Patient Safety and Medical Innovation

Jim Shannon Excerpts

Tuesday 9th December 2014 Commons Chamber

[George Freeman]

I am sure my hon. Friend is right. She makes an excellent point about the nature of the question having an impact on the answer one gets. I have repeated the concerns because they bear repetition and are important, and I want to signal that I am taking them seriously.

I want to set the scene in terms of the Government’s commitment to patient safety, the context in which innovative medicines are being developed, and the changes in the sector that are challenging some of the traditional methods of drug development. I will then address some of the specific points that my hon. Friends the Members for Totnes and for Cambridge have made and say something about the Government’s position on the Bill.

The Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry, led by Sir Robert Francis, “Hard Truths: The Journey to Putting Patients First”, demonstrated beyond any doubt, I hope, the Government’s absolute commitment to creating a new culture of openness, compassion and accountability and a renewed focus on patient safety right at the heart of the NHS.

The truth is that the NHS is one of the safest health care systems in the world. I am delighted to report that, in the recent Commonwealth Fund report comparing the US health care system with those of 11 other nations, the UK came top. However, there is always scope to improve health care standards universally and to reduce avoidable harm further. That is why the Secretary of State set the ambition this June, at the launch of the Sign up to Safety campaign, to reduce avoidable harm by half and save 6,000 lives over the next three years.

We have put patient safety right at the heart of the Government’s agenda for health. For that reason, I am delighted that the Government are actively supporting the Bill on patient safety sponsored by my hon. Friend the Member for Stafford (Jeremy Lefroy). The Bill has several important provisions on the use of data to drive safety across the system and to ensure transparency and accountability in health outcomes.

Why do we need to look at mechanisms for promoting innovation? My hon. Friend the Member for Totnes was kind enough to signal her awareness that the Government—particularly me, as the first Minister for life sciences—have taken an active role in trying to promote it. The reason is that we face a challenge in the field of drug discovery and development, as well as in medical technology generally. There is a challenge and an opportunity.

The challenge is that the more we know about disease, genetics and data—the datasets at our disposal in the NHS, and the history of drug reactions and the way in which patients respond to diseases differently—the more we realise that patients respond to the same disease or the same drug in different ways, and that those ways can often be predicted. These insights are beginning to change the way in which drugs are developed.

Increasingly, we do not need the one-size-fits-all, blockbuster drugs that we have traditionally expected the industry to bring us after long, slow, protracted and increasingly expensive clinical trials and randomised, double-blind trials. Of course, those trials have a strong part to play in our system, but the more we know about the nature of disease and the extraordinary breakthroughs that our biomedical and life sciences sector is making, the more the agenda shifts to designing around patients, as well as around tissues, data and genomics. That is why the Government are so committed to shifting our policy landscape to support the extraordinary role that our NHS can play globally. It is a uniquely well positioned, integrated national health care system, with extraordinary leadership in genomics and informatics, which the Government are actively supporting.

My hon. Friend made the point that the randomised, double-blind trial has given medicine great service in the 20th century, and I agree. As we move further into the 21st century and see the transformational power of new technologies, it is equally true that the system of expecting the industry to go away and spend 10 to 15 years, and an average of £1.5 billion, to develop a new drug—many of them fail in late-stage clinical trials, because of some toxic side effect in one patient or a few small number of patients—is leading to a crisis in the industry and in the pipeline for new drugs and new treatments, and to patients increasingly suffering because we cannot give them innovative medicines.

Part of the agenda for this Government and all western Governments is to look at how to accelerate the way in which our health systems support research and to bring innovative medicines, as well as devices, diagnostics and other innovations, to benefit patients more quickly.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being in the Chamber at the beginning of the debate, Madam Deputy Speaker, but I did not realise that the business had moved on so fast. In the university in Belfast, we have developed some great partnerships in relation to finding new drugs. Nearby Belfast city hospital works together in partnership with the university to address the issue of innovation for new drugs and to address how best to utilise them and make them available. I know that the Minister is aware of that, but does he recognise that such a partnership—with Queen’s university, financed by big business, alongside the NHS in the form of Belfast city hospital—is a precedent for how to innovate?

[George Freeman]

The hon. Gentleman makes an important point. I want to take this opportunity to pay tribute to the work being done in that cluster at Queen’s. I am delighted to say that I will be coming in the new year to support it and to show, as the UK Minister, that there are great clusters in Scotland, Northern Ireland and Wales. I very much look forward to that visit.

The truth is that the landscape is changing. Part of the challenge that we all face is to find ways to accelerate earlier access to innovative treatments for patients, and earlier access for those developing innovative drugs, devices and diagnostics to our health system, so that we can more quickly design innovations that are more targeted and personalised. We are seeing the first genuinely personalised cancer therapies and drugs that, in the unfortunate event that one is diagnosed with cancer, can be designed around one’s genetic profile. I was at a seminar on that development this morning. It is changing the landscape of drug development. We are keen to ensure that we benefit from it in the UK and that we use every mechanism in the NHS to support it.

Breast Cancer

Jim Shannon Excerpts

Tuesday 25th November 2014 Commons Chamber

[Annette Brooke]

I thank my hon. Friend, and yes, it is so important. We have the good news that life expectancy is increasing under these circumstances, but that makes it all the more important to think about the quality of those extra years.

There are far fewer clinical nurse specialists for secondary breast cancer. There is no definitive figure, but estimates from Breast Cancer Care suggest that there may be no more than 20 clinical nurse specialists who have expertise or experience of working with secondary breast cancer. This is despite there being approximately 36,000 people living with a secondary breast cancer diagnosis. Given the results of the cancer patient experience survey, and anecdotal evidence from those living with secondary breast cancer, we can assume that many secondary breast cancer patients are not having as positive an experience in their care as those with a primary diagnosis. Unfortunately, we do not know for certain as the cancer patient experience survey does not include a specific stand-alone question on secondary breast cancer. It is essential that the survey continues, so could it not include a question on secondary breast cancer?

Breast Cancer Care ran a taskforce on secondary breast cancer in 2006. Its final report, published in 2008, highlighted a number of issues, other than those already mentioned, that patients with secondary breast cancer face. Those include multi-disciplinary teams not discussing secondary breast cancer routinely, the information needs of patients not being met, and patients not being assessed for their psychological or social needs following a diagnosis—the point that my hon. Friend has just made. Unfortunately, it seems that little progress has been made in the six years since that report was released.

Underpinning the problems with care and treatment for secondary breast cancer—and key to much of this debate—is the lack of data and information about patients diagnosed and living with the disease. As I have already mentioned, we still do not have an accurate figure for the number of people who have been diagnosed with secondary breast cancer, only an estimate. We do not have enough quantitative evidence about the experiences of secondary breast cancer patients.

I had the opportunity to meet some women at a recent Breast Cancer Care event to mark secondary breast cancer awareness day last month, and they told me that the care they received was often inadequate, and certainly not at the same standard as the care that followed their primary breast cancer diagnosis. Some typical comments from patients with secondary breast cancer include:

“A diagnosis of secondary breast cancer changes your life completely—nothing is ever the same again”;

“When you’re diagnosed with secondary breast cancer you can have no idea of just how far and in how many different ways it’s going to change your life. So many people don’t understand what a secondary diagnosis means”;

“So many people tell me how great I look, or tell me that I can beat it with chemo and surgery. They don’t understand that I am in pain and I can’t be cured”;

“The pain I had, from when I was diagnosed, basically it was excruciating. But the pain had started slowly and I’d always had aching pains in my chest area. To the point that it was so bad that I couldn’t hold a glass in my hand or put a handbag on my shoulder. I couldn’t touch my head, I couldn’t dress myself. I couldn’t sleep. I couldn’t turn on my side. And also I couldn’t breathe properly”;

“One thing that does distress me is the lack of continuity in my care and I think that if I had one person who was with me through it all that would help a lot”;

and

“The strange thing about this whole disease is that they don’t really prepare you at all. It’s almost finding out as you go along”.

I think that those comments highlight how much progress we have made on primary breast cancer, with all the advice and support that is given to patients very early on. I want to use this debate to highlight not only that progress, but the need to address those issues for secondary breast cancer, some of which have been faced with primary breast cancer.

Although the comments I have just read out highlight the human story, they are not enough to help us find the solutions. Without firm data and evidence, it is impossible to understand fully the impact of secondary breast cancer. We do not really know enough about the types of treatment that patients are receiving or how the quality of a patient’s life changes over time. That lack of information makes it virtually impossible for commissioners to be able to plan and commission services properly that meet local needs. That, in turn, makes it much harder for clinical nurse specialists with the right knowledge and skills to be recruited, particularly when NHS budgets are under pressure. The result is that patients continue to miss out on the vital support and care they need.

As I mentioned earlier, the Government have committed to improving the collection of data on secondary breast cancer, making it mandatory for the NHS in England. When my colleagues and I met the Prime Minister, he agreed that adequate data collection was required. Following that meeting, in January 2011, the Department of Health published its national cancer strategy, “Improving Outcomes”, which committed to collecting data on secondary breast cancer for the first time, stating:

“During 2011/12 we will pilot the collection of data on recurrence/metastasis on patients with breast cancer with the aim of undertaking full collection from April 2012.”

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Lady for giving way and apologise for not being here for the beginning of her speech; I was at a do down below and could not get here in time. She has just outlined the importance of collecting and then using data to respond to those who have breast cancer. She will also be aware that Breast Cancer Care has campaigned strongly to ensure that data are collected in England. I understand that it hopes to have a similar initiative in Scotland, Wales and, hopefully, Northern Ireland. She refers to the NHS in England. Does she share my opinion that the data should be collected for the whole of the UK so that we can agree a strategy that all four regions of the United Kingdom of Great Britain and Northern Ireland can benefit from?

[Annette Brooke]

I thank the hon. Gentleman for his intervention. I hope that the Minister has taken that point on board, because it is really important. Although data are being collected, they are not being received by various groups, and the purpose of this debate is to address that.

The pilot was run by the National Cancer Intelligence Network in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report, published in March 2012, identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as being referred to a clinical nurse specialist, palliative care nurse specialist or other key worker at the time of diagnosis. That is despite the NICE quality standards and the evidence in the cancer patient experience survey of the benefit to patients of a named nurse.

--- Later in debate ---

[Jane Ellison]

I certainly pay tribute to all those who are trying to drive awareness of this issue. There are a number of very important campaigns. Prevention is so important; for example, it was good that it was right at the heart of the recent NHS “Five Year Forward View”. There is a lot more to do, and I have recently had discussions with some of the breast cancer charities about how we use their reach and undoubted public credibility, which is enormous, to raise awareness more about some of the things that people can do on the prevention front, as well as about their important work on care and drugs. I join my hon. Friend in paying tribute to those campaigners.

The NHS is treating more people with cancer than ever, as I have said. Survival rates for breast cancer are improving, with more than 85% of women with breast cancer in England and Wales now living for more than five years. The work that all the charities have done in that regard is really important. They have all made significant contributions, but we know that more needs to be done, and that is the focus of this debate. We need to catch breast cancers earlier, and to avoid the risk of secondary breast cancers. We also need to improve the detection and treatment of secondary breast cancer, as my right hon. Friend has highlighted.

My right hon. Friend spoke very movingly about pain and its management. I am sure that we all agree that our NHS doctors and nurses do everything that they can to alleviate pain. In fact, it was good to see from the 2014 cancer patient experience survey that only 1% of patients reported that they did not think that hospital staff did everything they could to control their pain. Indeed, 86% of patients—the highest level in the four surveys so far—reported that staff did everything they could to control their pain. She is right to say that referral to specialist palliative care services can provide more by way of effective pain relief. The NHS must do what it can to ensure that women with secondary breast cancer have access to the right services. She is also right to highlight the room for improvement on that.

On the patient experience for women with secondary breast cancer, the results of the 2014 cancer patient experience survey show improvements in many areas, with 89% of all patients reporting that their care was either excellent or very good. As my right hon. Friend said, there are two specific references to secondary breast cancer in the NICE quality standard. The first states that people who develop it should

“have their treatment and care discussed by the multidisciplinary team”,

and the second states that people with recurrent or advanced breast cancer

“have access to a ‘key worker’, who is a clinical nurse specialist whose role is to provide continuity of care and support”—

she mentioned that—

“offer referral to psychological services if required and liaise with other healthcare professionals, including the GP and specialist palliative care services.”

NICE clinical guidelines represent best practice, and we expect commissioners and clinicians to take them into account when making decisions, including on the provision of cancer nurse specialists. On the whole, breast cancer patients reported a more positive experience than many other cancer patients, and 93% were given the name of a clinical nurse specialist. My right hon. Friend is right to highlight the fact that we are not doing as well for patients with secondary cancer or a recurrence of cancer—those patients reported a worse experience and were less likely to have a clinical nurse specialist. NHS England is working with NHS Improving Quality, Macmillan Cancer Support and strategic clinical networks to improve the cancer patient experience and spread good practice across hospitals providing cancer care. That includes support from a clinical nurse specialist for those with secondary breast cancer.

[Jim Shannon]

The Minister is good in debates such as this and we always appreciate her response. One thing that is not always mentioned is the work done by pharmaceutical companies and their investigations to find and perfect new drugs to combat cancer. Current TV programmes often show people saying, “We’re almost there” when speaking about a cure for cancer—well, we are halfway there anyway. Together with pharmaceutical companies, universities such as Queen’s university in Belfast do fantastic work to find new drugs to address cancer and many other things. Sometimes that point is missed in debates such as this, so perhaps this is an occasion to get that on the record.

[Jane Ellison]

I pay tribute to the hon. Gentleman who is always present in health debates and makes an important contribution. If he were to secure a debate on research and clinical trials, I would be delighted to respond. He is right to say that that topic is sometimes a bit unsung, and it is enormously hope-giving for people to hear what is in the pipeline. He is right to highlight that issue, and perhaps we could explore it in a bit more detail on another occasion.

I alluded earlier to work that is taking place to bring everybody up to the best standard. That includes pairing highly rated cancer trusts with those that have potential to improve, regional events for commissioners to consider how patient experience survey results inform commissioning decisions, and the publication of guidance on using survey data to drive improvement. The survey is used in very hands-on ways, and in previous debates I have been impressed at the extent to which data are used right at the front line to say, “This is what really good looks like”, or to highlight where services can be improved by reference to those who are doing things well.

The need to improve is recognised by the NHS. In his forward to the 2014 survey report, Sean Duffy, NHS England’s national clinical director for cancer, recognised the importance of clinical nurse specialists and the need to be particularly sensitive to the needs of patients with a recurrence of cancer. We all recognise the picture that my right hon. Friend painted of people telling others of their diagnosis and what they say and the enormity of the news they are trying to convey not really being understood. Sean Duffy also highlighted the need for sensitivity when the cancer has not responded to treatment as had been hoped.

I understand that NHS England has no plans to discontinue the cancer patient experience survey. I have drawn on it a number of times when responding to debates, and it has been extremely valuable to front-line clinicians for understanding where excellence is being practised. I am keen and have stressed to NHS England on a number of occasions how much Members of the House appreciate the survey and feel that it informs our debates and the knowledge of our constituents.

The survey is overseen by the cancer patient experience advisory group, chaired by Neil Churchill, NHS England’s director of patient experience. Suggestions for amendments or additions to the survey can be addressed to that group. I will obviously draw this debate to the attention of NHS England, and the all-party group on breast cancer will continue to engage with it on ways that the survey could be improved or amended.



My right hon. Friend mentioned the need to improve detection and treatment of people with secondary breast cancer. We need to have good data about those affected. As she said, in the 2011 cancer outcomes strategy we committed to pilot the collection of data about metastatic disease, which had previously not been recorded. In March 2012, a report on the pilot data collection project was published. The pilot programme included data from 15 units and enabled the National Cancer Intelligence Network to identify deficits in the information recorded for those patients. Lessons learned from the pilot have now been applied to a country-wide programme. Since April 2012, all breast units have been required to submit information on all patients diagnosed with a new recurrence or with metastatic disease through the cancer waiting times process.

Analysis of the cancer waiting times data, based on referrals to hospital between 1 April 2012 and March 2013, shows that 7,176 patients were diagnosed or treated for recurrent breast cancer in England. However, we know we need to improve the quality of the data to ensure that we are getting the full picture. There are significant discrepancies between trusts and the analysis will need to be updated with more recent cancer waiting times data to ensure that the figures are robust. The NCIN, Macmillan and the Public Health England knowledge and intelligence teams are working collaboratively on a system to detect patients with recurrent breast cancer by looking at treatment patterns. Results from that collaborative work should be available in 2015. I know it is a source of frustration that they have not been available to date, but that work is at least ongoing. I will pursue that point further with Public Health England after the debate. We have regular meetings. I will of course raise the issue and ensure we keep the House up to date.

On the national peer review programme, I would like to assure my right hon. Friend that NHS England is currently reviewing the national cancer peer review programme with a view to considering how its success might be extended into other new areas of specialised commissioning. Regardless of the outcome of the review, cancer peer review will continue to play a critical part in any broader peer review programme the NHS might introduce. Further details will be published shortly as part of the wider review into specialist commissioning.

The clinical commissioning group outcomes indicator set is not designed for use as an accountability tool. For that, NHS England uses the CCG assurance delivery dashboard—I apologise for the jargon, which, unfortunately, is a feature of these debates—to hold CCGs to account. “Everyone Counts: Planning for Patients 2014/15-2018/19” was used by NHS England to identify the relevant indicators for reporting in the CCG dashboard. In addition, as new data have come on line throughout 2013-14, as well as feedback received on the indicators that are currently being used, NHS England has reviewed whether there is potential to make improvements in 2014-15. The cancer indicators used in the CCG assurance dashboard are based on cancer waiting times. NHS England is continually looking to improve the delivery dashboard. I know the all-party group will continue to engage with that process, as will the charity that supports it and the other charities.

As well as improving patient experience, we want to ensure that women are informed about the risks of metastatic disease so it can be diagnosed early. NHS England breast cancer clinical reference group is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. It is preparing a service specification for the provision of breast cancer services in England. NHS England knows that the information currently given to patients on the risk of secondary breast cancer is variable and frequently inadequate. That was brought to life for all of us in the Chamber by the deeply moving extracts from the comments of sufferers that were read out by my right hon. Friend. I do not think that any of us could have been unaffected by them. The clinical reference group’s service specification will require that all patients should have an end of primary treatment consultation, which will include advice on signs and symptoms that might indicate secondary breast cancer. That information needs to be delivered together with an holistic needs assessment as part of a recovery package. The evidence that this has been done will have to be recorded in the records of every breast cancer patient.

Touching briefly on research, the National Institute for Health Research is enabling patients to take part in trials of new treatments for metastatic breast cancer through its clinical research network.

As we all know, early diagnosis is key. Alongside the work to increase awareness, the Government have committed £450 million to achieve earlier diagnosis and the associated improved cancer survival rates. On breast cancer specifically, in February and March, we ran a Be Clear on Cancer campaign to increase awareness of breast cancer in women over 70. The proportion of women spontaneously mentioning breast cancer rose significantly, as did confidence in people’s knowledge of signs and symptoms of breast cancer. The campaign was well recognised, with many agreeing that the advertising would prompt them to talk to somebody close to them about the symptoms to watch out for. As well as increasing awareness, the campaign appears to have resulted in a large increase in referrals to secondary care in the target age group. The analysis, although only interim, suggests a significant increase in the number of women over 70 self-referring for breast screening. We are encouraged by that.

In addition, Public Health England is funding the biggest randomised control trial in the world and extending the NHS breast screening programme to women in the 47 to 49 age group and the 71 to 73 age group. As the trial is studying the effects of screening on breast cancer mortality rates over time, the results will not be known until the early 2020s, but it is an important and extensive study.

To conclude, I thank my right hon. Friend once again for bringing this debate to the House, the manner in which she introduced it and her important work on this subject throughout her parliamentary career, and I thank my other hon. Friends who have supported her and who also take a great interest in this subject. She is right to point out that fundamentally there is a message hope: so great is our progress that we can now compare of where we want to be with secondary breast cancer with where we increasingly are with breast cancer. However, she also rightly reminds us that more progress needs to be made.

I shall draw this debate to the attention of the national clinical director, Sean Duffy, and make him aware of the concern expressed in the House on this subject. I reassure my right hon. Friend of the Government’s commitment to reducing the incidence of secondary breast cancer and to improving outcomes for everyone diagnosed with this terrible disease. I offer a message of hope and improvement to all of them.

Question put and agreed to.

Physical Inactivity (Public Health)

Jim Shannon Excerpts

Tuesday 18th November 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on bringing this issue forward for consideration.

When we look at the figures for physical inactivity, some of them are horrendous. In a world where we are so image and health conscious, it makes me wonder why we have not moved forward in the way that we should have done.

We followed the Olympic games in 2012 by putting an emphasis on making more people do forms of exercise. Cycling was in, the gas-guzzlers were out and pedal power seemed to be winning the day.

We also have to look at ourselves, because we are all different—in fact, unique. We are all different shapes and sizes. Also, some of us have faster metabolisms than others. Some of us could eat buns and cakes until the cows come home and not get fat; others just look at buns and cakes and their waistline expands straight away. That is what we are—different—so sometimes we have our own in-built systems that have to be addressed as well, and physical activity is a way of doing that. We want to try to ensure that those who are inactive consider physical activity; if they do not do more physical activity, their lives could be shortened.

Thirty minutes of exercise—three 10-minute blocks of exercise—can increase our life span, and reduce our chances of developing a wide variety of diseases. I am a type 2 diabetic myself. My developing diabetes was not necessarily down to a lack of exercise; it was down to diet. What we eat is therefore also important. Physical activity is important, but so is diet.

There are international figures to show the number of people who are not getting the recommended levels of physical activity. In the Netherlands, the figure is just 18% of the population; in Germany, 28%; in France, 33%; Finland and Australia are tied at 38%; they are followed by the USA, the stereotypical view of which is that everything is supersized, including people’s thighs, and 41% of its population are not reaching the levels of activity recommended; but the figure for the United Kingdom of Great Britain and Northern Ireland is 63%, so we are at the wrong end of the scale, unfortunately.

Why is that important? It is important because Finland in 1970, for example, had the highest rate of heart disease in the whole of Europe, but now Finland has one of the lowest rates of premature cardiovascular deaths in Europe, the figure having dropped by 65% since 1970. In Finland, men are now living for an average of seven years longer, and women for an average of eight years longer, than they did in 1970. The right hon. Member for Rother Valley (Kevin Barron), who spoke before me, was absolutely right when he said that it has taken decades for that type of change to happen, but we have to start somewhere and hopefully we can start here.

At present, physical inactivity is responsible for 17% of premature deaths in the UK. According to ukactive, if everyone in England achieved their recommended amount of physical activity, 37,000 lives would be saved each year. Unfortunately, the other part of that equation is that if action is not taken, that figure of 17% will increase by another 15% by 2030. That is why the Government need to encourage the general public to be more active. In her response, perhaps the Minister could consider defining physical activity as a stand-alone public health issue, as has been requested by the World Health Organisation.

In its report, “Steps to solving inactivity”, ukactive found a clear correlation between physical inactivity and deprivation. That is also why this issue should be prioritised in public health, education, social care and transport policy. Active children are more likely to be active adults, so the education in this area must start at home at an early stage. It is for not only the Department of Health, but the Department for Education and other Departments to consider. When it comes to the education of children, we all know the benefits of eating well and exercising.

The right hon. Member for Rother Valley said that when we were younger we had physical exercise; we did not have Facebook or Xboxes. That is a fact. Some parents even tell me that their children contact them in the kitchen below by texting or Facebooking them from the bedroom above. That is ridiculous, but it is a fact; that is sometimes how things are done. That is where we are moving to, and we have to address those issues. We are also in a different age, one where the vulnerability of children is greater than before, and we are obviously concerned about that.

In his introduction to the debate, the hon. Member for Blaenau Gwent referred to the anti-smoking campaign. It has been so successful that since 1998 1.5 million people have stopped smoking. Physical inactivity is the fourth largest cause of disease and disability in the UK, contributing to one in six deaths here. When we consider what the anti-smoking campaign achieved, I believe that we can do the same when it comes to promoting physical activity. Exercise is necessary for everyone’s health, regardless of their shape and size.

Care Workers

Jim Shannon Excerpts

Wednesday 5th November 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I will certainly keep to that figure if I can, Mr Robertson. I congratulate the right hon. Member for Oxford East (Mr Smith) on bringing the matter to the House for our consideration. For us in Northern Ireland, the role of care workers is important, as it is across the whole United Kingdom. Every one of us will have personal knowledge from our constituents, and perhaps in some cases from a family point of view, of the good work that care workers do. As the spokesperson for health for the Democratic Unionist party here in Westminster, I am delighted to make a contribution.

There are a great many different kinds of care offered in the UK; a cross-section includes care homes and home care, which we probably all know about as individual MPs. There is also dementia care—we have to recognise that the population is growing older and that there are more cases of dementia and Alzheimer’s—palliative care and care for those with learning or physical disabilities, to name just a few. In the case of palliative care, Britain is the only country in the world where it is a recognised medical specialism with a full four-year training programme. We have the best palliative care in the world, and it is good to recognise that.

In a recent survey by The Economist, Britain was ranked first in the world for quality end-of-life care. The survey took in 40 OECD and non-OECD countries, including the USA, the Netherlands, Germany and France. When we are beating all those countries—many of us look across at them with some awe when we hear some stories about what they can do—and hearing that we are in the front line, that is something we can be proud of, as it is extremely important to provide the best possible care right through a person’s life, and particularly at the end of their life. I stand in awe of how care workers, of every kind, in every type of care, do their jobs. It takes a certain kind of person to be able to do those jobs—I am not sure whether I could do it, but I admire those who can and who do it well.

A variety of organisations throughout the United Kingdom of Great Britain and Northern Ireland offer these vital services. The NHS is, of course, the main one, but Care UK is also one of the leading independent providers of health and social care services across the UK. For those who do not need to go into a respite or care home, home help is available and care workers can help in a number of ways, from domiciliary care to shopping, cooking and cleaning, and driving the person to and from community events.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that there is sometimes a double whammy, in that the standard of care is put at risk because of the often condensed nature of a 15-minute visit, while that also puts stress and pressure on the care worker, because of the severe intensity of trying to ensure that they get there in time knowing that they have a very limited window? That is causing problems doubly, both for the carer and for those for whom they care.

[Jim Shannon]

I thank my hon. Friend and colleague for mentioning that. Every one of us will adhere to that and will have examples of that as well.

Care workers are responsible for looking after older people, including, as mentioned previously, the provision of dementia care and palliative care, and people with learning disabilities, in order to provide a full and independent life—it is important that we try to make their lives as normal as possible. My hon. Friend highlighted the issue of care workers rushing in for a 15-minute slot, in which they interact with the person verbally and help them physically, or whatever their duties may be. To do that and be out of the house in that time is, I would suggest, impossible.

Care workers also work alongside those with physical or mental health disabilities, as well as people who have acquired a brain injury and are working along the pathway to rehabilitation. On that matter, my brother Keith had a motorbike accident some 10 years ago. He had very serious brain injuries, but care workers gave him attention during their four visits a day. Without those care workers, it is clear that he would not be able to have a normal life at home—as much of a normal life as he could have—so again, everyone is aware of the work that care workers do and the difference that they make.

As was referred to earlier, dementia will affect one in six people over the age of 80. Some 750,000 people in the United Kingdom live with dementia, and having that disease does not always mean that someone goes to a care home. People can stay at home and have a good quality of life at home—that involves not only those who are at home, the family members, but those who call—and undoubtedly, that is due to the fantastic work and support of the care workers who enable men and women with the disease to enjoy an independent and rewarding lifestyle.

Hospice care can run for days, months or years. Most care is provided in people’s homes, but people also visit hospices for day therapy and stay as in-patients. Hospices provide expert care and support for 360,000 people—those are not just figures, they are people. They are individuals and their families, and that is a point I want to hit on as well. The care and support is based on the belief that everyone matters all the way through their life until the moment they die, and that no one should die in avoidable pain, suffering or emotional distress. Such care is very important, as Britain’s older population is set to rise sharply over the next few decades, with the number of people aged 85 and over expected to double in the next few years—some in this room may fit into that category, I suspect, and hope that they will have a good quality of life at that time as well.

Undoubtedly, the job of care workers is not an easy one, and we are deeply indebted to them—people have got to recognise that rather than miss it and not speak of it. However, in recent years, they have not always hit the headlines for the right reasons. Abuse is something that we take extremely seriously, but when we hear of it taking place in care and respite homes at the hands of care workers, who are employed to support and care for them, it is truly sickening. We have heard reports of physical, sexual and emotional abuse. Earlier this year, BBC 1’s “Panorama” did a story on some homes where residents were physically beaten, verbally abused and left in their own excrement for hours.

A Government initiative in England was set up in 2000 called “No Secrets”, aiming to set out the ways in which workers were expected to treat patients with dignity, respect and compassion, as well as ensuring that health and social care services work together effectively. It was a great initiative back in 2000, but given what has come to light in recent months, I feel—perhaps the Minister can respond to this point—that much more needs to be done to ensure that what was set out in the “No Secrets” initiative at that time works better.

The majority of care workers do fantastic work. They do their jobs because they are passionate about helping those who are in less fortunate positions than themselves. However, as with every job, there are those who take advantage, and we have to ensure that vulnerable patients are well looked after and that no abuse takes place. We all recognise the great work that care workers do. They are undoubtedly overworked and do a phenomenal job, and for many people, they are the only contact that they have with the world outside their door.

Transient Ischaemic Attacks

Jim Shannon Excerpts

Wednesday 5th November 2014 Westminster Hall

[Helen Jones]

I of course accept the Minister’s apology. I am sure that she would not be deliberately discourteous to any Member of the House.

Part of the reason why action is not being taken is that public awareness of TIAs is low. A 2012 poll for the Stroke Association found that few people understood the symptoms. In a recent survey of people who had experienced TIAs, the association found that 44% had no knowledge of TIAs prior to having had one and, astoundingly, 61% did not know that it was a warning sign of a possible future stroke. Those were people who had already had TIAs, so it is unsurprising that a third of people take no action following a TIA. Others do not realise that it is a medical emergency and wait for appointments. Astonishingly, the Stroke Association found that a quarter of the people surveyed did not take any action even though they had had TIA symptoms more than once. People may not know where to go for help, and some think that nothing can be done.

When people do seek help, however, it is fair to say that the service that they receive is variable. The all-party group on stroke heard from two former patients, one of whom had been treated quickly and efficiently, but the other had had the opposite experience. The Stroke Association found that while many people have a great deal of praise for how they were treated and for the care provided by health care staff—it is important to put that on the record—16% felt that they were not taken seriously and 25% said that their symptoms had been misdiagnosed. One person at the all-party group meeting had actually heard a paramedic say those classic words, “It’s just a funny turn.” Another person told the Stroke Association:

“Our GP has told us not to bother to attend GP surgery or A and E as it is not worth it for TIAs.”

Another said:

“I had numerous TIAs that were misdiagnosed as migraine.”

Such comments are worrying, particularly given that parts of the NHS deal with the matter well and show great examples of good practice. The south-western ambulance service, for example, has pioneered direct referral of suspected TIA patients to a TIA clinic. It has invested in training its staff and all ambulances carry details of TIAs, of the referral pathway and, importantly, information for patients. I have also heard a great deal about what has been done at Southend university hospital, which went from having a Monday to Friday TIA clinic to having an online rapid referral system, using new technology, that helps GPs and health care staff to assess patients and to transmit information directly to the clinic or even to the consultant’s mobile. It trained more clinical staff to do ultrasounds and changed the protocol for MRI scans, so that patients can be accommodated in between the normal list. As a result, its service operates seven days a week and sees all high-risk patients within 24 hours and others within a week, as recommended. That service saves lives and enables tests to be done and treatment to be begun on the same day. If that can be done in Southend, it can be done elsewhere. The first problem is actually getting patients to realise that they need treatment.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way, and I appreciate her bringing this matter before the House. The Government run the FAST campaign, which covers symptoms similar to those of TIAs. Could the issues be addressed through that campaign? The Government, officials, GPs and families could use it in the same way. That might be a way forward.

[Helen Jones]

The hon. Gentleman takes the words right out of my mouth. I was going to put it to the Minister that the FAST campaign has been excellent and has raised awareness of stroke symptoms and of the need to call an ambulance. We need to extend the campaign to TIAs, because people still wait for treatment or do not access it at all. There are also people who go to the wrong person for treatment, such as an optician, because they mistake their symptoms for something else.

Investment in staff training is vital, in particular for front-line staff, because TIAs are difficult to diagnose. Often when a patient is seen, their symptoms have gone and health care workers rely on reports of what happened. It is also true that TIAs can mimic other illnesses, such as epilepsy, migraine or visual disturbances, which is all the more reason why front-line staff—the first point of contact for patients—should be trained to recognise the symptoms. We must also ensure that referral systems are in place, so that people can access treatment rapidly. I hope that the examples I have given show that it is possible to meet the guidelines contained within the national clinical guidelines for stroke, so that people can be treated quickly and easily. However, the Stroke Association found that 22% of people wait more than a week for their first appointment, which is quite outside what the guidelines recommend.

The provision of information is absolutely vital. The Stroke Association’s report, “Not just a funny turn”, contains many examples of people who have changed their lifestyles and diet after being given proper information following a TIA, so that they hugely reduce the risk of a future stroke, but that does not always happen. Some 40% of people say that they are given little or no information following an attack, and some 50% do not know about the risk of a possible future stroke. The report contains some worrying comments. One person says:

“After TIA I had no support or advice or information… I didn’t know about risk of stroke—was not told this by anyone.”

I find that profoundly shocking. It is not even a case of spending a lot of money; it is simply about having information to give to patients. What will the Minister do to ensure that that actually happens?

My next point, which the Minister and I have debated with regard to stroke, is about the provision of emotional support after a TIA. Like a stroke, a TIA is an event that someone does not expect or plan for. Many people lack support afterwards, but with support they can make changes that reduce their future risk. Some people feel that they need counselling, others simply want to talk to someone who has experienced a TIA and others want to be in contact with patients’ groups or organisations such as the Stroke Association. If people are given the right information, they can do all that, but the information is often not given to them at all. That, too, could be done with little expense.

We have some good care in the national health service—some excellent care—but it is patchy. I want to hear from the Minister how she plans to raise public awareness of TIAs and to extend the FAST campaign to cover them, as the hon. Member for Strangford (Jim Shannon) said.

What will be done about training front-line staff so that we bring everyone up to the level of the best? That is a difficult matter. We cannot blame staff for misdiagnosis if they are not trained properly. We need to train them. What will be done to ensure rapid access to treatment everywhere in the country, not simply for those who happen to be lucky and live near an excellent hospital? The NHS works best when its organisations co-operate and learn from one another. We need to ensure that that co-operation takes place.

Finally, what will the Minister do to ensure that people get the right information following a TIA, as well as support afterwards to deal with the emotional issues and to help change their lifestyles to lessen the risk of stroke in future? That would be a sensible investment for the NHS. It would ensure not only that we saved a great deal of money, but that we prevented a great deal of disability and heartbreak and even deaths.

I look forward to hearing the Minister tell us what is to be done about the important issue of TIAs. We could save lives if we invested in it properly.

--- Later in debate ---

[Jane Ellison]

I note the hon. Lady’s comments.

Turning to the Act FAST campaign, when people have a TIA, getting medical attention quickly is key, as the hon. Lady said. Ensuring that the general public are familiar with the signs and symptoms is important. Public Health England continues to run the highly impactful Act FAST stroke awareness campaign, which covers similar signs to those of a TIA—I note that she is right to draw the distinctions—and the simple message to call 999 if such signs are witnessed. The campaign was run again in March this year, and new adverts feature an Afro-Caribbean man to underline the fact that people from some ethnic groups, whether south Asian, African or Caribbean, are at higher risk of TIA and stroke than others. PHE plans to run the adverts again later in the financial year. Over the summer, the Stroke Association also ran a campaign to raise awareness of TIA, “Not just a funny turn”. It was welcome and many of us saw it.

The hon. Lady also referred to front-line staff and to raising awareness of signs and symptoms. Act FAST and the Stroke Association’s campaign were aimed at public and professionals alike to ensure that everyone acts swiftly. PHE plans to run its adverts, which do not only face the public, again before April 2015.

In addition, NHS England has produced a resource for clinical commissioning groups, to support them in setting and delivering on the level of our ambition to reduce premature mortality. TIAs form an important part of that. The resource includes information on the most high-impact interventions that CCGs can consider commissioning to reduce premature mortality, and TIAs fit into that description. One such intervention is to increase the proportion of patients suffering a TIA treated within 24 hours from 71% to 100%. Let us recognise that TIAs sit right at the core of all the resources being distributed to our front-line staff and produced by NHS England.

NHS England has also been working with the 111 service to ensure that the protocols and triaging systems on the phone lines are used to identify as many people with stroke and TIAs as possible. We recognise that there is more to do and that such work is ongoing.

On getting patients the treatment that they need, quite a lot of work is under way in many parts of the country to reorganise services. That involves reconfiguring care for patients with TIAs as well as acute strokes. For example, in Birmingham and the black country, Warwickshire, Surrey and Sussex standards for TIA care have been set and services are being redesigned to ensure that patients with high-risk TIA can be seen and managed within 24 hours.

The reorganisation of vascular surgery services into a smaller number of higher-volume units is also improving the efficiency of the provision of surgery for TIA. There have been huge improvements in TIA patients’ access to neurovascular clinics in recent years. That is important because, as the hon. Lady said, we know that the risk of stroke in the first four weeks after a TIA can be as high as 20%. It is vital that people are seen urgently and their symptoms investigated, and that a management plan is put in place.

The hon. Lady said that services can be inconsistent. We want to ensure that we work towards making all services as good as the best, but part of that work is to define what the best standards are and to disseminate best practice. I will talk about some of the ways in which that is done.

The 2012 national clinical guidelines for stroke recommend that patients who have had a TIA are seen, investigated and treated in a neurovascular clinic within one week. A few years ago, such clinics were relatively unusual and waiting times could run to weeks or months. Information from the latest Sentinel stroke national audit programme organisational audit published in 2012 shows a picture of real improvement. According to the audit, 100% of trusts in England, Wales and Northern Ireland now have a TIA or neurovascular clinic, with a median of 20 clinics held in each four-week period. There has been a really big improvement in access to those clinics.

The same audit also said that there are very few areas of the country where a high-risk TIA patient would need to wait more than a week, and that over half of high-risk in-patients could be seen the same day, seven days a week. We are waiting for an update of that audit, which is due to be published quite soon. I hope to see further improvement.

In the mini-exchange I had with the hon. Lady at the beginning of my contribution, we touched on best practice. The strategic clinical networks are important for that. They bring together clinicians from across health care settings and the wider health and care system in 12 geographic areas. The SCNs share best practice and promote initiatives on their core service areas, which include cardiovascular disease. The networks hold regular meetings to enable communication and information sharing. As an MP for a London constituency, I saw the benefit of bringing that clinical excellence to bear in the reorganisation of stroke services in London. Such work is ongoing, to make sure that best practice is disseminated around the country.

[Jim Shannon]

One problem I am aware of—I suspect the hon. Member for Warrington North (Helen Jones) is as well—is that TIAs pass in two or three minutes and there is no real understanding of what is happening among friends, relatives or others who are close by when they occur. The hon. Lady is trying to push for raising the level of awareness, and I am sure the Minister would wish to achieve that as well. How can we better achieve that within the Act FAST campaign? That was what I was hoping the Minister would set out.

[Jane Ellison]

I am happy to put that issue on the agenda for my next meeting with Public Health England, which puts together such campaigns. We all wish to raise awareness of the symptoms of a lot of different conditions, but one has to be realistic about how many public information campaigns we can run and how those can be organised. However, I am happy to have that discussion with Public Health England, because we are pleased with the way in which the Act FAST campaign has been received. There is clearly something to build on. I also know that the Stroke Association feels strongly about the issue. I am happy to discuss it and perhaps feed back in due course.

Hon. Members might be interested to know that the National Institute for Health Research has recently funded research on TIAs to look at the pathways taken by patients, from symptom onset to specialist assessment. That research found that factors contributing to delay included incorrect interpretation of symptoms and failure to involve the emergency services. The research is something else we can build on in order to understand what needs to be put in place so that we can do better.

Work is under way, and I am happy to look at what has been said today about public information. However, we have made a really good start. The picture for stroke care is also really improving. Sometimes I respond to debates on issues where we have not seen improvements of the kind that I set out on specialist clinics and surgery. We can see some real momentum, so it is case of building on that and on awareness of symptoms. I pay tribute to the work of the Stroke Association and its report. I saw the “Not just a funny turn” campaign over the summer, which I thought was well judged and was put across well. It did a good job of attracting publicity to stroke and TIA, so I congratulate the association on the campaign.

I hope that what I have said will reassure the hon. Member for Warrington North that the Government and the NHS both recognise that it is vital to ensure that people who have had a TIA receive the right treatment and care to help them to recover. I have not touched on the issue of psychological support, which was the subject of our debate last year, at which time there were encouraging signs. I will write to her about how those have been built upon over the past year and whether we have continued to make progress.

The picture is improving, but we recognise that there is more work to do. I congratulate the hon. Lady on keeping this issue very much at the forefront of Parliament’s attention. As ever, I congratulate the hon. Member for Strangford (Jim Shannon) for contributing to this debate on health in the way in which he always does. We are all keen to see the best possible services for people to ensure that TIA care is of the highest quality and that we minimise the number of people who go on to suffer a stroke.

Question put and agreed to.

Ovarian Cancer (Gene Testing)

Jim Shannon Excerpts

Tuesday 4th November 2014 Westminster Hall

[Ms Ritchie]

I thank the hon. Gentleman his intervention. I agree that it is all about early diagnosis. Women who are diagnosed in the early stages of ovarian cancer have a 90% chance of surviving the next five years, but if the cancer is found at a later stage the five-year survival rate is reduced to 22%—quite a startling statistic. Clearly, early diagnosis and treatment is vital.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this important issue to the House’s consideration. Some 39% of women carry the harmful BRCA1 gene and up to 70% carry the BRCA2 gene. Does the hon. Lady think that those with a family history of the disease should be tested earlier to ensure they have regular check-ups and screenings? Does she also think that those outside that 39% should have checks?

[Ms Ritchie]

I thank the hon. Gentleman for his intervention. I agree that early diagnosis of ovarian cancer is the key for women.

UK survival rates for ovarian cancer are among the lowest in western Europe, with one woman dying every two hours from the disease. Sadly, according to the Department of Health in Northern Ireland, survival rates for the cancer have not improved significantly since the early 1990s. Dr Miriam McCarthy of the Public Health Agency in Northern Ireland pointed out at a recent hearing in Stormont that the northern European and Scandinavian countries have five-year survival rates above 40%, so we could clearly do more to combat the cancer.

Anybody who has personal or familial experience of this dreadful illness knows the devastating impact it has. In Northern Ireland, a lady called Una Crudden courageously documented her fight with the disease and inspired many others to do the same. I know of a young lady, a teacher in my constituency called Oonagh Carson, who died last year shortly after diagnosis, which took her a long time to get.

NHS Services (Access)

Jim Shannon Excerpts

Wednesday 15th October 2014 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

The motion is entitled “Access to NHS services” and I wish to comment on four categories of the NHS where services can be improved. Today we have heard one of the central themes of the next Westminster election on 7 May next year, because the battleground will clearly be the NHS. We have heard different opinions from both sides of the Chamber about the best way forward.

Parkinson’s disease is a progressive neurological condition that affects 127,000 people in the UK with an average age of 50 to 60. One person in every 500 has Parkinson’s disease, and there is no prospect of a person’s condition improving over time as there is currently no cure. Medication is the main treatment for the symptoms of Parkinson’s disease, and many people require multiple doses at specific times throughout the day. People with Parkinson’s who are admitted to hospitals are often prevented from managing their own medication, or are not given it in time. That leads to a deterioration in their condition, or even to permanent harm. It is clear that that costs the NHS some £20 million a year and that it is down to medication mismanagement in hospitals. It is a simple matter of receiving medication in time. What steps is the Minister taking to ensure that people with Parkinson’s always receive their medication on time in hospital, which in turn would mean that patients could return home sooner and that those costs could be greatly reduced? We talk about access to NHS services, but we need to know about funding, too.

Other hon. Members, including the hon. Member for Norwich North (Chloe Smith), have referred to Alzheimer’s. The numbers are horrific. Some 856,000 people in the UK have it: 720,000 in England; 45,000 in Wales; 70,000 in Scotland; and 21,000 in Northern Ireland. It will cost the UK £26 billion a year. Yet again, the question is: can access to NHS services happen? The costs are astronomical. How does the Minister plan to prepare for providing the necessary services in the years to come, perhaps at a reduced cost, and ever mindful of the access to the NHS services we all wish to have?

My third concern is diabetes. It is a great concern to many. It has been referred to in the Chamber and other places as a ticking time bomb that will cost the NHS the most money. It is also a question of access to services. I declare an interest as a type 2 diabetic—other hon. Members have the same problem. Diabetes UK says that, in this year alone, 280,000 people will be diagnosed with diabetes, which is the equivalent of the population of Newcastle—if we want to put the problem into perspective and relate it to a town or a city, that is the figure. The number of people living with type 1 and type 2 diabetes has increased throughout the UK: by 33% in Northern Ireland; by 25% in England; by 20% in Wales; and by 18% in Scotland. Some 738 people are diagnosed with type 2 diabetes per day.

The cost is significant. A report on diabetes in the NHS estimates a total cost of £3.5 billion per annum, or £9.6 million per day. An estimated 10% of the NHS budget is spent on diabetes, which is some £286 a second. The problem is funding and access to services. How do we ensure that people who are diabetic access NHS services?

A health survey in Northern Ireland—I am sure the figures are equivalent for the rest of the UK on the mainland—showed that some 62% of adults were classified as overweight or obese. The interesting thing that worries me a wee bit is children. Some 19% of children were reported to be overweight, and a further 6% were reported to be obese. When it comes to access to NHS treatment, what steps is the Minister taking to address childhood obesity and diet?

My final point is on cancer drugs. A central theme of the motion is cancer referrals and treatment waiting times. The problem impacts not only on those on the mainland, but on those of us in Northern Ireland and on our access to cancer drugs, despite Northern Ireland being an integral part of the United Kingdom and despite it being covered by the work of the National Institute for Health and Care Excellence, unlike Scotland, for example. Patients in Northern Ireland do not have access to 40 cancer drugs simply because of their postcodes.

In my discussions with Jim Wells, the Minister who has responsibility for health in Northern Ireland, he has referred to access in Northern Ireland to the individual funding request, whereby a consultant can submit an application for one of those 40 drugs on a patient’s behalf. However, there is a high hurdle, known as the “exceptionality test”, which is very hard to pass. Many consultants in Northern Ireland do not apply to use the IFR and know that the application will not pass. What discussions has the Minister had with the Minister in Northern Ireland on that? It is totally unfair. I am baffled and find it totally unacceptable that the access to treatments for my constituents who are diagnosed with cancer—they live in Northern Ireland and pay UK tax—is far more limited than it is for patients in the rest of the UK. With that in mind, I believe it is time for the provision of cancer drugs across the whole United Kingdom, and to the 331,487 people in the UK with cancer, irrespective of postcode.

Antibiotic Resistance

Jim Shannon Excerpts

Wednesday 15th October 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Chope. It is always nice to speak on health issues in this hall. It is also nice to see the Minister in her place—we seem to be here regularly discussing health issues—and I look forward to her response.

First, I thank the hon. Member for York Outer (Julian Sturdy) for bringing this issue forward for discussion and for his introduction. The issue is of the utmost importance, and, despite the warnings about it, some people still want to bury their head in the sand like the ostrich—“If you put your head in the sand, the car won’t run you down.” Antibiotic resistance is a serious issue but, for some reason, some people—perhaps many people —are under the illusion that if we do not talk about it, it will not happen. However, it is happening right now, and we should all be extremely worried about it. That is why the debate is important. Indeed, the hon. Gentleman and the hon. Member for Inverclyde (Mr McKenzie) both mentioned the example of the grazed knee—in the past, it was not an issue, but it could be in the future, and people could end up dying from it.

Antibiotic resistance is the ability of a germ to prevent an antibiotic from working against it, and it is a global problem. It is also part of the reason why, in recent years, we have been warned over and over again to take antibiotics only when absolutely necessary. That is a serious issue, which we must address. Although we cannot become resistant to antibiotics themselves, because they are designed to target germs not cells, antibiotic resistance is a major health problem, and we already face the reality of having fewer choices of effective drugs with which to treat basic illnesses.

Some 70% of the world’s bacteria have developed resistance to antibiotics. Unfortunately, we are now in the position of considering drugs of last resort. Before we are at the stage when only one antibiotic is left that can do the business, we need to think ahead. Other Members have talked about the pharmaceutical industry and the development of new drugs, and that is important. The more a drug is used to treat germs, the more resistance they develop. For example, just a few years after penicillin was developed, resistance to it was found in Staphylococcus aureus, in the skin. After years of heavy use, several species of bacteria are now resistant to penicillin. However, the biggest problem facing us is the development of multi-resistant germs, which are resistant to a large range of antibiotics. As they begin to develop, effective treatments become difficult. In that respect, I declare an interest as a type 2 diabetic. Every year, I am eligible for a flu jab to help me combat colds and flu. Some years it does, but some years it does not—I am not quite sure why—but, again, that shows there is resistance to the jab used to deal with flu and the cold bugs out there.

We have been advised to follow some simple instructions to try to prevent germs from becoming immune to our medicines. The advice includes getting antibiotics only when absolutely necessary, and it falls to our GPs to know when that is. Other advice includes washing our hands regularly, finishing a course of antibiotics as advised and ensuring that antibiotics are taken only by the person they have been prescribed for. Finally—I hope the Minister can give us some indication of what is being done on this—GPs should not prescribe antibiotics for colds and flu, because they are caused by viruses, not bacteria. Sometimes GPs need to have a better focus on what is best. Do people always need an antibiotic, or do they need something different?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that we require an educational process—from the Government, to GPs, to pharmaceutical companies and to the wider public—to ensure that we do not face an Ebola-type position, where we are trying to play catch-up and the end result is many deaths?

[Jim Shannon]

I thank my hon. Friend for his intervention. As always, he succinctly puts the issue into perspective. We are all aware of Ebola, although we are not talking about it today. The question is how we resist such bacteria.

When it comes to viruses and bacteria, most of the pieces of advice I mentioned are simple enough for us to follow. However, the two most important, which involve access to drugs, relate to doctors, and my hon. Friend referred to that. Undoubtedly, we need to encourage greater awareness through media campaigns and posters in doctors’ surgeries, and by educating our children and young people. This is all about knowledge and awareness.

The findings from the World Health Organisation are quite disturbing. In May 2014, it warned that we should expect “many more deaths” because dishing out too many antibiotics

“will make even scratches deadly”.

That is the point many people are making. Over the years, antibiotics have been used properly to extend our lives, but now we are at grave risk of turning the clock back on medicine, with the World Health Organisation claiming that antibiotic resistance has the potential to be worse than the AIDS epidemic of the 1980s, which was responsible for 25 million deaths worldwide.

The importance of necessary prescriptions cannot be underestimated. In England last year, 41.7 million prescriptions were written out, up from 37.2 million in 2006. The World Health Organisation looked at data from 114 countries on seven major types of bacteria, and the results showed that we have reason to be most concerned about the bacteria that cause pneumonia, urinary tract infections, skin infections, diarrhoea and gonorrhoea—the hon. Member for Inverclyde referred to sexually transmitted diseases.

As people become infected by resistant superbugs, they are likely to need to remain in hospital for longer than would normally be required. That may also result in their being moved to intensive care. Both those things cost the NHS money, which is simply not an option in this economic climate.

Medicine is amazing, and we are blessed to have the NHS, which is so efficient and helpful. What has been achieved over the last 100 years is astounding. However, our generation has come to rely on tablets. We are all busy, and with work and families it is not always practical to take time off, but the convenience of taking a tablet to reduce our recovery time is beginning to have adverse effects. Unfortunately, while bacteria were getting smarter, we were loading ourselves up with antibiotics. If one did not work we got another one, and if that did not work we got yet another. Now bacteria are outsmarting us, and there are few new antibiotics in the pipeline.

Although we bear responsibility for our own health, and must ensure that when prescribed an antibiotic we take it properly, much of the responsibility lies with general practitioners. They must prescribe such drugs only when absolutely necessary, and they must prescribe broad-spectrum antibiotics suitably, making sure that the selection, dosage and duration are correct. That is a clear role for the GP to play. It is vital to review and renew our campaign to research and assess microbiological data, with the aim of preventing any more bacteria from becoming resistant to antibiotics. Perhaps in that way we will find a way to reverse their immunity, and ensure that the drugs that we are using are not those of last resort.

Foetal Alcohol Syndrome

Jim Shannon Excerpts

Tuesday 14th October 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Sefton Central (Bill Esterson) on bringing this issue forward for consideration. The debate is long overdue. Now is a good time to air this matter, and Members have done that. I am pleased to also be able to make a contribution.

Foetal alcohol exposure is the most important preventable cause of severe brain damage in babies and children. For that reason, we should debate the issue and highlight it. Drinking while pregnant can cause miscarriage, stillbirth, premature birth and low birth weight. Furthermore, children with FAS have distinct facial features as a result of their mother drinking alcohol.

FAS can result in hearing problems, mouth and teeth problems, a weak immune system, epilepsy, liver damage, kidney and heart defects, cerebral palsy and other muscular conditions, height and weight issues, and hormonal disorders. Those clear health issues are preventable, which is why the debate is important for a number of reasons. First, as all the Members who have spoken have said, we should educate people. However, there is also the saving to the NHS from promoting prevention, and I will return to that.

The effects do not stop with those I listed. The invisible effects include attention deficit, memory deficit, hyperactivity and difficulty with abstract concepts such as maths, time, and money, to name just a few. People can also experience difficulty solving problems, as well as poor judgment, immature behaviour and confused social skills. We have to question why any mother would want to drink during pregnancy if she was made aware of all those horrendous effects.

Normally, there is no way of preventing a genetic condition from passing from parents to children. This is the only disorder that can be completely prevented by the mother’s actions. We therefore have to educate mothers and ensure they are aware of the issue. Some mothers may not be fully aware of the impact of what they are doing, which is why we have to look at this much more generally.

Most women are aware that they are not advised to drink alcohol when pregnant. For example, a 2007 report by the British Medical Association—a much respected organisation—concluded that women who are pregnant or who are considering pregnancy should be advised not to consume any alcohol. However, I fear that women are not always aware why they are advised not to drink or just how serious the dangers are for the unborn baby.

The hon. Member for Huddersfield (Mr Sheerman) referred to the need for the drinks industry to take specific issues on board. He also mentioned the need for GPs to—this is not a pun—harp on more about this issue and to be more aware of it. It is important that the serious dangers for the unborn baby are underlined.

When a pregnant woman drinks, the alcohol travels directly across the placenta to the foetus via the bloodstream, and the physical impact is clear. The foetus’s liver is not fully formed and cannot metabolise the toxins out of its system quickly enough. That leaves the foetus with a high alcohol concentration in its body, which causes a lack of oxygen and of the nutrients needed for the brain and other organs to grow properly. Those are the medical facts about what happens. If those were known to all pregnant mothers, I believe they would take steps to ensure they did not drink.

It is clear that alcohol should not be consumed even when couples are trying to conceive—the hon. Members for Sefton Central, for Chatham and Aylesford (Tracey Crouch) and for Huddersfield all referred to this—because a woman may not be aware that she has become pregnant in the initial weeks of the pregnancy. It is in the first three months of pregnancy that drinking damages babies’ organs, and it is during the first six to nine weeks that babies’ facial features are formed, so mothers who drink in that three-week window are more likely to have babies with deformities. Again, no mother wants that to happen. The question is how we ensure these things do not happen, and I am sure the reply from the Minister, by whom I am always impressed, will help us feel a bit more reassured.

The problems I have just set out are another reason why it is vital that women do not consume any alcohol at all at any point in their pregnancy, and that includes when they are trying to get pregnant. Perhaps the saddest thing about FAS is that it is the biggest cause of non-genetic mental handicap in the western world, but it is the only one that is 100% preventable.

In response to a question in October 2013, the Minister referred to the Government’s strategy. When she replies, perhaps she can give us some indication of what point the strategy has reached. There must be a way of measuring its success. Is it measured on the figures the Minister has? I would be keen to hear her thoughts on that.

The number of diagnosed cases of FAS has tripled since records about the condition were first kept 16 years ago. In 1997-98, there were 89 cases, by comparison with 2012-13, when there were 252, so clearly there is a problem. Figures for the UK are unknown at present, but international prevalence studies in the US, Canada, Finland, Japan, Australia and Italy show that at least one in 100 children is affected. That would mean between 6,000 and 7,000 babies a year born with FASD in the UK.

It is little wonder that figures show 98% of midwives agreeing that FASD and the dangers of drinking during pregnancy are a subject that should be mandatory for all practising midwives. I agree. Some midwives feel that the subject is taboo, and that they should not mention it. According to the figures, only 59% of midwives are comfortable asking pregnant women about alcohol. They should not be uncomfortable about something they do to prevent disability in a baby. The subject should be on the table for discussion early in pregnancy, to make sure that the mother knows.

The issue is a serious one, as the figures show, where there can be serious consequences. As has been noted, FASD is the only non-genetic handicap that is completely preventable. There is no doubt in my mind that we need to raise awareness of foetal alcohol syndrome. Some UK statistics are worrying, indeed. For example, recent analysis carried out at Brighton and Sussex university hospitals showed that between 80% and 90% of women of childbearing age drink regularly; 25% of people aged 18 to 25 and 21% of those aged 26 to 44 drink more than 14 units of alcohol per week; and 15% to 20% of those continue drinking during pregnancy, even though they know it is dangerous. Those are truly shocking figures about a serious problem, but I believe they would drop if more campaigns about FAS were started. I appreciate that the economic climate is difficult, and it is not always easy to fund new campaigns, but it is estimated that it costs us £2.5 million, based on 813,000 births each year, to help those who are living with FASD. Surely any short-term costs that would help to raise awareness and drive down the number of sufferers would be a long-term benefit, both financially and socially.

Canada leads the way in treating and campaigning about the dangers of foetal alcohol syndrome. For example, it is discussed in parenting programmes for four to 11-year-olds, ensuring that the message about not drinking during pregnancy is ingrained in the minds of the new generation. Not only that, but posters about foetal alcohol syndrome are displayed in various public places, including train stations, airports, surgeries and shops. We could do that, equally. Although large sums of money are set aside by various provincial governments each year, proponents argue that preventing FASD in just 10 babies a year saves enough money to fund the services. Undoubtedly that is the way forward for us in the United Kingdom of Great Britain and Northern Ireland.

As hon. Members know, health is a devolved matter in Northern Ireland, and I want to ask the Minister whether consideration has been given to a campaign that would encompass the whole United Kingdom. We must address the issue in England, Northern Ireland, Scotland and Wales.

Community Hospitals

Jim Shannon Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to serve under your chairmanship, Mr Owen. The Minister and I have spent a bit of time together in Westminster Hall in the past couple of days, and it is nice to see him in his place. I wish him well. I congratulate the hon. Member for Dover (Charlie Elphicke) on securing this debate, which gives us all an opportunity to participate, and we thank him for that.

I have a deep interest in community hospitals and I therefore look forward to making a contribution. As the Democratic Unionist party spokesperson for health, the issue is of some interest to me. It is not often that we are the second largest party in the Chamber. [Laughter.] With my hon. Friend the Member for Upper Bann (David Simpson) and me, we have two Members, which makes us the second largest party. It is a pleasure to speak on this issue. The local hospital in my constituency of Strangford is in Newtownards. It is a community hospital, like Bangor and Downe, which are in neighbouring constituencies, and all those hospitals feed into the major hub of our hospitals, which is the Ulster hospital. I put on record, because I have to, the excellent staff we have at those hospitals. We are very much indebted to their work, the commitment they give beyond their hours and the quality of their experience.

Community hospitals have a big role to play in our society. Without them, the NHS health system would be under even greater pressure. We have one of the best, if not the best health system in the world, but being the best comes with pressures. Due to the nature of our health system, which entitles all UK residents to health care, delays and backlogs can, unfortunately, arise sometimes. In January this year, the Royal Victoria hospital in Belfast was forced to declare a major incident due to the large number of patients visiting accident and emergency. Health is a devolved matter, and although our Health Minister at home, Edwin Poots, dealt with the issue extremely well, I am under no illusion that the Belfast hospital was alone in declaring itself under extreme pressure. The nature of the NHS means that that happens sometimes, but community hospitals can come in to address that.

I am always thoroughly impressed by the work of staff in A and E departments, because they are often run off their feet, with many people coming in with a variety of problems, but community hospitals play an important role in easing their work. Often, people have injuries that need to be seen to that are not emergencies, and sometimes people have to look at how best to categorise those issues and which hospital to attend. Some people could see their GP at their local community hospital and use the out-of-hours service, rather than attending A and E departments. That is not meant as a criticism; I am always conscious that people respond in the way they see best, but sometimes we need to take a longer look at how things work. Community hospitals can play a greater role.

One thing that we need to do is raise awareness of community hospitals through this debate and look at how best the community and our constituents can respond. The role of community hospitals is to provide accessible health care and ancillary services to meet the needs of defined local populations, particularly in areas remote from district general hospitals. As an extension of primary care, they enable GPs and the primary health care teams to support patients within their own communities. Rehabilitation is a major role of community hospitals, and many offer a wide range of health promotion, diagnostic, emergency, acute and convalescent services, as well as out-of-hours treatment.

Community hospitals provide an undervalued resource, and those wishing to close such hospitals or downgrade them to no longer being community hospitals have often presented community support as irrational, but it is not irrational in my area. The community hospital in my constituency looks after the Ards peninsula. Travel from Portaferry, Portavogie or Kircubbin to the Ards hospital takes 15 to 20 minutes, but travel to the Ulster hospital would take twice as long, because of the traffic. The community hospital has a significant and important role to play, and we must look outside this place, to see what the issues are for my constituents. In the community hospital, they feel like they are treated as people, rather than numbers. That is not a criticism, but it is a reality.

Figures for Northern Ireland show that the waiting times at A and E are extremely good with just 294 out of 62,193 people waiting longer than 12 hours to be treated or discharged. That figure of 294 must also be addressed, but the numbers show the importance of the role that community hospitals play in treating non-emergency injuries, as well as the large-scale rehabilitation programmes that they offer. Community hospitals provide more convenient services, are less costly for the local population to access and are tailored to the local community’s needs. The hon. Member for Dover referred in his contribution to the significant and important role that community hospitals play in that respect. Furthermore, community hospitals provide a range of safe and appropriate services, often with considerable cost benefit to the NHS—minor injuries units being a prime example.

Doctors can be summoned very rapidly to community hospitals, virtually all of which operate without resident medical staff in a satisfactory way. They have proved that they can do the job to a certain level, which is impressive and eliminates the argument that community hospitals do not provide enough of a service, forcing people to district general hospitals when injured or ill through the night. It is a fact of life that such things happen, but that does not downgrade the importance of the community hospital. It would be good, however, to see all community hospitals offering night-time services. In community hospitals, the patient is under the care of their own GP, who will continue to look after them on discharge. The community nursing teams are also able to retain closer links with the patient at community hospitals, which is vitally important for rehabilitation and is why community hospitals are so successful when it comes to patient recuperation

In conclusion—I am conscious that several other Members want to speak—the benefits of having the same doctors and nurses, who know a patient’s case and can get to know the patient, cannot be underestimated. That is why this debate is so important. I encourage the Minister to raise awareness of community hospitals’ work and to encourage people with minor injuries to use their local community hospital instead of A and E departments at district general hospitals. I congratulate the hon. Member for Dover on bringing forward this debate. I look forward to the Minister’s response and to hearing from the third party in the room today when the shadow Minister makes his comments.