Breast Cancer Screening

Jim Shannon Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Speaker]

Order. As colleagues know, I like to call everyone on statements, and I do not wish to make an exception today, but I remind the House that we also have a ten-minute rule motion and a very heavily subscribed Opposition day debate. In pledging to try to get all remaining colleagues in, I ask them to do us all the great favour of being extremely brief. I am sure that Mr Shannon has in mind just a short sentence without any preamble or subordinate clauses.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and for his compassion and care. Is he aware of any discussions on the continued alignment with the European Medicines Agency’s drug licensing process to ensure that our breast cancer patients, and indeed all cancer patients, have access to the benefits of the European trials and UK citizens are able to participate in clinical trials? This is very important.

[Mr Hunt]

That is a slightly different topic, but we have no greater priority than to ensure that Brexit does not interrupt the cancer care of UK patients.

Mental Health Services (Norfolk and Suffolk)

Jim Shannon Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Dr Poulter]

Yes, that is absolutely the right way to provide integrated services and joined-up care, because we cannot necessarily have a one-size-fits-all approach across Suffolk or Norfolk. We need to look at the local healthcare need. That is partly about working not just with housing providers, social services providers, primary care and GPs, as I believe is happening in my hon. Friend’s constituency, but with the voluntary sector, other third sector providers and local charities, many of which have knowledge of the needs of patients, families and carers. When we are providing joined-up, holistic mental healthcare, it is just as important to make sure that the approach is joined up and holistic in that regard, and I believe that the project in my hon. Friend’s constituency will have a very good chance of improving services for patients.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Dr Poulter]

I will make a bit of progress first and give way in two or three minutes.

The challenge from a lack of bed capacity is acute; 36 beds have been closed in recent months, 28 of them temporarily to be reopened as soon as possible. One of the challenges, as my constituency neighbour, the hon. Member for Ipswich (Sandy Martin) said, comes from the lack of joined-up working and a failure of commissioners, to some extent, to work collaboratively with the trust to identify short-term solutions. None of us wants to see patients travelling outside Suffolk. The commissioners have not worked well with the trust, because beds are available. My neighbour, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is unable to speak because of her Government role, has rightly highlighted that bed capacity is available at the Chimneys in Bury St Edmunds—18 beds, including specialist eating disorder beds, which are available and could be commissioned if the commissioners worked more collaboratively and supported the leadership of the trust more effectively. I hope that will come out of the collaborative and pioneering work on which the trust’s partners are now supporting it.

None the less, there are some positive things to point towards. Building work is going on to deliver some new wards, and it is hoped that Lark ward in Ipswich, the psychiatric intensive care unit, will be able to reopen later this year. There are hopes that more can be done for child and adolescent mental health services, with continuing expansion in the number of beds.

--- Later in debate ---

[Jim Shannon]

I congratulate the hon. Gentleman on securing the debate. I sought his permission to intervene beforehand and told him why I wanted to. With the prevalence of mental health issues 25% higher in Northern Ireland than in the rest of the United Kingdom, and with our NHS unable to meet the demand on the service, does he not agree that mental health reform must be UK-wide and undertaken urgently, before people who simply need a bit of help to cope become people who need in-patient care and a strong drug regime to survive? Do it now and it can stop problems later.

[Dr Poulter]

I agree entirely with my hon. Friend. He is always a strong advocate for the needs of his Strangford constituents. He is right to highlight that early intervention and early support can be very effective. That is partly because it often prevents some of the other unwanted effects of having a mental illness. When people have been untreated for a long period, they may well lose their job and struggle with their relationships. A number of the supportive and protective factors that can help to support someone through mild and moderate ill health, such as being in work or in a supportive relationship, can be lost. If we can do more to help people in the early stages, that is a good thing—quite apart from it potentially reducing the number of acute admissions later on.

I want to make the important point that the staff shortages at the trust are one of the major challenges that need to be addressed. It is frankly, and I do not use this word lightly—I do not think I have ever used it before, even though we often hear it used by politicians—a scandal that there is such a shortage of staff at Norfolk and Suffolk mental health trust. I hope the Minister can think of better ways to fund and support the trust. Without enough staff, it cannot expand services or deliver safe services. The trust has struggled with CQC inspections because there are not enough staff on the ground to deliver the care it wants to deliver. That is not entirely the fault of the trust, however, as it is constrained by its funding.

I will outline some of the issues that the trust faces. It has had difficulty recruiting band 5 registered mental health nurses—there are approximately 125 full-time vacancies; there are 35 full-time equivalent vacancies for psychiatrists, partly owing to a national shortage, but also owing to particular challenges in the east of England; almost one in five medical posts at the trust are vacant—that means that doctors who should be there treating patients are not because of staff shortages; and 16.02% of qualified nursing posts are vacant. That is not acceptable or sustainable. If we are to improve patient care and help the trust to turn around, the fundamental issue of recruitment has to be addressed. There are fewer than 15 psychiatrists per 100,000 people in the region, which is much lower than the national average. In fact, the east of England has the fewest psychiatrists per head of population in the country.

Doctor recruitment is not a good story either. Issues with the junior doctor contract might not have helped, but we are where we are. Recruitment for CT1 junior doctors in 2017 saw only 16 of 45 vacancies filled—that is 36%—so only one third of the number of doctors who should have started training at CT1 level are working in the trust. That is a big rota gap to fill and will of course affect patient care. In 2015-16, about one third of ST4 vacancies in child and adolescent psychiatry were filled. In general adult psychiatry, which is the bread and butter of psychiatry, only nine of 18 posts were filled in 2015. In 2017, only five of 22 posts were filled, which means that less than a quarter of posts for registrar trainees in general adult psychiatry are filled. The story goes on and is equally bad in older-age psychiatry—and we have a lot of older people with dementia to look after in the east of England.

Recruitment, then, is vital. We have to do more to recruit psychiatrists. The current strategies are not working, so I ask the Minister to look at what has been successful overseas—in Queensland, Australia, and other places—and to put financial incentives in place to support nurses and doctors to come and work in the east of England, because at the moment patients are paying the price for a lack of doctors on the ground. The trust is doing its best to recruit, but it needs extra financial support through Health Education England, and it needs to be given support and the go-ahead from the Department. We know from elsewhere in the world that financial incentives work in rural and coastal areas, as long as doctors and nurses are helped with a relocation package. The Department’s successful health visitor programme is a good example of how financial incentives can work. I hope she will look at that.

The pressures on the trust’s finances have been there for many years—since the merger of Norfolk and Suffolk mental health trusts—and we know that mental health has been underfunded nationally for decades. The trust needs £9.2 million to meet CQC recommendations for improvement. Some £4 million can be funded from the capital budget, but given that the CQC has criticised the building’s infrastructure, it seems ironic to raid the capital budget for buildings and infrastructure and put it into the revenue budget to deal with immediate quality of care issues.

Even with that £4 million, however, there is still a shortfall of £5.2 million, and that was the subject of a recent funding bid to NHS England. The bid will be resubmitted fairly soon, and I hope the Minister will encourage NHS England to look favourably on it. It is important that the trust is given the financial wherewithal to deal with the quality issues raised by the CQC, to reinvest in vital community services and to undertake the vital work on integration that my constituency neighbour, the hon. Member for Ipswich, mentioned in his intervention.

There is some positive news. The ligature reduction project is proceeding successfully, and some good work is being done in the rebuilding programme at Chatterton House. The Norfolk and Waveney perinatal mental health service was launched in September. I pioneered support for the expansion of perinatal mental health services when I was a Minister, and I am pleased to see that it is now happening on the ground. In February a specialist perinatal mental health service was launched in Suffolk, which is a very good development. However, severe challenges remain and need to be addressed.

Finally, let me say something about services for patients with addictions. I will be brutally honest: I think that we created a problem with effective addiction treatment through the Health and Social Care Act 2012. The commissioning of addiction services has been transferred to local authorities, although the bulk of mental health services and physical health care for patients with addictions is still run by the NHS.

In the east of England, the amount invested in drug misuse services has been reduced by about £6 million over the last four years. Drug misuse is a serious challenge in areas such as Lowestoft, Ipswich and Norwich, not just as a result of underfunding but because those services are not working in a joined-up way with mainstream physical and mental health services. That must be addressed as a matter of urgency, because patients are falling through the net and not receiving the holistic care that they need. Many end up in the criminal justice system as a result, and the police and, in some cases, communities are picking up the pieces because of the failure to provide joined-up care for those patients. The lack of substance misuse services as part of any NHS system affects the dynamics and practicalities of good care, such as the sharing of information. Barriers are created, and the good intentions of staff on the frontline are undermined. That has an adverse effect, and I am sure that we will continue to see a rise in the number of drug-related deaths as a consequence.

Let me ask the Minister some questions. What additional support can be offered to the trust to help it to deal with its historical and current financial challenges and transform its services in the wake of the CQC’s report? There is a shortfall in funding; the trust has submitted a funding bid, and I hope that the Minister will support it. What additional resources can be made available to improve the recruitment and retention of psychiatrists and nurses, and what can be done to attract junior doctors to the east of England? One in five doctors who should be at work are not there because of staff vacancies. What steps are being taken to stop the transfer of patients out of area for treatment? Finally, what can be done to ensure that there is proper integration of addiction services with mental health services in our region, to ensure that patients are given a better deal?

It is time for the rhetoric about mental health to join up with the reality, and for patient care to improve. It is time for Norfolk and Suffolk mental health trust to be given the support that it needs, so that it can do the best for its patients.

HPV Vaccination for Boys

Jim Shannon Excerpts

Wednesday 2nd May 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is a pleasure to serve under your chairmanship, Sir Henry, I think for the first time. I congratulate my hon. Friend the Member for North Thanet (Sir Roger Gale) on securing the debate and bringing this important subject to the House. He was in the Chair the last time I was in Westminster Hall, which was just yesterday. I am surprised that so few Members are present for the debate. As the shadow Minister suggested, perhaps matters elsewhere in the House and outside are occupying their minds.

As my hon. Friend the Member for North Thanet mentioned, our expert group, the Joint Committee on Vaccination and Immunisation, is considering this matter, and it is important that I do not pre-empt its final advice, as he rightly said. That does make the timing of the debate challenging, but I will respond as fully as I can and give as much context as possible.

I will first set out some of the context. In 2008—before I was even a Member of the House—on the advice of the JCVI, an HPV vaccination programme for girls was introduced. The primary objective was to protect against cervical cancer. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) kindly said, my mission in life—not just in my job—is to challenge and beat that dreadful disease. While I am on the subject, I pay tribute to Jo’s Cervical Cancer Trust and the brilliant Rob Music, who leads it—I know that the hon. Lady knows them well. The trust’s work in this area over many years, including with me as Minister, has been truly transformative for many women’s lives.

The HPV vaccine that is used in the UK offers protection against the two types of HPV that are responsible for about 70% of cervical cancers, and since the introduction of our vaccination programme the number of young women infected with HPV has fallen dramatically. Protection is expected to be long-term, eventually saving hundreds of lives each year, which I am sure we all agree is very welcome. Today, however, our focus is on boys and men.

[Jim Shannon (Strangford) (DUP)]

Is the Minister aware of the paper on this subject by Dr Gillian Prue of Queen’s University Belfast? Dr Prue’s six recommendations are very similar to what the hon. Member for North Thanet (Sir Roger Gale) and others have put forward today. They include: first, that both men and women should be vaccinated against HPV-related diseases; and secondly, and more importantly, that the significant human cost of HPV-related diseases should be the primary consideration for including boys in vaccination programmes. If the Minister has not been made aware of the paper, I am happy to furnish him with the copy. Its recommendations are integral to moving forward on the issue.

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.

Bowel Cancer Screening

Jim Shannon Excerpts

Tuesday 1st May 2018 Westminster Hall

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

I beg to move,

That this House has considered bowel cancer screening.

It is a great pleasure to serve with you in the Chair, Sir Roger, and I am glad that you have taken your seat.

Bowel cancer is the fourth most common cancer in the UK. Sadly, around 16,000 people die from the disease each year. It is estimated that between now and 2035, around 332,000 more lives could be taken by this awful condition. Nearly everyone will survive bowel cancer if it is detected at its earliest stage, but unfortunately only 15% of bowel cancer patients fall into that category.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman for securing the debate. Does he agree that early-stage cancers are not only easier to treat, but less costly for a cash-strapped NHS? That is why we need an effective screening programme that includes lowering the screening age to 50 and implementing the simpler and more accurate faecal immunochemical test. That would help to get the earlier diagnosis, to stop the cancer.

[Nick Thomas-Symonds]

I entirely agree with the hon. Gentleman about the need for an optimal screening programme—I will come to that in a moment.

In Wales around 2,200 people are diagnosed with bowel cancer each year. Nearly half of those are diagnosed at a late stage. Approximately 900 people in Wales will die from bowel cancer every year, but 78% of patients will survive for one year or more, and 58% for five years or more. These figures are not mere statistics; every single extra day with the people we love is a great joy.

I lost my own mother, Pamela Symonds, to bowel cancer on new year’s day this year. She lived just under two years after her formal—too late, I am afraid—diagnosis. She was one of the 10,000 people diagnosed annually at the late stage of bowel cancer. I know only too well the impact that bowel cancer has on families.

Cancer Targets

Jim Shannon Excerpts

Tuesday 1st May 2018 Westminster Hall

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered NHS cancer targets.

I thank Mr Speaker for granting this important debate, and I thank you, Mr Streeter, for chairing it and the Minister for taking time out of his busy schedule to address it.

The matters I will raise today, as briefly as possible, are matters I have raised throughout my nine years at the helm of the all-party parliamentary group on cancer. As I near the end of my chairmanship, I thank all those parliamentarians, and the wider cancer community, who have supported and continue to support the group. They have been great stalwarts; the group has achieved much and has much to achieve. I look forward to remaining involved, but at the same time I look forward to handing over the reins.

Despite the fact that, when in government, both main parties have highlighted improving survival rates and supported process targets as a means of driving change, it remains an inconvenient truth that cancer survival rates in England and, indeed, the rest of the United Kingdom continue to lag well behind the international average. What is more, there is only limited evidence that we are catching up. In 2009, the Department of Health estimated that we could save an extra 10,000 lives a year if we matched European average survival rates. In 2013, the OECD confirmed that our survival rates rank near the bottom compared with other major economies, and for some cancer types only Poland and Ireland fare worse.

Of course, Health Ministers are right to point out that cancer survival rates continue to improve. That is welcome news, but it is not the full story. As our survival rates have improved, so have those of other countries, and there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. The major inquiry by the APPG on cancer in 2009 uncovered the main reason our survival rates are so far behind international averages. It is not that the NHS is worse at treating cancer—once cancer is detected, NHS treatment generally bears up as strongly as that of other healthcare systems—but that it is not as good at catching cancers in the early stages when treatment has the best chances of success. Late diagnosis, therefore, lies behind our comparatively poor survival rates, and addressing that is the key to improving our cancer performance. Early diagnosis is cancer’s magic key.

So how can we best achieve it? Since the publication of our 2009 report, we as an all-party group and the wider cancer community have come together and successfully campaigned for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level. Clinical commissioning groups are now held accountable for their local survival rates through both the delivery dashboard and the Ofsted-style scores.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman: we all know the hard work he does through the APPG and his personal passion for the subject. It is important to put that on the record, because we know why he is here. I have apologised to him, and I apologise to you, Mr Streeter, because I cannot stay. I have a meeting with a Minister at 3 o’clock, so unfortunately I cannot make the contribution that I would have liked to have made. I am sure that the Minister is disappointed, but none the less he will hear from me again in the near future.

Is the hon. Member for Basildon and Billericay (Mr Baron) aware that the target for 95% of patients with an urgent referral to wait no longer than 62 days for first treatment has not been met at all in the past year and, further, that the target for 98% of patients to receive first treatment within 31 days of a cancer diagnosis has also not been met in any of the last four quarters? Does he share my concern and, I am sure, that of the Minister?

[Mr Baron]

I thank the hon. Gentleman for his kind words. I am aware of those statistics, and I will come to the 62-day target specifically later in my address. He is right to say that many CCGs and cancer alliances are not close to achieving many of those targets. That is obviously a problem when treating cancer, but it highlights a bigger issue: we should be focusing on outcome indicators rather than process targets as a means of encouraging earlier diagnosis. I will address his point specifically in a moment.

We tried very hard to get the one-year survival rates into the DNA of the NHS. The Government listened, and we now have CCGs being held accountable for their one-year survival rates, which is good news. The logic is simple: earlier diagnosis makes for better survival rates, so by holding CCGs to account for their one-year figures and, in particular, the actual outcomes, we encourage the NHS to promote earlier diagnosis and therefore improve detection.

A key advantage of focusing on outcome measures is that it gives the local NHS the flexibility to design initiatives tailored to their own populations to improve outcomes. CCGs can therefore choose whether to widen screening programmes, promote better awareness of symptoms, establish better diagnostic capabilities in primary care, embrace better technology or perhaps improve GP referral routes—any or all of those, in combination—to try to promote earlier diagnosis, which in turn will improve the one-year cancer survival rate figures.

Rather than the centre imposing a one-size-fits-all policy, the local NHS has been given the freedom to respond to and focus on local priorities, whether that be lung cancer in the case of former mining communities or persuading reticent populations to attend screening appointments. As an all-party group we try to do our bit. Each summer, the group hosts a parliamentary reception to celebrate with the 20 or so CCGs that have most improved their one-year survival rates. Successive cancer Ministers have supported that in the past, including the incumbent.

There is strong evidence, however, that that outcome indicator is being sidelined by hard-pressed CCG managements, who are focused on those process targets that are connected to funding. If the process targets are missed, there is a cost; if the one-year figures are missed, there is not. In recent decades, the NHS has been beset by numerous process targets that, instead of measuring the success of treatment, measure the performance against process benchmarks, such as A&E waiting times.

National Bereavement Care Pathway

Jim Shannon Excerpts

Tuesday 24th April 2018 Commons Chamber

[Will Quince (Colchester) (Con)]

It is a pleasure to lead this debate this evening, and may I thank the Minister for being here to respond?

I never entered politics with the intention of becoming a baby loss awareness campaigner. As with so many in this field, the loss of a child—my son in 2014—brought about my interest and desire to bring about change. And being a Member of this House, gives every one of us the platform to make a difference. It can be a small change that affects just one of our constituents, or it can be something larger that affects everyone in the UK. I am proud that through my role in this House I have been able to play even just a small part in the development and roll-out of the national bereavement care pathway, which is something that will make a difference to tens of thousands of bereaved parents and families up and down the country.

Before I move on to the pathway itself, I want to pay tribute to you, Mr Speaker. You have been hugely supportive of our baby loss awareness campaigning efforts in this place, and I know I speak for all members of the all-party group on baby loss when I say a heart- felt thank you.

Launched last year at 11 sites across England, the pathway has been developed by a number of baby loss charities, royal colleges and professional organisations with the support of the Department of Health and Social Care and the APPG. It is designed to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and baby loss up to 12 months. The pathway provides a practical framework for all those healthcare and other professionals involved and has been informed and led by the views of bereaved parents at every stage of its development. Parents have stressed the importance of sensitive and consistent care, of making informed choices, of privacy, of not having to repeat their stories to different members of staff and of having opportunities to create memories and spend time with their babies. As one bereaved parent put it:

“Parents don’t need protecting; they just need the chance to be parents, provide their child with dignity and create memories.”

Each year in the UK, thousands of parents and wider families sadly go through the devastating experience of losing a child. While we cannot take away that devastation and grief, good care can make a devastating experience feel more manageable, while poor-quality or insensitively delivered care can compound and exacerbate pain.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on his hard work in this area—we are all greatly moved—and he is right to thank you, Mr Speaker, for all you have done. The combination of both your efforts is highly regarded in the House. Does the hon. Gentleman agree that, with three babies a week being stillborn or dying in the first four weeks of life in a nation as small as Northern Ireland, those suffering this heartbreak must be supported, which is why the care pathway is essential?

--- Later in debate ---

[Will Quince]

The hon. Lady—and I will call her my hon. Friend—has made a very valid point, and I thank her for all her contributions to the formation and the continuing work of the APPG. She is right: there is a taboo surrounding baby loss, and we must break it. I remember the first debate about it that we held here, in November 2015, and the floods of e-mails and messages that we received from parents out there who were saying, “Thank heavens, someone is now talking about baby loss.” They had felt so enclosed, and unable to talk about it, to the extent that people would cross the street to avoid having to have that awkward conversation.

That is exactly why the pathway is so important. Although NHS professionals up and down our country are caring and compassionate to their very core, not everyone has experienced this kind of grief. It is important that the pathway is parent-led, because that enables parents to share the experience of what they went through, how they were feeling, and how things could possibly improve in the future. I encourage the hon. Lady to continue her work in the APPG and continue to participate in debates like this, because that shows the country as a whole that we are willing, ready and able to talk about baby loss, and will not stop talking about it until as have addressed some of these big issues.

[Jim Shannon]

The hon. Gentleman is being gracious in giving way—I thank him for that. One of my staff members had two miscarriages, and the loss for her was immense. What sustained her through that time of grief, which he knows about himself, was the support of family, friends and all of us associated with her, but probably more than anything else her faith and her Christian beliefs. Does he agree that it is critical that that is part of the pathway?

Cancer Treatment

Jim Shannon Excerpts

Thursday 19th April 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak in any debate, but especially one on cancer. First, as others have done, I congratulate Baroness Tessa Jowell. I see her not in stilettos but as a real soldier and a real warrior. I thank her for her courage and determination. I thank the hon. Member for Croydon Central (Sarah Jones) for setting the scene. To pick out one speaker in particular, with no disrespect to anyone else, I thank the right hon. Member for Old Bexley and Sidcup (James Brokenshire) for his contribution. What a joy it is to see him back in the Chamber again making a valuable contribution, as he always does.

This is always a tough kind of debate to speak in, for a number of reasons. We rightly all use the statistics and numbers that are so informative, but tend to gloss over the pain felt by the families and loved ones. We rightly talk about how far we have come in terms of greater life expectancy, yet those families who watch this debate with an empty chair beside them cannot share the victory. We are rightly bombarded with requests from charities and families asking us to highlight their particular issue that needs to be addressed. We want to do that, yet we do not have the time to discuss all that needs to be discussed. We rightly discuss value for money in funding research, yet which one of us is comfortable in putting a price on the cost of the quality of life for someone, and which one of us is happy to dictate a cut-off age when someone is too old to be treated or given innovative new drugs? We all seek to do what is right and to do our best, but it can never be enough when it comes to a debate like this. My father is a three-time cancer survivor. He did not die because of cancer—he died three years ago of natural causes. His survival from cancer was down to the good work of the NHS, the skill of the surgeon and the care of the nurses—and it took all of our prayers.

I highlighted in my own press release background information from Brain Tumour Research, which was probably in the paper today. I recently had a photo with a lovely lady called Phyllis Scott, with whom I have had a great friendship over the years, in aid of raising awareness of brain tumours—I know that that is close to the Minister’s heart. I wore my country sports hat for the purposes of the photograph, and today I am wearing my MP hat to look at the issue of brain tumours.

Brain tumours reduce life expectancy by, on average, 20 years—the highest of any cancer. The statistics are well known. In Northern Ireland, 344 people were diagnosed in the last year. Some 60% of people diagnosed with a high-grade brain tumour will have a very short life in this world. The figures are shocking, but when we meet someone like Phyllis Scott, the human face is very clear. Some 62% of children who survive a brain tumour will be left with a life-altering, long-term disability. Brain tumours are the biggest cause of preventable or treatable blindness in children, as the right hon. Member for Old Bexley and Sidcup pointed out. Some 91% of adults said that their brain tumour affected their emotional and mental health. Those are the key figures—many of those diagnosed with brain tumours have tremendous issues.

I love the hard-hitting new Cancer Research advert that shows an older couple in bed together as a stark reminder that the issue is not simply surviving, but living with a husband or wife and children. The hon. Member for Redditch (Rachel Maclean) spoke about being a breast cancer champion. I am one too, and I very much wanted to do that. The number of people diagnosed in the UK went up by 17% between 2006 and 2016. Some 95% of women will survive one year and more than 80% survive five years or more. None the less, every year around 11,500 women and 80 men in the UK still die from breast cancer.

I have asked the Minister about the drugs fund many times, and so many other hon. Members have mentioned it that it would be remiss of me not to do so. The threshold is £30,000, and the hon. Member for Ilford North (Wes Streeting) mentioned putting a price on the drugs that help a young child survive. In Northern Ireland, the Department of Health, Social Services and Public Safety has now endorsed the NICE recommendations on Kadcyla, Ibrance, Kisqali and Perjeta, as a result of the flexibility shown by NICE, tough negotiation by NHS England and a willingness to compromise on price by the pharmaceutical industry. However, this flexibility, negotiation and compromise can lead to long delays in decisions. I urge the Minister to consider how we could best provide access to drugs more quickly and urgently to increase the quality time that people have to spend with their loved ones.

I want to put on record my thanks to Cancer Research, Macmillan, Marie Curie and others that make the difference to the quality of life that those who suffer from cancer experience. We must push forward and keep doing all we can, and know in the end that we gave all we had to fight this disease that affects our mothers and fathers, sisters and brothers, sons and daughters, grandchildren, even the person we buy our paper from—all the people we meet every day. Cancer is a blight on society, but if we continue to fight on, someday we will be able to say that we have won, and cancer has lost.

Cyber-bullying: Young People’s Mental Health

Jim Shannon Excerpts

Monday 16th April 2018 Commons Chamber

[Alex Chalk]

I am very grateful to my hon. Friend for that intervention. He should not be modest about his contribution, which was absolutely fantastic and gratefully received.

To say a little more about the context, recent research by the Prince’s Trust suggested that young people’s wellbeing has declined over the last 12 months and is now at its lowest level since the study was first commissioned in 2009. What is interesting as well is that this is not just a British phenomenon. A recent article by NBC in the United States, citing research from Johns Hopkins University, referred to an acute mental health crisis happening among members of the youngest generation of Americans, with, as the article put it,

“critical implications for the country’s future.”

Similar data is emerging from France and Germany.

Much of the debate in this House has been about a cure—about how we go about fixing the problems after they have emerged. We have debated achieving parity of esteem, funding child and adolescent mental health service beds closer to home, and so on. All that is vitally important, of course, but equal attention must be paid to prevention. Why is the surge happening in the first place? How can we stop it taking root?

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate, and I sought his permission beforehand to intervene. With 20% of young people—that is one in five—indicating that their fear of cyber-bullies makes them reluctant to go to school, does he agree that much more must be done to thwart the faceless keyboard warriors who are making the lives of so many young people so very difficult?

[Alex Chalk]

I do agree. The hon. Gentleman makes the point very powerfully, and in a moment I will develop why I agree with him so wholeheartedly. I found from speaking to young people that the role of social media has become impossible to ignore. It is not the only issue, of course, but it is a recurrent theme. Although there appeared to be a correlation between the rise of social media and the decline in adolescent mental health, I, colleagues and hon. Members wanted to know if there was causation, too. The report provided powerful evidence to suggest that there is.

By way of context, I should make it clear what the inquiry and this debate are not about. The inquiry was not set up to blame all the world’s ills on the internet or social media. My view is that social media is broadly a force for good. Equally, the internet as a whole fosters social mobility and opportunity. It spreads ideas and enhances freedom across the world. The inquiry did not seek to address all the concerns posed by social media use either. It deliberately left out the issues of fake news, sexting, sleep deprivation and others. All those are important but have been traversed elsewhere, and dealing with them would have made the report unwieldy and unfocused.

Instead, the report and this debate are about one issue only, cyber-bullying, and that is because the evidence from young people, including those we spoke to in the inquiry, suggested it was the single biggest risk factor in mental ill health associated with social media use. We wanted to drill down on that by taking evidence not just from young people but from experts in brain development, and the evidence from more than 1,000 young people was clear: cyber-bullying can be utterly devastating. It is relentless and inescapable. We heard harrowing evidence from young people taken to the very edge of despair. No one is saying of course that bullying does not exist in the analogue world, but it is this added toxic cyber layer, with its extraordinary capacity to amplify torment, that can prove so destructive.

What is so troubling is that the inquiry also found that children are using social media at a very early age —61% had a social media account at the age of 12 or under—and for a long time too: nearly half use it for more than three hours a day and nearly 10% check their social media feeds between midnight and 6 am, with girls twice as likely as boys to be high-intensity users. A troubling proportion—68%—of young people were affected by cyber-bullying, and the medical evidence showed that its impact could last into adulthood, with what one expert called

“lasting consequences on the adolescent brain”.

It seems that this searing experience can be a scarring one too.

Autism

Jim Shannon Excerpts

Thursday 29th March 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) on bringing this debate to the Floor of the House, and I thank all the right hon. and hon. Members who have made significant and wonderful contributions, including personal points of view, to this debate. World Autism Awareness Day is designed to highlight autism and, more importantly, the struggles that those who have autism go through and how we as a society can help them. We certainly are making strides towards that. The Minister will be able to highlight some of the things that we have done and, to be fair, some of the things that we still need to do.

Some local churches in my community allow local autism groups to use their facilities as a safe space to meet and have fun with the children in a controlled atmosphere. The Moviehouse chain of cinemas in Northern Ireland screens autism-friendly screenings on the first Friday of every month, making certain changes to make the experience more enjoyable for the child and their families, including having the sound and lights on low and no trailers, giving people the freedom to move around and take their own food and drink, and offering free entry for carers with a valid CEA card. Odeon cinemas also offer certain autism-friendly screenings.

I want to say a public thanks to those chains and to my own local cinema, Movieland Newtownards—now part of IMC chain since the sad passing of Ernie Watson—which has plans to begin autism-friendly screenings in my constituency. I suggest that other hon. Members have a chat with their local cinemas to see whether they will do the same. Such screenings may not make the most money—that is not what they are about—because people are allowed to bring in their own snacks for their children to eat and because there are no adverts, but they provide a service that is appreciated by families throughout the community. The life of an autistic child can be somewhat isolated, and the nature of the complex needs of the child can also mean an isolated family life for those who live with the experience every day.

Research cited by the Royal College of Psychiatrists that has been mentioned by others highlights the high levels of suicide among autistic people. Roughly 40% of autistic young people have symptoms of at least one anxiety disorder, compared with 15% in the general population. The hon. Member for Glasgow South West (Chris Stephens), who has just left the Chamber, referred to the welfare changes, and I want to put on the record my concerns about them. Autistic children and adults are affected by changes to ESA, work capability assessments and PIP. Assessors need to be aware of what it is to have autism. With respect, if they had that ability, it would make things a lot easier.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

Constituents have told me that they are absolutely terrified by the assessment process, so does the hon. Gentleman agree that there needs to be a far more sensitive and direct approach to dealing with people with autism?

[Jim Shannon]

The hon. Gentleman is absolutely right, and he and I regularly share comparisons between our constituencies. Assessors need to be sensitive, reactive and understanding.

Autism is a massive issue for schools to deal with, and only a seasoned teacher may be able to spot the signs of autism in a child. The hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) referred to a child who was able to go and sit on a cushion behind a desk, and that shows an understanding teacher who knows how to deal with such issues. We cannot reach out and cure the situation as such, but it is important that we build in the support systems. While there has been significant improvement in the number of diagnostic assessments, and many hon. Members have referred to early diagnosis—the hon. Member for Berwick-upon-Tweed referred to her own circumstances in a personal and honest way, and it is important that we listened to that—coverage is still very patchy. Will the Minister outline how the Government are ensuring equity of access across the country? Have discussions been held with the Northern Ireland Department of Health to ensure parity of accessibility?

Northern Ireland has a slightly different system in that we have the Autism Act (Northern Ireland) 2011, and the hon. Member for North Ayrshire and Arran (Patricia Gibson) referred to the Scottish legislation, which also came into force in 2011. The regions across the United Kingdom have some really good stuff in place and have done significant work, and I suggest that we should be exchanging that good practice. If we do that, I think we will all gain. Northern Ireland has gained from what has been done in Scotland, and Scotland and Northern Ireland can gain from what you do in England. I again suggest very gently that you could really gain from what has been done—[Interruption.] Sorry, Madam Deputy Speaker, not you; I meant the Minister. Someday I will learn not to use that word—you live in hope.

In Northern Ireland, one in 40 or 2.5% of children have a diagnosis of autism. Accurate prevalence figures for adults can be difficult because many adults with autism do not have a formal diagnosis so the statistics are misleading, but 25% of individuals with autism have an accompanying learning disability. It is not just the autism but the spin-offs such as anxiety disorders and learning disabilities. Their education may be a wee step behind, but we have heard good things today about the results for children when effort and time are put in.

The fact that four males are diagnosed with autism for every one female is perhaps an indication that we might need to address the gender issue. However, we know that it is sometimes harder to diagnose females with autism, so the statistics may hide the true number of autistic females.

Statistics show that 16% of autistic adults are in full-time employment, despite individuals with autism having ability. Again, it is important to put the issue of employment on the record. Many autistic people, especially those diagnosed in adulthood, have little or no access to post-diagnosis support, as the hon. Member for Cardiff West (Kevin Brennan) also mentioned. Young adults with autism should not be forgotten, so what are we doing nationwide?

Diagnoses of autism are as different as snowflakes, which means that a one-size-fits-all approach simply does not work. We have to look at it individually and not collectively, because that is not how it is done. We must diagnose the level of each individual and provide appropriate support not simply to them but to their family. It must also be highlighted that, although one in four people with autism has a learning disability, three in four do not. Whether or not there is a learning disability, we must do more to support all of them to reach their full potential rather than be held back by a lack of understanding from society in general.

Our job in this House, through the Minister, whom we are pleased to see and to support, is to ensure that adequate support services are in place and to raise awareness to foster greater understanding among the general public.

Patient Safety

Jim Shannon Excerpts

Wednesday 28th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I wish to start by congratulating my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this really important debate on patient safety. All patients have a right to expect care that is compassionate, effective and safe. The courageous testimonies of individuals such as Julie Bailey, who exposed the scandalous failings at Mid Staffordshire NHS Foundation Trust, and Sara Ryan, who campaigned fearlessly following the death of her son, Connor Sparrowhawk, while in the so-called care of Southern Health, show that safer care starts with listening to patients and their families.

It is important that we recognise that there are many victims when care fails—the families and the loved ones, of course, but also the healthcare professionals who carry the burden of their mistakes. The great majority of NHS patients receive effective and successful care. However, according to international studies, levels of healthcare harm range from 1% for the most “negligent” adverse events, to 8% to 9% for preventable adverse events. We are clear that any level of harm over 0% is unacceptable, and we believe that the route to a safer NHS is through transparency, learning and action. What is most frustrating is when harm persists, despite our having the knowledge and wherewithal to prevent it. There are approximately nine “never events” in the NHS every week—avoidable harms such as wrong-site surgery or foreign objects left after an operation.

Thirty years ago, the aviation industry stood at a similar crossroads. Since then, there has been a massive reduction in fatal accidents every decade, despite a huge increase in the number of passengers. According to the Civil Aviation Authority, there is an average of one fatality for every 287 million passengers carried by UK operators. Compare that with the 150 avoidable deaths every week across the NHS. That rate would potentially equate to the loss of 52 airliners per year.

How has the airline industry transformed its safety record so successfully? The key has been a “just culture” that recognises honest human error, but continues to hold people to account for criminal acts or wilful negligence. Creating a safe space that protects the evidence provided by pilots and air traffic controllers when there is an investigation is a cornerstone of the approach. It helps to create a culture in which people can be open about their errors and a system of learning from one’s mistakes, rather than blaming individuals.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Sleaford and North Hykeham (Dr Johnson) on securing this debate on an important matter. NHS staff are greatly restricted by their work and the long hours they do. We all know that and pay tribute to them. Sometimes, however, we have to look at better ways of keeping records and at innovations to streamline things to make sure that the real focus of NHS staff is on the work that they do. Has the Minister looked at streamlining and innovations to take away the red tape that restricts the caring job that NHS staff do?

[Caroline Dinenage]

The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.

As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.