, the Northern Ireland Assembly endorsed it and gave a commitment to publish an implementation plan, and last year’s meeting provided an opportunity to underline the need for that to happen. Perhaps the Minister can give us some idea today of what discussions he has had with his fellow Minister to move things forward so that we can deliver on that commitment.

The debate has dealt with access to drugs. It has also given us an opportunity to bring out the gaps in the patient experience. Let us remember the patients, the families, the children and all those who suffer. They require a co-ordinated response from not only the health service and the social services, but research bodies and the relevant charities. I hope that the common experiences we have described signal the urgent need for access to these vital treatments. I remind all those in a position to have a tangible impact on drug access that while we are debating these issues, somebody else is falling into the trap and will, unfortunately, be unable to access the necessary drugs. I urge the Minister to respond positively, and I thank the hon. Member for Leeds North West again for giving us all a chance to speak about this issue.

[Several hon. Members]

rose—

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[Dr Whitford]

Obviously, devolution gave us the power to do things differently, but I do not think that we should re-invent the wheel. Often, we will accept work done by NICE or re-evaluate it quickly, to see whether things should be applied differently, but we do not just go back to the beginning. However, I am sure that ideas can be shared in both directions.

It seems that certain drugs were left as orphans when the system changed. We know that patients with the brain tumour form of tuberous sclerosis, which the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) mentioned, can access the drug through the cancer drugs fund, but if they have a kidney tumour and are treated by urologists they are not part of that system and simply will not be aware of it. Such random unfairness exists.

[Jim Shannon]

There is a forum and association, driven by the Health Minister, that discusses matters together with the three regions. A UK-wide strategy is already in place. The process is allowing that to happen already. However, it is delayed and has not happened yet; that is why we are concerned.

[Dr Whitford]

I think it is a matter of what ideas go on the table and what is being discussed in the meetings. Good ideas are going ahead. I commend the idea of including patients and clinicians in evaluations, because the numerical data from trials will often be small due to the nature of the diseases in question, and we will have to look wider. The problem for children is that if these drugs are to prevent deformity, they have to be got in early. People with Morquio already have the changes. We do not know yet how much change could be prevented, or how much saving there could be on a person’s disability in the long term if metastatic breast cancer treatments, which eventually become adjuvant treatments, are given earlier.

I commend the system I have talked about. I know it is difficult and challenging, but it is clearly fair, with an interim period for compassionate reasons, and people know where their voice should be heard.

Health Services in Staffordshire

Jim Shannon Excerpts

Wednesday 3rd June 2015 Commons Chamber

[Jeremy Lefroy]

I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.

To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:

“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”

My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.

Macmillan says about the first two years of the contract:

“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”

That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.

According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to

“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”

That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.

I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.

The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.

[Jim Shannon (Strangford) (DUP)]

In Health questions this week, an issue close to my heart was raised about GP numbers and how many doctors are choosing to become GPs. We have similar issues in Northern Ireland. The difficulties in Staffordshire have been outlined, but they are mirrored across the whole of the United Kingdom, and particularly in Northern Ireland. Could any steps be taken to encourage more doctors to become GPs, thus dealing with the problem of the massive number of patients that each doctor has, because we are getting to the stage where doctors will not be able to cope?

[Jeremy Lefroy]

I am grateful to the hon. Gentleman, who hits the nail on the head. It is vital to increase the number of medical students and those training as GPs. I know that the Government want to do that and are committed to it, but I believe they need to expand the number of medical school places.

What plans do the Government have for expanding the number of medical school places and ensuring that those trained stay and work in the NHS, particularly in those areas that are running short of GPs? A seven-day personalised service is an ideal, but those GPs who take the care of their patients extremely seriously—and that is the vast majority of them—are already working extraordinarily hard. The European working time directive most certainly does not apply to GPs, even if it does to the rest of the NHS, and if it were to apply, our family doctor service would fall apart.

Finally, I wish to address the financing of the NHS in Staffordshire. All parts of it are under strain. The KPMG report showed, although some of its solutions have rightly not been accepted, that there is a serious problem. The answer is not to be found in short-term fixes, whether they be in Staffordshire or elsewhere. The NHS England 2020 plan—tough though it is—gives us the opportunity to think long term. Yesterday, I argued in this place for a cross-party commission, including the medical professions, on the future of health and social care and its provision and financing for the 20 or 30 years beyond 2020. I repeat that call today, and I urge the Minister and his colleagues to take up the challenge.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

We will absolutely remember them. That is why it is so important to embrace new technology. Sometimes people who have to travel long distances are able to use such things as Skype or to make a phone call to receive important advice. This is a big priority for us.

[Jim Shannon (Strangford) (DUP)]

With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.

[Jane Ellison]

The hon. Gentleman is right to draw attention to the important role of research. We will leave no stone unturned in looking at all aspects of the treatment or prevention of diabetes. The issue of research is something I recently discussed with the chief medical officer. I will draw to her attention the point he makes. As he knows, although health is a devolved matter we always make a point of sharing all research right across our United Kingdom.

Health and Social Care

Jim Shannon Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Let me first pay tribute to the former Member for Ross, Skye and Lochaber and thank him for his massive contribution over some 32 years and for his dedication and his humour, which were evident to all those whom he met in this House. He was a friend to everyone. I just wanted to put that tribute on record on behalf of my party.

It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce), as there are many issues on which we agree. It has also been great to hear the contributions from some of the new Members on both sides of the House.

It is an honour to be back in this House as the Member of Parliament for Strangford. When I was first elected five years ago, I said that everyone in the House would remember Strangford, and I believe that they do. The Ministers, shadow Ministers and Members who visited my constituency always said that they were mesmerised by the beauty of Strangford and wished to come back. I now extend an invitation to Strangford to all new Members —and old ones as well—of this House.

I am, unashamedly, a Unionist. All four nations bring their qualities, traditions, history, culture and experiences to the United Kingdom of Great Britain and Northern Ireland, and together we are stronger. Having Scotland, Wales, Northern Ireland and England together in the Union is our strength.

As I listened to the Gracious Speech, I was delighted to hear the topics that were raised. I was pleased to hear about the EU referendum and that everybody in the United Kingdom of Great Britain and Northern Ireland will have the chance to cast their vote. I am pleased to hear about more free childcare, which I hope will be carried over to Northern Ireland, as well as the vital freeze on increases in income tax, VAT and national insurance for five years. I am delighted to hear that 3 million new apprenticeships will be created, that there will be measures to reduce regulation for small businesses and a bid to boost job creation, but I would have been glad to have seen an end to the iniquitous bedroom tax.

Those are debates for other days, however. As the Democratic Unionist party spokesperson for health, I am pleased to hear that there will be legislation to introduce a blanket ban on the production and supply of so-called legal highs.

[David Simpson (Upper Bann) (DUP)]

Does my hon. Friend agree that although we welcome the legislation on legal highs we must ensure that we have proper enforcement? We have not had much success with the other illegal drugs, so we need proper enforcement.

[Jim Shannon]

I thank my hon. Friend and colleague for that intervention. He clearly outlines the case, and I want to make a comment about that as well. A young constituent of mine from Newtownards, Adam Owens, a 17-year-old boy, died some six weeks ago because of psychotropic substances, or legal highs, as we all know them. Our community is rightly angry at this loss of the life of a young man and we put on record our concerns for the family and everyone else.

We must address the issue of what is classified as legal, particularly when a young man has lost his life. I have spoken to the Police Service for Northern Ireland, to the Department of Health, Social Services and Public Safety and to the Department of Justice to ask for urgent legislative change. They all said that the change would have to come from this place, so I welcome the Government’s commitment in the Gracious Speech.

[Gavin Robinson (Belfast East) (DUP)]

My hon. Friend will be aware of the work on legal highs I have done at Belfast City Council. For the benefit of the Minister and the Department here, will he encourage those with the power in England and Wales to take advantage of the legal precedent we have set in Northern Ireland where we have secured not only destruction orders but prosecutions for the sale of legal highs?

[Jim Shannon]

I thank my hon. Friend and colleague for that comment, and the precedent has been set in Belfast in the past three weeks. I am pleased that we have set the precedent for the rest of the United Kingdom, as we often do in Northern Ireland. That legislative change has been made by local councils and I am pleased to see it.

The loss of that young man to legal highs should not be repeated. My hon. Friend the Member for Upper Bann (David Simpson) mentioned previous legislation. In a previous job, as a Member of the Legislative Assembly, I spoke about one substance that was an issue at that time, mephedrone. We changed the legislation in Stormont, but an ingredient was changed, the name was changed and all that good work was set aside. That is why we need this legislative change and why we need it urgently.

We had a rally in Newtownards organised by a teenager and his friends in response to the death of Adam Owens. It was attended by every age group, every social class and every religion, with people all there to express their concern and the need to see change on legal highs. We should bring this matter to the Chamber as soon as possible. As I said to the family, we cannot ease their heartache but we can work together to try to ensure that something worth while comes from the shock—that is, the end of legal highs. If we achieve that in this House, we achieve it not only for Strangford but for every constituency across the whole of the United Kingdom of Great Britain and Northern Ireland. That is why, although I welcome the Government’s promise to address the issue, I must ask for the timeline for the fulfilment of the promise. Perhaps the Minister can give us some information about what will happen.

As a Northern Ireland Member, I am well known for continually pressing for more funding UK-wide that is ring-fenced for the NHS and I am delighted to hear that the Government are responding to those calls and making more funding available for the NHS. Can the Minister give us some idea when the ring-fenced funding in the block grant will be made available to the devolved Assembly and whether there will be any restrictions on the use of the money?

There are many issues in the NHS that we must address. We need to address the long waiting lists that mean that people wait almost a year for simple hernia operations. Justice cannot be done to a pay rise for nurses within the current budget allocated to the Health Department, yet those men and women dedicate much of themselves to a job that most people in this room would find unbearable. It has been impossible for them to be recognised within the current budget. In addition, money should be set aside to make more cancer drugs available in all postcodes, instead of being subject to the postcode lottery that often operates.

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

I thank the hon. Gentleman for giving way in this important debate on health and social care. Does he agree that a lot of these cancer drugs are trialled in specialised labs in the oncology department in Belfast, and that it is particularly sad that they are not available in Northern Ireland because of the lack of a cancer drugs fund?

[Jim Shannon]

I thank the hon. Lady for her intervention. Clearly, that is the issue for us in Northern Ireland. We want the cancer drugs to be made available throughout the United Kingdom.

Great progress has been made in cancer drugs. In fact, 60% of skin cancer cases can now be addressed with medication and chemotherapy. Those are fantastic steps forward. The other issues are all there—for example, GPs’ surgeries and diabetes. I declare an interest as a type 2 diabetic.

There are mental health issues that we need to address, not only for everyone in society but throughout the United Kingdom and for our soldiers too. I understand that there is not a bottomless pot of money, but we must do the best with what we have. It is also important to understand that your health is your wealth, that we must invest in the health of this nation, and that it is essential that such investment is UK wide.

In closing, I am thankful that the Government pledged to prioritise health, to ban legal highs and to take action on all the other issues that have been raised, but we need to have the pledges implemented urgently. They must not be left until next year or the year after. There is good news in the Gracious Speech, but I ask for details, and for implementation to take place as soon as possible, so that every benefit can come to everyone in the United Kingdom of Great Britain and Northern Ireland.

--- Later in debate ---

[Jane Ellison]

It is a very important part of cancer care, and something we have debated often in this House. I have seen for myself while on visits just how important the services that wrap around clinical care are.

Let me turn to an issue that we hope to give particular focus to in this Parliament: the need to tackle obesity. It is appropriate that I do so just after an intervention on cancer, because we are understanding more and more about the links between obesity and cancer in later life. They are frightening and shocking. We want to tackle issues such as childhood obesity fiercely in this Parliament. The biggest link between obesity and ill health, however, is that between obesity and type 2 diabetes. If not properly managed, type 2 diabetes can have devastating consequences, including loss of eyesight and limb amputations.

[Jim Shannon]

In my contribution I asked about legal highs. Perhaps the Minister could give some idea of what will happen with those.

[Jane Ellison]

The relevant Bill is being brought forward by another Department, but I noted that the hon. Gentleman welcomed it and am sure that we will return to that.

The start of a new Parliament provides an opportunity to take a serious and thoughtful look at how we tackle a big issue such as obesity. As I said during Health questions earlier today, there are no silver bullets; it will require effort on a global, national and local scale. We are working up our plans for that and will announce them in due course, but they will involve everyone. All parts of Government, local government, industry and individual families will need to move the dial on such a big issue in a way that has not been done in the developed world. There will be interest right across the House in tackling it, particularly the link with diabetes. I note that the right hon. Member for Leicester East (Keith Vaz), who has so often championed the issue in the House, is in his place.

The NHS is coping well with unprecedented pressures. That achievement has been possible only through the hard work of doctors, nurses and health professionals, together with our commitment to invest in the NHS, but a strong NHS needs a strong economy. It is only by having a long-term economic plan that we can increase the NHS budget by £8 billion in real terms over this Parliament. The public got that, even if the Labour party did not. However, there is much more to do. I hope that the era of scaremongering and running down the NHS is over—[Interruption.] Sadly, I am beginning to think it is not. I really hope that we can make a new start. One of the saddest conversations I had during the election—I am sure that this could be echoed by many colleagues on the Government side of the House, particularly new Members—was with an elderly constituent who had been informed very seriously by a Labour canvasser that the NHS was going to be sold to an American company. That was absolutely shocking.

Social Care and Military Compensation

Jim Shannon Excerpts

Wednesday 25th March 2015 Commons Chamber

[Mr Gordon Marsden (Blackpool South) (Lab)]

As has now been confirmed several times, this is the last occasion to raise such issues in this Session, and I wish to speak about the unfair treatment of some veterans owing to the disparity in the way that different armed forces compensation schemes are treated when social care costs are calculated. I pay tribute to Poppyscotland and the Royal British Legion, which highlighted that issue with their Insult to Injury campaign. In the past, I have been pleased to work closely with the Royal British Legion, both nationally and locally in Blackpool, and together we delivered a petition with 3,000 signatures calling for stronger punishment for those who vandalise war memorials. I was also pleased to support the Blackpool armed forces covenant and veterans charter in 2011. I wish to touch on that veterans charter and covenant, praying in aid the arguments I will present tonight.

As chair of the all-party group on veterans, which deals with a number of issues, including welfare, I was fortunate to initiate a meeting in Parliament with the Forces in Mind Trust. Its latest report is about support for veterans’ families, and we will hear tonight about veterans who are losing the means to support their families when compensation payments are removed. Fundraising year-on-year by the Royal British Legion and other ex-service organisations, including Poppyscotland, provides extra support for veterans. Locally and nationally, our veterans should not be left by the state in financial circumstances that are unfair. The state must do its bit, particularly when there are unequal Government regulations.

Tonight I will focus on the disparity between the way that the two different compensation schemes operate. Those injured before April 2005 received compensation for particular injuries through the war pension scheme, which provides regular payments based on the severity of injury. Those injured from April 2005 onwards receive support for any disablement through the armed forces compensation scheme—AFCS. That comes in two parts: a lump sum and, in a similar fashion to the war pension, a regular payment for the most severely disabled veterans and ex-servicemen. Those two schemes seek to compensate for the pain and challenge of particular injuries that some veterans receive when serving bravely in our armed forces, but when it comes to how they are processed through the social care system, they are treated very differently.

As of 2012, any veteran supported by the newer AFCS scheme has all that income disregarded while they are means-tested for social care. Although their other forms of income are rightly considered so that they make the same contribution as any civilian to their social care, they will still have left over the income they receive to compensate for the injuries they received in the military. Those on the older war pension scheme, which could cover awards from the second world war up to 2005, receive far less support. Only £10 of their war pension is automatically disregarded, and the rest can be clawed back by local authorities into paying for their standard social care. The full value of the war pension—which of course reflects the level of disablement suffered by that veteran—is on average £80 a week and can be as much as several hundred pounds a week for the most severely injured.

Does the Minister agree that it does not show enormous respect to veterans on the war pension scheme, who have fought in conflicts from the second world war to Korea, the Falklands and in some cases as recently as Afghanistan, if we suggest that the pain of those disabling injuries is worth only £10 a week? What compounds that regrettable diminishment of the veterans’ sacrifice is the apparent injustice and inconsistency in the way the two schemes are treated in social care and the way different arms of Government look at the problem.

Almost all local authorities use their discretion fully to exempt the income from both compensation schemes when council tax or housing benefit is calculated, and central Government have recognised that both types of compensation should be left untouched when the new universal credit is calculated for recipients who have served in the forces. Yet protecting that income for council tax and housing benefit will be in vain if the great majority of it is then lost to pay for social care. As I have said, Government guidelines only disregard £10 of the war pension, and in present circumstances local authorities have not been able to go much further, with only 12% of councils using discretionary funding fully to exempt those on the older scheme. That is completely inconsistent with the way that civilian personal injury compensation is treated in social care means-testing. When saved in a trust fund, that income is fully disregarded by local authorities as they calculate care costs. What is left appears to be a social care system that, however worthy its objectives, fails to meet two criteria of the armed forces covenant that Members from both sides of the House were proud to support.

[Jim Shannon (Strangford) (DUP)]

It is appropriate that the last Adjournment debate of this Parliament concerns our veterans and our soldiers, and I congratulate the hon. Gentleman on securing it. Many Members have a particular interest in the armed forces. In the years that I have been a Member of Parliament, we have had the chance to speak on behalf of our veterans. I know many veterans who suffer from post-traumatic stress disorder and their number, after Iraq and Afghanistan, has increased significantly in the past few years. Does the hon. Gentleman agree that the onus is on the Ministry of Defence, the Department of Health and local government to work together to address this issue? The Minister represents the Department of Health. Other Departments, which are not represented here tonight, need to work alongside her.

[Mr Marsden]

I agree with the hon. Gentleman, who is assiduous in covering veterans’ issues in this House. I pay tribute to the military from Northern Ireland for the sacrifices they have suffered over the years. He is absolutely right. We are pleased that the Minister is here tonight, but the issue can only be solved out of Government silos.

The covenant enshrines the principles of no disadvantage and special treatment. These, in turn, dictate that a person should experience no disadvantage as a result of military service and that it is appropriate in some cases for special treatment to be applied to those who are serving or have served. We have already seen that as a result of failing to disregard the war pension, Ministers are not providing any special treatment for veterans. More fundamentally, however, they end up failing the rule of no disadvantage, too, as the injuries incurred purely as a result of action in the armed forces receive little compensation when income such as the war pension is diverted into providing standard civilian social care.

I am pleased, therefore, that my colleagues in the Labour Front Bench team have pledged, under a future Labour Government, to review the compensation schemes to see where they might be improved. In particular, the focus should be to take a laser-like focus to existing and new rules that affect veterans through the prism of the armed forces covenant. We want to ensure that the principles of no disadvantage and special treatment are met by all arms of government.

All Members have, at one time or another, drawn attention to the strong feelings of many veterans and others about insufficient engagement with the concerns raised in relation to social care and military compensation. I welcome the reports from the Government, the Royal British Legion and Poppyscotland that talks are ongoing about how the two schemes might be aligned, but we need to see results. After all, every year, as more elderly veterans pass away, the group of people who could benefit from a change in the rules diminishes by 5%. Half that group are aged 70 or over. We are running out of time to offer these people the chance to navigate social care in far greater comfort, with access to the full deserts of their military compensation. With a change in the rules, we can put this right, but it needs real Government commitment. I have to say, however, that when we look at the Government’s stated objections so far, they seem to give the impression of delaying progress rather than accelerating it.

Ministers have claimed that some of those on the old war pension scheme also receive top-ups to their pension, which are designed to help to pay for care costs. Only 6% of war pensioners actually receive such care top-ups. More to the point, it is surely not beyond the wit of the Government to devise guidelines that will include those care top-ups in the payment for social care, but not include that part of their income that relates to the pain suffered through injuries received in the field of conflict. This is a position that the Royal British Legion accepts would be perfectly reasonable.

Ministers have also suggested that military compensation could be placed in a trust fund to protect it from social care means-testing. However, given how war pension works, only a small amount is provided as a lump sum. For the most severely injured veterans, most compensation is provided through regular payments that cannot be placed in a trust. It has also been suggested that the war pensions scheme was established before the modern understanding of personal injury compensation, yet it is clearly understood that way, as is evident, as much as anywhere, from the words of the veterans Minister, who said:

“The War Pensions Scheme provides no fault compensation to Service personnel disabled as a result of their service in HM Forces.”

In the discussion of all these disregards, different schemes and allowances, the human effects of these rules and their perceived injustices can too often be forgotten. In my area, the Royal British Legion estimates that 600 veterans in the pre-2005 group could see their war pension eaten up by care costs, and Members across the country will have service constituents who have told emotive tales of the effects of losing their compensation.

Keith Clarke, who is 43 years old, was left paraplegic while attempting to put out a fire on his submarine. He receives a large war pension for the most severe injuries, but £100 is lost every week to meet the cost of his care worker, who visits daily to help him dress and look after his two children, one of whom is also disabled. His only other benefit comes from statutory benefits. He told The Daily Telegraph:

“I feel angry and frustrated. It’s…an injustice to be treated as a second-class citizen.”

Fred Cannon, who fought on the Gold beach at Normandy on D-day when he was 19 years old, was the only survivor of the company to come home, but a severe bullet wound left him with one leg shorter than the other. Now in his 90s, like too many others, he is left with only £10 a week compensation. Then there is the 50-year-old Lancashire veteran who was diagnosed with osteoporosis from his time in the Army. He said:

“Unless the system changes, I’m concerned that I will lose a lot of my pension, which isn’t fair. People who receive AFCS don’t pay for their social care—and rightly so—but why should we pay just because we were injured before April 2005? It doesn’t make sense.”

Of the two principles of the armed forces covenant, it is ultimately not special treatment that veterans want; all they want is not to be put at a disadvantage: to have the injuries they suffered in the armed forces compensated for in their own right and then to make a contribution from their other income towards social care, just as any civilian would rightly do. They want fair treatment for all and a system that does not discriminate on the basis of an arbitrary date; they want to be treated the same in the different means tests that central and local government operate; and they want to be treated in the same way as civilians who receive compensation for personal injury.

Whatever the historical context of the creation of the war pension scheme or the complexities of its operation today, it is surely possible to design a system that will meet the requirements of the proper 21st century fairness that the veterans are asking for. The time has come to go beyond discussions and look for concrete solutions to the disparity between the two different military compensation schemes, rather than focusing on the obstacles to a more just system. I am pleased to note that Labour would review the fairness of military compensation in the light of the armed forces covenant, and I call on Ministers to show a similar political will and commitment.

Many Members will have the date of 7 May on their minds tonight, but many other people will have a possibly more important date—the next day—on their minds. That will be the 70th anniversary of VE-day. I feel honoured that both my late parents served in that conflict, and I am mindful of the debt we owe to those of that generation who remain with us. At this time, we must surely refocus our energies to ensure that we provide all the support that the brave men and women who have served in conflicts spanning the last 70 years deserve, particularly as they make their way through challenging periods of their lives in the social care system.

Vaccine Damage Payments Act

Jim Shannon Excerpts

Tuesday 24th March 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Dumfries and Galloway (Mr Brown) for setting the scene. He spoke passionately and told us why we need to do better. He said, “Is there a better way to do this?” and I wrote down, “I think there is.” This debate will perhaps give us a chance to have an idea of how we can do better. He and the hon. Member for Worsley and Eccles South (Barbara Keeley) illustrated where the system falls down and how we can improve it. I would like to do something along those lines as well.

It is of utmost importance for us to reflect upon this issue once more, as the quality of innocent individuals’ lives are at stake. We vaccinate to prevent illness, to protect the most vulnerable in our societies and to protect those we care about, whether they are our family, children or constituents. It is very unfortunate when good intentions do not result in their intended outcome, which is to protect and not harm. Unfortunately, harm is what can occur. The contributions so far have shown that harm has taken place. We need to learn how best to deal with that and how Government could respond in a more generous manner.

Although such tragedies are thankfully rare, it is a reality for the few who are affected and we must take responsibility for dealing with the outcomes of vaccination damage. We must take account of individuals who have become severely disabled when they may otherwise have led a healthy life without the burdens of their condition, because of a vaccination that was believed to be medically safe. We must think of their well-being. We must also take account of those who, through their work, found it necessary to have vaccinations, resulting in effects that they had not foreseen.

It is a difficult thought to come to terms with. Affected individuals could not have imagined that these vaccinations would lead to their living with debilitating conditions. We must do our best to aid those families and individuals to deal with the burden as best they can in the circumstances and with the everyday realities that they have to face. We must investigate why, out of 1,483 claims made between 1 January 2000 and 31 December 2010 to the vaccine damage payments unit, only 26 have resulted in an award. Why is that? Something must be wrong with the system. Either it is too complex, or the delays are too long, or the questions that are asked are difficult to answer. The system needs to be looked at.

We need to reform the Vaccine Damage Payments Act. It is too outdated to deal with the financial and practical realities of living with the adverse effects of a vaccination, and too outdated to recognise that there is a spectrum of difficulties that those affected face, not only those above the 60% threshold. That is also an issue. The hon. Member for Dumfries and Galloway talked about the 60% threshold, which almost debars people. I always feel that we as parliamentarians are here to help those who need help. We must do it in a good way and make it simple and easy for them to find help. Today’s debate gives us a chance to try to chart a way forward that is easier for individuals to deal with.

The Vaccine Damage Payments Act provides an opportunity to apply for a one-off £120,000 lump sum to meet the burdens of coping with a disability. Whether this is to assist the person who has become disabled as a result of a vaccination, or the family who cares for the person, there are costs to be met. These are costs that individuals and their families would not have foreseen, caused by the adverse reaction to a vaccination that requires them to be met. To be eligible for such a scheme, the individual must be over two years old and must apply within six years of vaccination, or up until their 21st birthday, whichever is the later. This means that if the adverse reaction results in death, but the victim is less than two years old, nothing can be awarded to the parents. That discrepancy must be addressed. Furthermore, it leaves carers to pay independently for the care that is needed until the claimant is eligible at the age of two. The rules simply do not deal with the emotional realities of such situations.

We cannot always mark a family’s problems solely on physical issues. There is the emotional trauma that the family and their relations go through as well. What is even more striking is that not all those affected by vaccination damage are recognised in the current legislation as requiring financial assistance. The requirement that a person has to be 60% disabled to be eligible for a single amount of £120,000 is a very hard and fast rule, and cuts out others who are vulnerable and need compensation to deal with the difficulties that disability brings. To be 60% disabled, or above, has a profound impact on a person’s life, reinforcing that we must change how we deal with payments to those affected. It seems too absolute to have a 60% cut-off when we come to a situation in which a victim may fall below this figure, yet be affected in their life. They can be greatly affected, but, because of the eligibility criteria, not entitled to any assistance.

A range of degrees of disablement can affect an individual’s life and irreparably alter it. For that reason, reform needs to look at assisting all those who have been affected in different ways through vaccination damage, and as a result deviate from the standard fixed sum given on a sliding scale. I hope that the Minister’s response will give an idea of how those suffering as a result of the vaccine can be given better financial assistance.

As has been pointed out on a number of occasions, including in the work of the all-party group, the provisions to deal with adult cases are poor. It would be appropriate for the 1979 Act to be applied more comprehensively to adult cases. The requirement that vaccination must occur before a victim’s 18th birthday, apart from in the exceptions outlined in the Act, means that the scheme’s adult application is far from lucid. There are workers whose jobs mean they must be vaccinated to deal with the dangers of their workplace. Hepatitis B is one such vaccination, but it is not included in the Act. Is it proposed that it should be included? It is important to consider that question.

The workers most affected are doctors, nurses and social workers, but members of other similar professions that revolve around a duty of care are in a similar situation. Those people, in aspiring to fulfil the requirements of their job, have availed themselves of vaccines and that has resulted in their being left without livelihood or career, and with a quality of life that is not as it was before.

The question of access to life-saving or life-changing drugs has also been on my mind, and other hon. Members have touched on it. There was an example in the debate pack of a family who had to leave England for the States to qualify for drugs, which they got free there. I presume that that was because they would also be part of a testing scheme. The drugs greatly improved the child’s life. They moved to California to qualify for drugs that they could not get here, because they cost too much. The Minister and I have previously talked about drugs for cancer sufferers, and so on. I suppose more is possible with a large budget, but I think that something must be done about improving the availability of drugs.

The legislation often makes adult payouts subject to the industrial injuries schemes, with the result that the compensation often cannot come close to what is required to meet the financial challenges of the affected person. We must remember that it is not financial considerations that are at stake, but rather recompense for loss of a career and personal independence, and a reduction in quality of life. I am inclined to argue that those victims should be equally able to obtain the £120,000 payout through the Government’s vaccine damage payment scheme. There is a clear need for hepatitis B to be covered by the legislation.

Although I have spoken of the £120,000 figure and argued for it to be extended to a wider range of cases, that is not to say that the sum is adequate; it is almost speculative in relation to the life expectancy of individuals eligible to meet the requirements of the scheme. That is wrong. We should be doing all we can to extend and make easier the lives of those affected, by giving higher levels of financial support. The fact is that the costs of caring for someone with a disability are high, and in the case of a child the sum offered will not span a lifetime’s care, so families can be left to struggle when money becomes stretched and the pressure is on. Adult cases also involve personal livelihood if the disability becomes debilitating. Inadequate and unrealistic payouts or failure to be compensated at all can make financial considerations an added concern in an already stressful and emotive situation.

Is there a better way? I suggest there is, and I urge the Minister to review the matter.