Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that the inclusion of more innovative drugs in the NHS medicine cabinet is essential for improvements in one-year cancer survival rates? Does she also agree that information shared between the devolved Assemblies, such as the Northern Ireland Assembly, is a vital part of that process of improvement?

[Jane Ellison]

We want people in England to have the best cancer outcomes, and to bring those outcomes up to the best in Europe. We know we are not there yet, but we have done a range of things to try to make that happen, including putting a lot of money into early diagnostics. In my area of public health there are award-winning public campaigns such as Be Clear on Cancer, and I know that the cancer drugs fund has been appreciated by many people. I hear what the hon. Gentleman says about the Northern Ireland example.

Ambulance Resources and Response Times

Jim Shannon Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Wright]

It could have been a factor in Mr Gouldburn’s case, because originally his family contacted the ambulance service via 999 but subsequently they went to 111. I do not think that there is sufficient join-up between the ambulance services and the contact centres about what is appropriate to 999 and what is appropriate to 111. I hope that the Minister will respond to that point.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman is being very kind and gracious in giving way, although I had asked his permission to intervene beforehand.

Obviously I do not represent the immediate area covered by the ambulance service that the hon. Gentleman is referring to. In Northern Ireland, however, we have a system whereby the ambulance service can respond to someone who has had a heart attack, as was the case with his constituent. It is a rapid response unit, whereby a car goes out in advance of the ambulance and staff take the urgent remedial and medical action that is necessary in the critical first minutes after what has happened, and then the ambulance follows. Does he feel that the Minister could consider using that system in parts of England as well?

[Mr Wright]

We should have that system already, but it is simply not working in the north-east and in other parts.

Let me cite another case. A constituent of mine from the Headland part of Hartlepool, which is an urban area, contacted me to say:

“My dad has kidney failure and has only 12% of his kidneys working. Just over three weeks ago, my mam rang me concerned about dad. When I arrived at their house, I could see he was very, very ill. I rang immediately for an ambulance. A nurse rang me back for an assessment of dad. No ambulance. I rang again, another assessment, no ambulance. I rang again, another assessment, (the 4th one), this time stressing that I was angry because he was dying and the family would be driving dad to the hospital if they didn’t come, even though this was impossible. After two hours ten minutes, the ambulance finally arrived. In each phone call that I made, I stressed the fact that dad had kidney failure, which results in potassium build up, which results in a heart attack.”

Thankfully, my constituent’s father went to hospital and, almost against the odds, is slowly improving. As my constituent stated to me:

“He is still weak but my dad has always been a hard worker and a tough, strong man. He is at home but missing going to his allotment! There is no doubt the wonderful nurses and doctors saved dad’s life.”

I want the Minister to respond to and take action on a number of points raised by the examples that I and my hon. Friends have given. First and foremost is that stark admission from a manager within the NEAS that the service does not have the resources to meet demand, and that that is a national problem. As my right hon. Friend the Member for Oxford East (Mr Smith) said, demand is clearly rising. Since the 2010 general election, emergency calls to ambulance services in England have increased by about 12%, and calls in the north-east have gone up by about 13%. An ageing population will only increase demand further. In the next decade, this country will need more ambulance resources, not less.

Cervical Cancer Screening

Jim Shannon Excerpts

Thursday 1st May 2014 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for North Ayrshire and Arran (Katy Clark) and I thank her for her contribution. Today’s debate is an emotive one as it directly concerns the loss of a 19-year-old lady. May I pass my sincere condolences to the family of Sophie Jones, some of whom, as the hon. Member for Wirral South (Alison McGovern) has said, are in the Gallery today? As a father of children around that age, my heart breaks a little to think of what the family are going through, and I congratulate those family and friends who worked so hard to see this issue brought before the House. We are debating this issue because of their enterprise and commitment, and the response from hon. Members. May I especially commend the hon. Members for Liverpool, Walton (Steve Rotheram) and for Wirral South for their massive contributions here today, and the other Members who clearly, excellently and passionately made detailed contributions?

I am a major supporter of the HPV vaccine being brought into schools so that we can take a hold of this cancer. I was delighted when the vaccine became standard in schools. The statistics for cancer are beyond frightening, and if anything can be done to prevent cancer or ensure its early diagnosis, we need to implement it as a matter of urgency. It is estimated that by 2020 one in two people will either suffer or have family who suffer from a form of cancer. That statistic makes me go cold, but it is a reality that warrants action, and today we have an opportunity to discuss and highlight cervical cancer and how it affects people.

In 2010, 2,851 women in the UK were diagnosed with cervical cancer, which is the 12th most common cancer in women and the most common cancer in women under 35 in the UK. Again, that shows the magnitude of the issue. In 2011, there were 972 deaths from cervical cancer in the UK. Between 2005 and 2009, 66.6% of adult cervical cancer patients in England survived their cancer for five years or more. A number of hon. Members have made the point about early diagnosis, and I know that the Minister will indicate the steps that the NHS has taken to address early diagnosis. The statistics I have given warrant this debate, and we must examine the case of Sophie Jones to see whether the age limit should be changed. What is clear to me is that if a young lady requests a smear test, there should be a mechanism through which she receives it as a matter of urgency. Clearly that did not happen in Sophie’s case when it should have done, which is why we are discussing this matter today. That is a terrible lesson that must be learned from this case, and I ask the Minister to confirm that tests will always be given in those circumstances from now on. That is the issue we are asking the question and seeking the answer on; everyone who has spoken on this matter has asked that question.

Among women in their 30s, cervical screening can prevent about 45% of cervical cancer cases. That figure rises with age to 75% among women in their 50s and 60s who attend screening regularly. Clearly, screening works, and there is a case to be answered. I ask that the Minister, in providing an in-depth response to the debate, also indicates what discussions have taken place with the devolved health bodies to ascertain their opinion and to ensure that the strategy we are discussing can be allocated to and introduced in all regions of the UK. She often hears me ask about the following issue in our debates, but I am always conscious that we have good practice in many parts of the United Kingdom and that when we exchange our viewpoints and agree strategies all can gain across the United Kingdom of Great Britain and Northern Ireland. I know that our Health Minister in Northern Ireland is well aware of this issue and has a well-informed opinion on the matter, and I am anxious to ensure that there is a UK-wide informed strategy in place.

This is one of those occasions when the House excels, coming together, across party lines, to grasp an issue that we can all support and try to push forward. It is good to have that unanimous support today from across the Chamber, with all parties giving their contribution. Cancer is a dreadful disease and if something is in our grasp that will prevent any of our constituents from going through it, we need to act. I am no medical expert—far from it—and I cannot give an answer, but I can demand, as the Member of Parliament for Strangford and on behalf of my constituents, that the medical experts give reasons why they have reached the decisions they have. I would like to understand the implications of dropping the age limit back down to 19, as is the case in Scotland and as was the case in Northern Ireland until 2004, when it was changed.

As I have said, there is a case to answer. The terrible loss of Sophie Jones has prompted this debate. To honour her memory, I support the calls for a review of the age limit for cervical screening UK-wide.

Type 1 Diabetes (Young People)

Jim Shannon Excerpts

Wednesday 30th April 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Member for Knowsley (Mr Howarth) for bringing this issue to our attention in Westminster Hall today. It is good to have a subject that we can all relate to and on which we can speak on behalf of our constituents. The right hon. Gentleman has knowledge of it on a very personal basis.

I was just sitting here and thinking about those deep sleeps that people get into—not that we often have them, Mr Havard. Young children who are diabetic are woken out of their sleep and will wonder what is happening to them. Someone—one of their parents—takes their hand, pricks their finger and checks their blood. That is the reality that many children in the UK face today, and many parents have the same reality because they have to wake them up during the night and have to set the alarm for that purpose. They have regularly to monitor and check their child’s blood sugar levels. It is surprising just how many children have to go through that every day.

The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, there are 1,092 children with type 1 diabetes. The hon. Member for Cities of London and Westminster (Mark Field), who has just left the Chamber, referred to there being 400,000 diabetics in the United Kingdom. In Northern Ireland, we have almost 80,000; one fifth of the diabetics are in Northern Ireland.

[Mr Gregory Campbell]

When my hon. Friend refers to the high prevalence of diabetes in Northern Ireland, as well as across the UK, does he agree that need for greater emphasis on research, which has been repeatedly raised this morning, is a fundamental way to address the increasing problem? The UK, and the various regions thereof, must place greater emphasis on higher expenditure and greater research to ensure that future generations do not suffer in the same way as the present generation.

[Jim Shannon]

I thank my hon. Friend for that contribution. He and other hon. Members have reiterated the need for research, including stem cell research, to enable us, I hope, to come up with a cure for diabetes. The prevalence of diabetes in Northern Ireland is now more than 4%. In addition to almost 80,000 people in Northern Ireland who have diabetes, some 10,000 have not yet been diagnosed. As an elected representative, I have had the opportunity to fight cases on behalf of parents who are under intense pressure because they have a type 1 diabetic child. In Northern Ireland, health is devolved. We have been able to speak to the Minister, Edwin Poots, and through his office and through the pressure that we and others have created, we have succeeded in getting the health service in Northern Ireland to provide 400 insulin pumps for type 1 diabetics. Getting the pumps is only one part of the story. The second part is to train people to use them, so the second stage of the process has been training parents how to do that. Good things have happened.

Diabetes has increased in Northern Ireland, but it has also increased worldwide. Type 1 and type 2 diabetes have increased by 33% in Northern Ireland, by 25% in England, by 20% in Wales and by 18% in Scotland, and some 24.5 children in every 100,000 aged 14 and under have diabetes. That shows the magnitude of the problem. The Minister is responsive and has a particular passion for health. He has attended, as have others in the Chamber, the type 1 diabetes events that have taken place here with young children. Those events have given us all a chance to see how important the issues are. We have far higher rates of diabetes in children than do Spain or France. In Northern Ireland, there are 1,092 children under the age of 17 with type 1 diabetes, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

In my constituency, the number of diabetics has gone up by 30%, with 800 people becoming diabetic in the past seven years. I should have registered an interest at the beginning of my speech. I am a type 2 diabetic, and I am one of those 800 people who were diagnosed in the past seven years. In our small part of the United Kingdom, the total number of adults aged 17 and over who have diabetes and are registered with GPs is just shy of 76,000, and there are a further 1,092 under the age of 17. Diabetes UK Northern Ireland has launched a report that highlights the latest findings into diabetes in Northern Ireland, and I think it is important to put those figures on record. The Diabetes UK Northern Ireland national director Iain Foster said:

“The State of the Nation report is a timely and important piece of work which highlights, not only that Northern Ireland has seen the biggest rise in people being diagnosed with diabetes compared to the rest of the UK but that there is a real difficulty in collecting data as Northern Ireland is not included in the National Diabetes Audit. Our State of the Nation report gathers limited local information and we have found that there are now over 80,000 people living with diabetes in Northern Ireland.”

The official figure is just shy of 76,000, but the latest figures from Diabetes UK Northern Ireland indicated that more than 80,000 people are affected. Therefore, within the past five years, there has been a 33% increase in Northern Ireland in the number of people living with type 1 or type 2 diabetes. More than 100 new diagnoses are expected each year if the current trend continues, and 4% of the local population now has a diagnosis of diabetes.

I cannot emphasise enough that diabetes is a ticking time bomb, which has the potential not only to destroy lives, but to bankrupt the NHS. The financial cost of diabetes cannot be discounted. I agree with Iain Foster:

“It is not enough to shout from the side-lines: ‘something must be done’”—

we have been talking today about what must be done, and we want to see what will be done—

“so instead we have outlined ways in which we think the situation could be helped, for example, working to enable access to available treatments including insulin pumps for both adults and children and integrating diabetes clinical databases to create an accurate diabetes register.”

My hon. Friend the Member for Upper Bann (David Simpson) and the right hon. Member for Knowsley referred to education. It is so important, as hon. Members have said, for teachers, classroom assistants and staff in our schools to be aware of what it means to be a diabetic in school. In Northern Ireland, we have implemented a system of training for teachers and classroom assistants to ensure that they have the knowledge to deal with the condition.

In conclusion, I ask the Minister to outline what co-operation exists between regional assemblies to deliver a better strategy for the whole United Kingdom. He will be aware of the 10-year strategy that ended in 2013. I have asked on a number of occasions for a new strategy to be put in place, because it is important that all the regions of the United Kingdom of Great Britain and Northern Ireland work together to deal with the problem. To address the issue of the many children who suffer from diabetes, and many more who are predicted to be diagnosed, we must take action and take it now. I congratulate the right hon. Member for Knowsley on bringing the matter forward, and I urge the Minister to do more than simply talk about it. He must take action quickly, while there is still time to make safe this ticking time bomb.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship for the second time this week, the first time being during the Defence Committee sitting yesterday.

I pay tribute to the right hon. Member for Knowsley (Mr Howarth) for securing the debate and for his articulate and reasoned contribution to it, and for his passionate advocacy of the needs of people with type 1 diabetes. He has family experience of these issues that will have strongly informed his understanding of them. The balanced, perceptive way that he approached the debate, raising important issues, particularly about tariff-setting, which is in my view the strongest and best way to drive up the quality of care available for patients with type 1 diabetes, is of great credit to him and helped set the tone for a consensual debate. It is also a pleasure to respond to the right hon. Gentleman formally, because he responded to my maiden speech when I was first accepted into the House. He was kind to me then and I hope that my response will do this debate justice and will bring some comfort to hon. Members who have raised concerns.

I also pay tribute to hon. Members’ contributions to the debate. As always, the hon. Member for Strangford (Jim Shannon) makes important points about how, although we have devolved health systems, we need to learn lessons from best practice throughout England and Northern Ireland. It is important, even in a devolved health system, that we work collaboratively together to improve standards of care. I will try to deal with points raised in the contributions from the right hon. Member for Tynemouth (Mr Campbell) and the hon. Member for Brighton, Pavilion (Caroline Lucas).

My hon. Friend the Member for Cities of London and Westminster (Mark Field) eloquently outlined for all of us what this means on a day-to-day basis for a young person with type 1 diabetes. In many respects, that sets out the challenge for our health service: working together with the education sector and with other parts of our health and care system, it needs to help improve the day-to-day quality of life for people with type 1 diabetes. My hon. Friend the Member for Torbay (Mr Sanders) made a similar point. My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) raised the importance of research funding. I will address those points later in my remarks.

As we have heard, type 1 diabetes has a potentially devastating effect on children’s health. Poor diabetic control for children increases their risk of developing long-term complications over the course of their lives—we have heard about renal complications, diabetic retinopathy and the consequences of diabetes-related peripheral neuropathy. Such consequences are potentially life changing, and so it is important that we do all that we can to address them and to support people with type 1 diabetes. It is a question not just of early diagnosis but of the right care and support in the secondary care setting, in primary care and in the community, to give better support to people with the condition so that they can stay well and be properly looked after. That is a challenge that we face in all aspects of the care that we provide to young people.

The children and young people’s health outcomes forum, which was set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), highlighted a number of challenges faced by children with long-term conditions such as diabetes and by their families. It is worth highlighting two or three. The first was that there are poor arrangements for transition to adulthood—that has been highlighted throughout our debate. Secondly, there is a need for better integration of care, with co-ordination around the patient—the child or young person. We need a comprehensive, multidisciplinary team approach to care, with a much greater emphasis on better support for young people in the community and in their own homes. There also needs to be much speedier diagnosis of long-term conditions in young people, including asthma, diabetes and epilepsy.

The NHS atlas of variation has identified an unacceptable variation between different areas, a point raised by the shadow Minister. That is clearly unacceptable to us all. There is variation in the quality of management of children’s diabetes, and in the number of children with previously diagnosed diabetes admitted to hospital for diabetic ketoacidosis. We all know, then, that we have some way to go on improving the care of children and young people with diabetes. I hope my remarks will be able to give some reassurance that we are now firmly on the right track, particularly with our best practice tariff.

[Jim Shannon]

In my contribution I outlined the diabetes strategy that was in place for the 10 years up to 2013. I have asked Ministers about that issue a number of times and am keen to see a continuing initiative for a UK-wide strategy. Will the Minister give us an idea of his intentions in that regard? That strategy could address regional variations.

[Dr Poulter]

As I mentioned earlier, it is important that we learn from good practice, not just in the UK but elsewhere. A key driver of improving practice is clinical audit of the quality of services delivered. Outcomes for people with diabetes in England will also be assessed by the national diabetes audit, which includes a core audit, the national in-patient diabetes audit, a diabetes pregnancy audit, the national patient experience of diabetes services survey and the national diabetes foot audit, which is due to be launched this summer. Having that high quality comparative data, gathered through clinical audit from different care settings across the UK, will help us to understand where services are and are not delivered well. Audits in particular care settings always make recommendations for improvement, and the following year there is another audit. Exposing where care is good or not so good and putting in place plans for improvement on the ground will be a big step forward. At a national level, we can then look at which improvement plans have worked and which have been less successful. That learning is a good way of driving up standards and can be shared with Northern Ireland and other devolved parts of the United Kingdom, and indeed on an international basis. I believe that in this country we are historically good at collecting data. The purpose of national audits is to drive up standards of care, which is why NHS England is putting many more national audits in place throughout the health service. We will be able to compare what is done in different care settings, learn where care needs to be better and drive up standards throughout our health service.

We all understand the importance of the integration of mental health care and diabetes care for the young people who have serious health issues resulting from that combination of issues, which puts them at high risk of complications and premature death. The Government are investing £54 million over four years to enhance the children and young people’s improving access to psychological therapies—CYP IAPT—programme. That programme is helping to transform services through training in evidence-based therapies to support children and young people with a range of mental health issues. I am sure we all support that programme and want to see it expanded further.

I am glad to say that investment in type 1 diabetes research by the Medical Research Council and the National Institute for Health Research has risen from more than £5.8 million in 2011-12 to more than £6.5 million in 2012-13. The National Institute for Health Research is funding a £1.5 million trial focusing on children and young people with type 1 diabetes, which is comparing outcomes for patients treated with multiple daily insulin injections to outcomes for those using pumps, one year and five years after diagnosis. The report of the trial is due to be published in a few months. When we are looking at how best to support people with type 1 diabetes in leading as normal a life as possible, whether that be in education or in the workplace, it is important that we understand which interventions and methods of support work best. I am sure that that research will put us in a much better place on that.

Abortion (Disability)

Jim Shannon Excerpts

Wednesday 9th April 2014 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this very important matter to the House for consideration. It was mentioned in Prime Minister’s questions today, for example. Does she agree that the UN convention on the rights of the child, which protects the rights of children, and the Equality Act 2010, which outlaws discrimination on grounds of disability, would demand that this House should change this grossly offensive law that allows children over 24 weeks to be aborted?

[Fiona Bruce]

The hon. Gentleman makes a relevant point.

Developments in the law, in medicine and in cultural attitudes have led me to introduce this debate. Because of the lack of clarification, the law is being applied in what one barrister has called a haphazard fashion. In 2007, the Select Committee on Science and Technology recommended that the Department of Health produce guidance that would be clinically useful to doctors and patients in this regard, and in response the Royal College of Obstetricians and Gynaecologists provided updated guidance in 2010, but there still seems to be a considerable difference in views and working practice about what comes within the law and what does not. That is concerning for parents, practitioners, law makers and disabled people, many of whom believe it is now time to review the framework within which this law operates.

It is hard to see the differing treatment of disabled fetuses and able-bodied fetuses as anything other than discrimination, about which disability groups are particularly concerned. Medical knowledge has changed radically since 1990, and even more since 1967, and there have been improvements in fetal medicine, including the ability to correct disabilities, even within the womb before birth.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

My hon. Friend is right to highlight this important nutritional need for women who are planning to get pregnant or are pregnant. He and I are meeting soon to discuss fortification as a policy area. I urge all GPs and health services to take every opportunity to highlight to women this important nutritional requirement.

[Jim Shannon (Strangford) (DUP)]

Last week at Queen’s university in Belfast, a significant breakthrough for ovarian and breast cancer means that women who might otherwise opt for an oophorectomy can still have children. Does the Minister agree that money spent on cancer research can increase quality of life and life expectancy? What help will Government give to cancer research at Queen’s university in Belfast?

[Jane Ellison]

The hon. Gentleman is right that research is vital, and a great deal of it is going on in this area. I recently met the all-party group on ovarian cancer to update it on that research, and I will be happy to update him after questions. He has mentioned before how research applies across our United Kingdom. As he knows, whatever we learn through research in England is always shared across the different countries.

Stillbirths and Infant Mortality

Jim Shannon Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Loughton]

I agree. My hon. Friend the Member for Bracknell (Dr Lee) gave the example of Scotland, where people have clearly examined the matter a bit further; they appear to be achieving more than people in other parts of the United Kingdom. We should be sharing that best practice, rather than being parochial and not sharing it beyond the United Kingdom, with or without Scotland after 18 September. That goes beyond sharing ministerial best practice on health issues; I would guess that not just health considerations but deprivation, housing and other local environmental factors are involved, too. More than just the Health Ministers of the respective parts of the United Kingdom need to be involved. If we compare deprivation with infant mortality rates, some signs certainly start to emerge.

Last year there were 3,558 stillbirths; in 2011 there were 3,811 and in 2003 there were 3,612. The stillbirth level has remained persistently high for a long time. One in 200 pregnancies ends in stillbirth, but stillbirths are currently defined in law as being after 24 weeks of gestation, which still means that there are 15 times more stillbirths than cot deaths—the progress on cot deaths was alluded to earlier. The problem with the definition is that it masks the higher number of stillbirths that happen before the 24-week gestation qualification currently in legislation. If a woman gives birth to a stillborn child at 23 weeks and six days or earlier, the child counts not as a stillbirth but as another “miscarriage.”

That was the case for my constituent Hayley, who came to see me and was present when I presented my ten-minute rule Bill in January. She had been through the dual tragic experience of giving birth to a stillborn son at about 19-and-a-half weeks. She had to have her pregnancy induced, and she went through labour. She experienced all the pains and anguish of labour in a hospital for more than 24 hours before giving birth to her son. She and her partner, Frazer, held their son and took handprints and photographs. To all intents and purposes, their son had been born, but sadly born dead. In the eyes of the law, their son did not exist, because he had been born after less than 24 weeks. That child had no recognition in the eyes of the law. Some months afterwards, Hayley tragically went on to have a miscarriage after five or six weeks. Those two experiences were different—that is in no way to belittle the pain, anger and trauma of going through a miscarriage—but in the eyes of the law, they were identical: neither of those children was recognised as having been born.

That is what my Bill is all about. Since introducing it, I have been swamped by the experiences of women and families up and down the country. To take one example, a woman gave birth at about 21 weeks to twins. It might have been slightly more than 20 weeks—I forget now—but it was less than 24 weeks. One of the children was born just alive and lasted for a few hours. The other twin was born dead. As the first was born alive, albeit at less than 24 weeks, that child was recognised. The other twin, born dead, did not exist. How traumatic and cruel is that on the part of the state? Someone gave birth and had two dead children, but only one existed in the eyes of the law. That is why the law needs to change.

I will persist with the Bill well beyond the confines of this Session, when it will expire because of the constraints of this place, until I persuade the Government to take the issue on. It is about fairness and recognition for people who have had to go through trauma, anguish and pain unimaginable to those of us lucky enough to have had healthy, albeit slightly annoying, children. It is not acceptable for those who have lost a child before that child was ever able to breathe then to have the second blow of the state not recognising that child.

My Bill would amend the Births and Deaths Registration Act 1953, but not in a way that says that we should redefine the 24-week limit. I do not want to make it 23 weeks or 22 weeks; this has absolutely nothing to do with abortion thresholds and things like that. I want to make a differentiation between what are clearly miscarriages and instances of when women, to all intents and purposes, go through all the pains and experiences of giving birth to a child. The definition in my Bill of a “stillborn child” does not mean a child born dead from 24 weeks’ gestation onwards, but

“a child which has issued forth from its mother and which did not at any time breathe or show any other signs of life, following the recognised processes of labour including regular, painful uterine contractions resulting in progressive cervical effacement and dilation; and the expression ‘still-birth’ shall be construed accordingly.”

It is a bit technical and a bit physical, but it is a way of giving some comfort to mothers: if they gave birth to a stillborn child, it would be a birth. The Bill would say that they had had a child, that there had not been a miscarriage and that the state should recognise that.

We have not introduced the Bill to meddle with the abortion laws—it has nothing to do with that—and it is not intended to meddle with bereavement leave entitlements or benefit entitlements. The more enlightened employers of someone who has been through such an experience would give the employee some allowance on the time they need to get over the death. For them to receive some sort of closure and to give them the support and relief that they desperately need to be able to move on, the state needs to recognise what they have been through in giving birth to a stillborn child.

At the moment, a hospital or clinical practitioner can issue a certificate of birth. It has no status in law. It is of some comfort to some people, but it is certainly not sufficient comfort for many of our constituents. That is why I am putting forward the changes to the law. They are simple and do not involve a lot of cost, but they would offer huge support, relief and comfort for mothers and their partners who have been through these sorts of experience.

As well as wanting to change the law and calling for better research into why we appear to be so vulnerable to perinatal mortality and stillbirths, we need greater research and better guidance. I do, however, pay tribute to the existing guidance, particularly that issued by the Royal College of Obstetricians and Gynaecologists on recurrent first and second trimester miscarriage, and some of the best practice.

I echo the points that my hon. Friend the Member for Chatham and Aylesford made about foetal alcohol syndrome, which strays slightly beyond the confines of the debate. When I was a shadow Health Minister, I considered the issue. I visited children’s homes in Copenhagen that specialised in children born with foetal alcohol syndrome. In many cases, the child was born to parents from Greenland’s Inuit community, which has high alcoholism rates. A lot of research has been done on that in Denmark.

It is undeniable that a lot of our children are being damaged due to excessive drinking through pregnancy and that an awful lot of that is not being properly diagnosed. In my simple layman’s view, a lot of the symptoms have parallels with autism and the autism spectrum, and there may be links between autism and foetal alcohol syndrome.

The issue is very little researched in this country, but it potentially affects an awful lot of our children, and we need to do much more to identify it. More importantly, we need to give clear, stark, but accessible warnings to women about the practical perils of drinking irresponsibly at all stages during pregnancy. That is not to say that pregnant women must not drink at all, but we need to set out clearly what is and is not tolerable, just as we should for women who smoke during pregnancy.

To make a side point—a point I made during a debate on the Children and Families Bill—I cannot understand why the Government have set criminalising smoking in cars with children in them as a priority, yet have done nothing to criminalise, if that is the principle they want to follow, smoking for pregnant women whose foetuses are in rather more confined spaces than the back of a car. Smoking and drinking are highly damaging to children before and after they are born. People are irresponsible if they do that, and we need a much clearer and more pungent health message to mothers. We need to disseminate best practice better than we do now, whether that is from Scotland or other parts of the country that appear to have achieved some success in reducing some of these mortality rates.

This is a bigger public health crisis than we have given it credit for. I have met constituents and heard some tragic stories from around the country of families who have been through stillbirths and other perinatal mortalities. We need to take this issue much more seriously.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being here on time; I had a Committee to go to. This issue is important to all of us here, as well as to those outside the Chamber. In Northern Ireland, there are four infant fatalities a week. The UK mainland has 17 to 19 infant fatalities a day. Obviously, the populations are different, but that figure tells its own story. Does the hon. Gentleman feel—perhaps it will be in the Minister’s response—that those in the health service should consider why the infant mortality rate is so low in Northern Ireland?

[Tim Loughton]

I agree with my hon. Friend, who is a co-sponsor of my Bill. The hon. Member for East Londonderry (Mr Campbell) made references to Northern Ireland, and earlier in my speech—I think before my hon. Friend entered the room—I did flag up the regional differences between parts of the United Kingdom. Far more research must be done to discover why certain parts of the United Kingdom are affected more or less than others and why women of certain ethnic backgrounds are affected more. We simply do not have the level of research to discover why such things are happening so we cannot better target our resources, as my hon. Friend the Member for Chatham and Aylesford mentioned earlier.

Finally, we need more work on mental health support for women before and after giving birth. There have been too many tragic stories of women self-harming or, in extreme cases, taking their own life and those of their children. We need better targeting of resources and better diagnosis of mental health problems. We need health visitors—I hope we will get the phalanx of new health visitors that the Government have rightly committed to provide—who can work with new parents and get into homes, where there is a much better chance of spotting problems. They can refer on to mental health services or parenting skills classes through children’s centres. That will form an important part of dealing with the epidemic of perinatal mental illness, in particular for first-time mothers.

This is an important subject for constituents across the country. The Minister is sympathetic to the problem and the Government would like to do more. Working with the royal colleges and some of the excellent charities, which have worked tirelessly over many years, we can get a better solution for better support for families who suffer from the pain of infant or perinatal mortality and hopefully do more to prevent the problem from occurring in the first place.

NHS Funding (Ageing)

Jim Shannon Excerpts

Tuesday 25th March 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to make a contribution to the debate. I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on bringing the matter before the House for consideration and giving us all the opportunity to contribute.

We are long past the days when people who die at the age of 68 would be considered to have had a good innings. Now, we would shake our head and describe them as in their prime. The rising age of our population has meant an increase in the pension age, with further increases to come. That is something my parliamentary aide has questioned, saying that she will have to work until she is 72. She wonders who will hire her to write speeches and come to the House then. At the age of 35 or thereabouts, she is already thinking of the future.

One of the figures in the press last week, which hon. Members have referred to, was that we in the United Kingdom now have the greatest number of people living to the age of 100 since records began. Approximately 600 people have lived to 105, which is another indication of the statistical trends. Although that is perhaps great for families who use the free grandparent babysitting service offered nationwide—that is what grandparents do—and which has ensured that families get to enjoy time together, with stories and wisdom passing easily down the generations, it has also put a lot more pressure on our NHS. The NHS is not equipped to handle that pressure without major investment or a redirection and reprioritising of funding.

The sheer beauty of my constituency and the area’s strong links to Belfast and other cities make it one of the most desirable places for older people to retire to—indeed, Strangford and the neighbouring constituency of North Down are the top two retirement locations in Northern Ireland. The hon. Member for Suffolk Coastal said that people want to retire to her constituency because it too is beautiful, and quieter and more serene than many places. As they do in my constituency, people might look forward to seeing the sea in the morning and taking walks, because these are the attractions of such locations. More people retiring to such places, however, certainly puts pressure on our local NHS.

If the Government took account of this debate and increased the funding given to the NHS, offering additional ring-fenced funding to the devolved Assemblies, the level of care would be much greater. I look forward to the Minister’s response, as I always do, because he understands the issues and I respect his comments. It is fantastic to read about the available drugs, treatments and therapies, but the fact is that the NHS cannot afford to provide them fully. Any additional funding would benefit not simply the ageing population, but the entire community. There are pressures on the NHS, given the prioritising of funding to the sections where it is needed most, but I am sure I am not the only person in the Chamber to have read the media speculation about the NHS and the ageing population. Statistics from the Institute for Fiscal Studies indicate that spending per patient will have fallen by 9% within four years even if health service funding is ring-fenced and protected.

I have already alluded to the reasons: 2 million more over-65s on the UK mainland, which is a 20% rise, will place far greater demands on the NHS. To give the Northern Ireland perspective, new figures released by the Northern Ireland Statistics and Research Agency show that the number of people aged 65 and over is projected to increase by a quarter, to 344,000, by 2022. That indicates the pressures on the NHS in Northern Ireland, where health is a devolved matter.

[Dr Coffey]

Has the hon. Gentleman seen the figures circulated by the Royal College of Physicians, which show that two thirds of people attending A and E and admitted to hospital are aged over 65? We all recognise that we need to do more to prevent people going into hospital when they might not need to, and certainly to expedite their leaving. Does he recognise that, right here, right now, we still need to allow CCGs to have appropriate funding to address that need?

[Jim Shannon]

I agree with that. If more preventive action is taken at an early stage in surgeries, that will have dividends further down the line. The hon. Lady is quite right and I wholeheartedly agree with her.

[David Simpson]

Does my hon. Friend agree that more emphasis is needed on care for the elderly at home, and that adequate funding needs to be put in place so that the older generation can be comfortable and be looked after at home?

[Jim Shannon]

I thank my hon. Friend for that contribution. That is probably a subject for a different debate, but at the end of the day it is also clearly a matter for us all. Most elderly people in my constituency would like to spend their days at home. They do not want to go into homes, which may not be as homely, if I can use that terminology, but there are additional pressures on carers who support the elderly at home. That is a debate for another day, but it is an important factor. It is about balancing the budget and making the butter go even further, as it were. Many elderly people want to spend their time at home and enjoy being with their families.

That puts us under even greater pressure in providing a high-quality NHS. The number of the oldest people—those aged 85 and over—is expected to rise by 50%, from 33,000 to 48,000. When we take into account the fact that the average 80-year-old costs the NHS seven times more than a typical person aged 30, even those without a degree in mathematics can see that there is a major accountancy problem in the NHS, and difficulties with funding streams.

Thus far only efficiency savings have been requested, but they have not been enough to keep things ticking over. The Institute for Fiscal Studies has said that to keep pace with the ageing population, spending needs to grow by 1.2% a year above inflation, which has been running at about 2.4%. Again, that gives a clear indication of what the financial issues are. Such an increase has not happened so far, and the pressure cannot be sustained without something giving. I look forward to the Minister’s response on the difficult but urgent question of how that situation will be addressed.

I recently held a public meeting on the provision of cancer care in my trust area, at which were the top breast cancer consultant and the director of policy for the trust. Both cited the pressure their hospital faces due to care of the elderly. Indeed, almost 10% of the people at that meeting said they had been operated on by the consultant and owed their lives to that man, but probably only one of them was under the age of 50. Again, that shows the pressures that are on the elderly generation and the greater level of care that they need.

Those pressures, ranging from broken bones to cancer, diabetes and strokes, are increasing. Levels of diabetes are higher among the elderly population. The lifestyles we have lived over the years have contributed to that, I suppose, but it is a growing problem affecting those over 50 much more seriously than any other group. Given those increased pressures, we need to increase the funding. We cannot ignore the situation. Unless we, God forbid, begin to put an age limit on what services and treatments are available, we will have increased pressure every year. It therefore follows that funding must keep pace with that pressure. I see little point in funding research and development into cutting-edge technologies if the Government are unable to fund their use within the NHS.

I am a great believer in the notion that money does not grow on trees. I have used the analogy on many occasions. My parents said it to me, I said it to my children and they in turn now say it to their children. I understand that we need to cut borrowing and to restore a workable bank balance, but I also understand that life is precious and that if there is one thing we cannot afford to scrimp on, it is health care and quality of care for our elderly. There are a large number of elderly people in my constituency—I meet them, probably, more than any other group. They tell me what the issues are and I want to see care delivered for them in every way possible.

It is said that a society is judged on how it treats the most vulnerable, including the elderly and children. I ask the Minister to consider the compelling facts that all hon. Members have put on the record today, and which will be added to by those yet to speak, and to realise that there must be a ring-fenced increase in NHS spending if we are to do our duty by the most vulnerable in our society.

NHS Patient Data

Jim Shannon Excerpts

Tuesday 25th March 2014 Westminster Hall

[Barbara Keeley]

Very much so. I must tell the Minister that we have not had time to absorb all of what has happened at the HSCIC, but we are disturbed by much of what we have learned. It seems as if there has been a proliferation of organisations and committees and that, as the use of that data and commercial data has burgeoned, the NHS has lost control of what is going on. That is of real concern.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to debate and on her perseverance at every stage. Does she agree that although the commitment given regarding a patient’s right to their data will be respected, perhaps patients in the NHS see this issue from their own points of view? They do not see the IT implications of what is taking place; because of that, there need to be more assurances for the patient on what happens.

[Barbara Keeley]

I very much agree. Last night I tweeted that I was to have this debate today and I was astonished with the response I got—an awful lot of people are very concerned about the issue. I will come on to opt-out in a moment, but let me conclude the point I was making about the director of public assurance’s post being made redundant. There will be considerable interest from Parliament on the basis for and the terms of that redundancy. I hope there will be no suggestion of a compromise agreement or gagging clauses. There are serious questions to ask about some of the activities.

While Dr Davies is still in post, there are a number of questions to ask about his role and those of his colleagues in the NHS Information Centre that later became the HSCIC. Dr Davies has been the chair of the four-person data access advisory group. Having two senior HSCIC employees on the advisory group on sensitive data releases, including its chair, brought criticism about a lack of independence. As chair of the group, Dr Davies also had the right to approve data releases unilaterally from the HSCIC, outside the committee. He was therefore in a powerful position. Indeed, it was reported in The Guardian last year that Dr Davies used that power to release to the Cabinet Office the confidential medical records of teenagers taking part in the national citizens service.

Perhaps more recently, Dr Davies’s views were becoming out of line on some aspects of the Government’s stance on care data. The Guardian reported in January that Dr Davies said that there was a “small risk” that certain patients could be “re-identified”, because insurers, pharmaceutical companies and other companies had their own medical data that could be matched against the pseudonymised records. He said:

“You may be able to identify people if you had a lot of data. It depends on how people will use the data once they have it. But I think it is a small, theoretical risk”.

The risks in this area have been rightly getting much attention and the Health Committee heard more about them this afternoon. Examples can be taken from the websites of both Harvey Walsh, a company that boasted of having more than a billion linked patient-level records and an ability to track patients over time, and OmegaSolver, the company with the patient analyser tool that it claimed can track patients throughout their hospital care.

In the case of OmegaSolver, its website held example screens showing use of its Patient Analyser tool, which it said could track actual patients within every hospital in England, providing up-to-date information for every disease area.

Atrial Fibrillation

Jim Shannon Excerpts

Wednesday 12th March 2014 Westminster Hall

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

I hope that colleagues from Yorkshire who have been listening to the debate on trans-Pennine rail would like to stay for this important debate on atrial fibrillation, but in truth I know that many would ask what on earth atrial fibrillation is. Part of the purpose of the debate, therefore, is to open up our understanding and knowledge of the condition. I am sure that some colleagues at least will know that atrial fibrillation is a disease of the heart—[Interruption.] Excuse me, Mr Turner; I thought that that was the Division bell. Atrial fibrillation is a disease that causes an irregular heartbeat. It can often lead to a stroke and therefore to either a disabling long-term disability or death.

I called for this debate because 750,000 people in this country have atrial fibrillation. We know that because they have been tested for it. They may or may not be receiving treatment, but we know about them. It is estimated that another 750,000 suffer from atrial fibrillation but are undiagnosed, so we do not know where they are, although we have an idea because we can do the stats. If we know the average number of AF sufferers in a given area, we can extrapolate the numbers across the country. Where we see very low diagnosis numbers, we know that the local GPs and health service are not getting to grips with discovering who has AF, checking them out and treating them.

I would like to tell a little fairy story. There is a fantasy world in which a dreadful heart condition affects more than a million people in our country. A great deal of research is carried out, because no one really knows how to tackle it, and then there is an enormous breakthrough: we discover a new class of drugs that can not only help people to avoid having a stroke in the first place, but allow them to live a good, full and healthy life. However, the wicked godmother arrives and says, “Thou shalt not have any of these wonderful drugs, even though the National Institute for Health and Care Excellence says that they are good and should be available.”

I remind Members that the NHS constitution states that patients have a right to

“treatments that have been recommended by NICE”

when they are deemed “clinically appropriate”. That is the right of your constituents, Mr Turner, and mine. However, the fact is that most people with AF in this country are not getting the opportunity to receive such drugs. There is a real problem: we have a new generation of drugs that are recommended by NICE, but they are not available. What is the barrier? The barrier is the clinical commissioning groups and GPs.

If someone is a sufferer of AF—my wife is, which is why I know something about the condition—they are traditionally treated with warfarin, which is a very popular drug in this country. You will not be surprised to hear, Mr Turner, that even on the Isle of Wight GPs know—because they are highly skilled and knowledgeable —that warfarin is very cheap indeed. It is one of the cheapest drugs that can be prescribed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing such an important matter to the attention of Westminster Hall and of the Minister. Warfarin can be used to treat hyperthyroidism, as well as many other conditions. The issue that comes to my attention is that of GPs and their training, and their ability to administer to atrial fibrillation as required. Does the hon. Gentleman feel that GPs can do more in their own surgeries?

[Mr Sheerman]

The hon. Gentleman is absolutely right. I was going to come on to that issue and I am grateful to him for making that point. The fact of the matter is that a very high percentage of people who are diagnosed with atrial fibrillation are currently either not treated with anti-coagulants, or they are given aspirin. Everyone knows that aspirin is very cheap but not effective as an anti-coagulant.

People with AF may also be given warfarin, which is a good treatment. I can say that from the heart. I have watched a close member of my family—it does not get any closer than one’s wife—undergo treatment that must be evaluated day in, day out. It is quite complicated to ensure that the dosage is right. If someone does not have a home testing kit, they will have to go regularly to the hospital for their blood to be tested and their dosage evaluated. If they have a full-time job or family responsibilities, that is an onerous requirement. As a result, many of the people who are taking warfarin are not taking it in the right dosage and so are not getting the proper, balanced treatment.

It is a scandal that 8.5% of atrial fibrillation patients are not receiving treatment, 35% are receiving aspirin, and only 56.9% are receiving oral anti-coagulation treatment. What is more, we now have three drugs that could be prescribed. We should be saying, “Isn’t it wonderful? We’ve had a breakthrough!” I hope that I can pronounce them properly—they are dabigatran, rivaroxaban and apixaban. However, compared to the 3p that it costs for a dose of warfarin, they are more expensive—I have seen an estimate that treatment would cost around £800 a year.

That might be considered an excessive cost compared to the tiny amount that warfarin costs, but strokes cost this country £2.5 billion a year. If we really want to wreck the national health service, we should not treat people with AF properly. They will have a stroke and end up in long-term care, making great use of hospital beds and highly qualified medical staff. Such a burden on the health service could be avoided.

I have been a member of the all-party group on atrial fibrillation for some time now, and I know that its chair, the hon. Member for Montgomeryshire (Glyn Davies), is going to speak after me. We served together on the Education and Skills Committee, Mr Turner—do you remember when we had a very good Clerk working for us? I think he is sitting on your left-hand side. When we were on that Select Committee, you will have heard me articulate many times the watchwords, “I like evidence-based policy.” The atrial fibrillation campaign is the one, against all others, for which the evidence shows that if we have a drug that can sort out the condition, it should be used.

NICE says that we should use it, and it is clear that it is the right of patients to have it. The people getting in the way are GPs—not because they are malign, but because the cost means that they are leant on by their practices about prescribing it. Also, a very substantial population of GPs do not understand the treatments and their effectiveness—which treatments work and which do not. It is a scandal that people suffering from AF are prescribed either nothing or aspirin by their doctors. That is a very serious problem for the profession, and we have been taking it up with the Royal College of General Practitioners.

There is a second barrier, which is that even with the cheapest of the drugs—warfarin—the sophistication of the treatment and the monitoring are very difficult for very large numbers of our population to deal with. My constituents and your constituents, Mr Turner, find it very difficult to get the right dosage and to maintain the quality of treatment.

The third barrier is the clinical commissioning groups. There is no doubt that the clinical commissioning groups are a barrier to this spending. These are relatively new drugs. They were approved by NICE about 18 months ago—I am looking at the chair of the all-party group in case that is not correct—and NICE said that by now it would expect about 20% of AF sufferers to be on the new anti-coagulants, but only 3.4% of sufferers are on them. Even NICE, projecting forward, thought that the figure would already be 20%.

I do not want to talk for too long, because other hon. Members want to speak, but it is a national scandal that people are dying today, are dying every day and are having incapacitating strokes, and that that is costing the national health service an enormous amount of money and requiring the use of an enormous amount of expertise. It is a burden on the national health service that should not be there.

There is an easy resolution. It is based on science, based on research, based on evidence. It is about time that the ministerial team took the lead on this matter, that GPs woke up, and that clinical commissioning groups heard the hard words that we will not allow our constituents unnecessarily to die or suffer long-term disability just because of the inactivity of the system. We are seeing this short-term saving, this mean-minded pettiness of saving a bit of money on the balance sheet of a CCG today, when the real cost to the health service is a generic one right across our country.

This is the beginning of a campaign. We have been campaigning for a long time, but it is at a new level. We are not going to let this issue go away. This is not party political. We will chase the Minister, chase the Secretary of State and chase the Prime Minister, because this issue is important and we cannot allow this injustice to continue any longer.