Pharmacies and the NHS

Jim Shannon Excerpts

Wednesday 20th November 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on bringing this matter for our consideration today. Although I agree with him on many things, his football team, Ipswich Town, is playing my team, Leicester City, on Saturday, so our opinions will differ on that.

[David Simpson]

You’ll get beat.

[Jim Shannon]

Well, I hope we won’t.

To return to the matter in hand, having run my own business, I can well understand the pressures on businesses—the need to make profit and to pay the bills at home. I can also understand the principle behind paying for what you get and that a good service needs to be paid for. At the same time, however, from what I have read in the media and the considerable background information to the debate today, the scandal of double-invoicing and cashback to the detriment of the NHS cannot ever be accepted.

I take my hat off to the whistleblowers who have highlighted the practice, which it is claimed has robbed the NHS of up to £120 million. The headlines are clear: “Pricing scandal sees NHS pay £89 for cod-liver oil capsules”; “Firms boast of profits on drugs that cost ‘pennies’”; “‘There’s a lot of flexibility over prices’”; “Pharmacies and suppliers accused of price rigging”, and last, but not least, “The NHS, the drug firms and the price racket”. All those headlines are cause for concern.

I have asked several questions of the Secretary of State regarding the provision of new cancer drugs, Alzheimer’s drugs or any number of other new drugs that are not accessible on the NHS. How do I tell my young constituent suffering from cancer that there is no funding for a drug that has been proven in other countries to help when she is reading about double-invoicing? Is the cost of her life so little for the House that we can allow the practice to continue? I have asked those questions of myself and my constituents ask me them, too.

I was angered when I read about £10,000 monthly kickbacks and other horror stories. It is clear that any agreement needs to stop that from being able to happen. I have the greatest respect for the Minister and I am sure he will hit on such issues in his response. If we need new legislation that enables the NHS to go deeper than merely checking invoices, so be it. It concerns me greatly to think of the number of families who could have received life-changing help this year with the money—our money, our constituents’ money—that has been lost to those who are working the system. That has to stop.

Many heads should hang in shame over how bills have been creatively put together by providers, but I cannot simply allow the Government not to understand that they need to do more.

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

Does my hon. Friend agree that one of the most significant recent statements in the press was when a senior executive of one of the large companies said that it would be more than happy to agree to a 70% discount if that is what it took to get the contract? That is a damning indictment of the original price.

[Jim Shannon]

I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.

On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:

“Medicines should not just be seen as a cost.”

They should first and foremost be about healing and curing illnesses. The letter continues:

“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”

That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:

“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”

Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?

Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?

[Oliver Colvile]

Does the hon. Gentleman recognise that drugs and medicines can be dangerous if they get into the wrong hands? Pharmacies also have to face people using the internet to acquire drugs, which is an option that does not carry the same regulation that we expect in the domestic market.

[Jim Shannon]

I thank the hon. Gentleman for that contribution. It is something that many of us have highlighted and I know that the Minister has spoken about it in the past. The availability of drugs on the internet is an anomaly in the system, and perhaps the Minister can give us an indication of how best to deal with it.

Back in April, we were told that the number of cancer drugs on the approved list was to be halved. Will the Minister commit to ensuring that the savings will be used to increase the amount of drugs that might save lives and give a better quality of life?

I read the story of a mother with terminal cancer, who was forced to fund herself a drug that she believed would give her extra time with her young children, after being refused by a special Government fund. I find such stories incredible, hearing about the real heartache and issues that impact on family lives, and yet we—as collective representatives—are unable to help and assist as we should. In America, Obama is trying to bring in a health care system similar to ours. It is referred to as Obamacare—people say that it will make or break him, and it probably will. We, however, seem to be turning ourselves into an American system, whereby we have to fundraise to get treatment. That is certainly not what my constituents or I pay our taxes for, and I am sure that others agree with me.

I want to make a quick comment about Northern Ireland, where our Health Minister abolished prescription charges. That was done on the understanding that cheap generic drugs were not prescribed. Health is a devolved matter in Northern Ireland, and our Minister made a decision, which I support entirely. Will this Minister—I ask this with respect—liaise with the Northern Ireland Minister, Edwin Poots, to ascertain how the scheme is working and how we have been able to stick within our budget in Northern Ireland on prescription drugs?

The right hon. Member for Rother Valley (Mr Barron) made a valuable contribution today. One of the things that he referred to was the drugs that people have and do not use; they sit until they go out of date and are then dumped. In Northern Ireland, the Minister, the GP surgeries and so on have taken steps to ensure that the prescription of drugs is better controlled. Sometimes, people might run out of drugs, rather than having extra in the cupboard, but such steps help and take away wastage in the system. The right hon. Gentleman made that clear in his contribution.

Over the years in Northern Ireland, through the Minister and in co-operation with the pharmacies, we have also tried to reduce the number of people attending accident and emergency. If people have a minor ailment, they should go to their pharmacist or chemist; he or she will be able to give some direction on what needs to be done. There are ways and means of good practice, to which I have referred on many occasions. I say what we do in Northern Ireland with humility, but we actually do some things very well. If such things are done well, they can be a marker for elsewhere.

Time is flying past, but changes clearly need to be made soon. Yes, pharmaceutical companies and pharmacies need to make a profit, but that must be done in the right way; we need legislation in place to ensure that that is done in such a way. Yes, NICE must protect people from drugs that promise all, but deliver nothing, and yet that cannot be used to count pennies and to justify saying no to drugs that will make a difference.

Finally, yes, Government must make savings, but those cannot be taken from the most vulnerable by denying them treatment; any savings should be used for new drugs, to give people a better chance of life, for the sake of our constituents in the whole of the United Kingdom of Great Britain and Northern Ireland. We are not talking simply about numbers on a hospital list—the changes need to be made, and made soon.

--- Later in debate ---

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

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

Urgent and Emergency Care Review

Jim Shannon Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

The hon. Lady makes some important points, and I congratulate her on being the first Opposition Member to raise the fact that it has become harder and harder to get an appointment with a GP. [Interruption.] I know that it is hard to accept, but it is a fundamental problem, and a challenge facing our A and E departments that the Government are determined to sort out.

[Jim Shannon (Strangford) (DUP)]

Before tomorrow’s report on the urgent and emergency care review, may I tell the House that in Northern Ireland, we treat urgent referrals by direction to the doctor on call and linking up with the chemist. Emergency referrals are done through hospitals, showing good practice and delivery. Is the Secretary of State prepared to contact the Northern Ireland Assembly and the Minister responsible to see how best practice works?

[Mr Hunt]

I am in regular contact with the Northern Ireland Minister for Health, Social Services and Public Safety about good practice in Northern Ireland, and I am delighted to hear that they are doing some good things in urgent and emergency care. We should be open to all good practice, not just in our country but all over the world.

Hearing Loss in Adulthood

Jim Shannon Excerpts

Tuesday 12th November 2013 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I am glad that we are debating an issue that affects all our constituencies, and I know that it is a matter of real concern to many Members in this House and in the other place.

I would like to begin by paying tribute to the work of the Ear Foundation, a cochlear implant support charity in my constituency. I was glad to secure the debate, and I hope that it will draw attention to the vital work it does to support adults and children with hearing loss.

One in six people in the UK experience hearing loss, and seven in 10 can expect to be affected by the time they reach their 70th birthday. That means that 10 million people live with hearing loss, and an ageing population means that that number will rise in the years ahead. To communicate is to be part of society. Losing one’s hearing is not just about the absence of sound—if not addressed, hearing loss can result in the loss of our social life, cutting us off from family, friends and work.

Deafness in adulthood is linked to depression, unemployment, poor mental and physical health and an increased risk of other conditions, including dementia. Hearing loss is a constant condition, and in most cases there is no cure. It is no exaggeration to say that it can destroy lives. People with hearing loss can find it difficult to negotiate everyday challenges in the workplace, on the bus, at the supermarket, or in the local doctor’s surgery, leading to isolation, exclusion and frustration.

Research carried out by Action on Hearing Loss has found that adults who lose their hearing are likely to withdraw from social activities. When they do take part, communication difficulties can result in feelings of loneliness. Hearing loss can also damage personal relationships. Many deaf people find it difficult to join in with family conversations and jokes. Couples say that they feel more distant from their friends, and partners of people with a hearing problem describe feelings of loneliness and frustration. Travelling on public transport becomes a challenge, and a platform alteration or a delayed connection can be a major problem if someone misses the announcement. That can leave deaf people feeling anxious and vulnerable when travelling, and worried about being stranded or lost. The debate among policy makers focuses mainly on quality-of-life issues, but failure to address hearing problems has implications for society as a whole.

[Jim Shannon (Strangford) (DUP)]

I have sought the hon. Lady’s permission to intervene in the debate. In Northern Ireland, 300,000 adults experience deafness or tinnitus—a sixth of the population, which is similar to the rest of the United Kingdom. Does she agree that a UK-wide strategy—and perhaps the Minister would respond to this—would benefit the core of the community across the United Kingdom, especially people with deafness?

[Lilian Greenwood]

I thank the hon. Gentleman for his intervention. He is quite right: these are issues that affect the whole of society, and I hope that the Minister will respond positively to his suggestion.

A 2006 study estimated that unemployment resulting from hearing loss cost the UK economy £13 billion a year. Too many people are forced to resign, retire or face redundancy as a result of their disability. People with hearing impairment report that their employers often have a passive attitude, providing adjustments and support only when prompted, and a significant number face outright discrimination.

Of the 300,000 people of working age with severe hearing impairment, 20% report that they are unemployed and are seeking work. Another 10% report that they cannot seek work as a result of their condition. As the state pension age rises and more jobs depend on communication skills than was the case 20 or 30 years ago, that vulnerability to unemployment is a growing problem. It represents a worrying underuse of the economic capacity of the nation.

Despite the scale and impact of hearing loss in the UK, adults with profound and severe hearing problems face major challenges when accessing health services. For many people, even seeing their GP can be a challenge, especially when surgeries rely on telephone booking systems and do not use visual display screens. One in seven respondents to an Action on Hearing Loss survey reported missing the call for their appointment while sitting in the waiting room. Poor deaf awareness among health professionals, such as not looking directly at a patient to allow for lip-reading, can lead to patients with hearing loss feeling unclear about the medical advice or information provided. According to the same survey, 28% of people with hearing loss have been unclear about a medical diagnosis and 19% have been unclear about their medication.

Diagnosis of hearing loss among adults is too often down to chance. Many are reluctant to seek help, and evidence suggests that people wait an average of 10 years before doing so. Stigma is a key factor in this delay in taking up hearing aids, which makes some people unwilling to tell others about their hearing loss. An Action on Hearing Loss report found that one element of stigma is the fear that deaf people are seen as less capable. A 2005 MORI poll of more than 20,000 people showed that one in five expressed concern about being treated differently.

Earlier diagnosis is essential to ensuring that people with hearing loss can access the support and services that can help them best manage their condition. A hearing screening programme for people aged 65 would help to overcome some of the barriers that prevent people from addressing their hearing loss. I pay tribute to the hon. Member for Eastbourne (Stephen Lloyd), who has led the Hearing Screening for Life campaign. Research by the consultancy London Economics suggests that such a programme would represent good value for money, so will the Minister consider establishing a pilot hearing screening programme?

There are approximately 4 million people with undiagnosed hearing loss in the UK who could benefit from hearing aids or, in a smaller number of cases, a cochlear implant. However, research suggests that GPs are often reluctant to refer patients for assessment or lack the knowledge to do so. Forty-five per cent. of patients presenting hearing loss symptoms are not referred, so something is clearly amiss. GPs’ lack of awareness of the impacts of deafness in general and a lack of knowledge of the benefits of cochlear implantation in particular give rise to concern. Greater education of GPs and audiologists on hearing technologies and the potential benefits of cochlear implantation for adult patients is therefore vital. I would be grateful if the Minister updated the House on the Government’s plans to ensure that training and updating on hearing technologies is provided consistently across the country.

Despite the obvious need, there is relatively little recognition of the impact of hearing loss or of the latest technologies that can improve hearing. We know that hearing aids improve adults’ health-related quality of life by reducing the psychological, social and emotional effects of hearing loss. For those who are severely or profoundly deaf, and for whom hearing aids offer little benefit, cochlear implants offer the chance of useful hearing.

[Jim Shannon]

I thank the hon. Lady for giving way; she is being very gracious. One of the issues that have come to my attention as an elected representative is that hearing aids are sometimes thought of as a big thing attached to the ear, but thanks to the advance of technology hearing aids are very small now. Perhaps that means that cosmetically they are less noticeable, and people can have the implant and lead a normal life. Is that one of the things that the hon. Lady feels should happen?

[Lilian Greenwood]

My hon. Friend is right. There is a need to increase awareness of what a cochlear implant is, how it operates and even what it looks like.

Despite the digital revolution in the NHS, in which high-quality hearing aids are now routinely fitted, there remains an under-utilisation of implants for adults, notwithstanding comparable advances in implant technology. One person who has benefited is Abigail from Nottingham, who found her implant an enormous benefit to her life. She was born deaf and grew up wearing two hearing aids until her hearing deteriorated, and doctors told her that hearing aids were no longer of benefit to her. Following detailed and intensive assessment she was approved for an implant, and when this was switched on it gave her new-found confidence. It rebuilt her self-esteem, enabling her to communicate more comfortably with her husband, family, friends and colleagues. Having a cochlear implant has given her a new lease of life, without having to rely on others to help her with communication, such as by telephone. It has also helped her immensely at work, where she can now communicate with colleagues on an easier level. It has helped her gain promotion and do a job that she enjoys. The cochlear implant has enabled her to get on with life at home, at work and socially, and with her hobbies, including music. She also does volunteering work in the community.

A cochlear implant stimulates the hearing nerve by means of rapid electrical impulses, which bypass the non-functional inner ear in people who are severely or profoundly deaf. Sounds heard with a cochlear implant are not the same as those heard with a human ear, but with the right support a person with a cochlear implant can adapt to the novel signal and use their implant to understand speech and other sounds, much like normal listening. One cochlear implant recipient said:

“I feel that so much of my previous life and true self has been restored, regaining my pride and ability to contribute actively in society on an equal basis.”

The late Lord Ashley, who is remembered and was rightly held in extremely high regard by many in this place, was known to call his cochlear implant a miracle. Surely it is time that everyone who needs a cochlear implant had access to their own miracle. There are an estimated 100,000 people with profound hearing loss, and 360,000 with severe loss. Although it is difficult to determine the exact number of adults who need an implant, on any of the current measures of profound deafness the current level of provision for cochlear implantation would appear to be significantly below any predictions of need.

The Ear Foundation suggests that as few as 5% of adults who might be able to benefit from an implant are currently getting one, and the UK is fitting only half the number of implants in adults as Germany and Austria. Speaking at last month’s Westminster launch of the Ear Foundation report “Adult Cochlear Implantation”, Dr Andrew Dunlop, a GP who suffered sudden hearing loss himself, described his own experience of deafness, undergoing assessment and receiving a cochlear implant. He said:

“I was fortunate, that as a healthcare professional, I knew my way around the system and was not overwhelmed when dealing with fellow doctors, audiologists and consultants. Sadly, the story for less informed individuals is not quite the same. My return to Practice emphasized to me just how much of an iceberg of unmet need is within the community at large, with many very able individuals assuming wrongly that they have no options after optimal provision of hearing aids and seem reduced to a second class life of social isolation, loss of self-esteem and frequently unemployment.”

Today’s debate is my attempt to chip away at that iceberg.

The criteria for implants are set by the National Institute for Health and Care Excellence, with guidance last reviewed in 2011. However, the criteria are based on evidence from patients who were predominantly wearing technology from the late 1990s, and since then there have been significant advances in cochlear implant technology. Many clinicians would argue that the criteria do not reflect real world listening, and that more realistic tests should be deployed instead.

Since the last review, there have been supportive studies on the effectiveness of bilateral implants—one implant for each ear—which NICE believes provide too little benefit for adults to justify NHS funding. One patient who was refused implantation described the process as follows:

“The conditions they did the testing in were ideal. It was perfect but they made no allowance for the difficulties you get if somebody is talking from the side, or if there is any background noise…and of course under those circumstances you do very well and it makes no allowances for the problems you run into in real life.”

In addition, the use of sentence tests, rather than monosyllabic words, enables deafened adults to use their previous linguistic knowledge to complete the test, thus appearing to have hearing that is too good for cochlear implantation. Brian Lam and Sue Archbold, authors of the Ear Foundation report, conclude that there is an urgent need to look at the deployment of a wider range of tests. They also argue that testing in noise and assessment of performance with monosyllabic words would be more appropriate. This would reflect current practice in Germany, where criteria are more flexible.

A growing body of evidence indicates that bilateral implants provide added improvements in speech perception in noisy environments over unilateral implantation, and better sound localisation, leading to improved quality of life. The Ear Foundation has recommended that NICE review its current guidance on cochlear implantation, and in particular on the criteria for unilateral and bilateral implants for adults. Will the Minister look into this matter and consider asking NICE to conduct such a review? Does he agree that where a clinician believes that it is in the best interests of an individual patient, there should be some discretion in applying these guidelines?

Charities in the field have welcomed the Department of Health’s development of a national hearing loss action plan, but they are disappointed that it has been delayed by a year. I join those charities in urging the Government to prioritise its publication. Last month the noble Baroness Jolly stated in the other place that the Government aim to publish the action plan as soon as possible. I would be grateful if the Minister updated the House on when it will be published and how its implementation will be monitored. Has he assessed the suggestion of establishing a lead commissioner for audiology so that there is greater focus on good commissioning across all clinical commissioning groups?

The right hon. Member for Gordon (Sir Malcolm Bruce), who chairs the all-party group on deafness, last month challenged the Government, and any Government who come after them, no longer to leave deaf people behind. Today I echo those words. I hope that the Government can help move this issue, which affects all our constituencies, beyond debate and ensure that action is taken to address it.

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship for the first time, Madam Deputy Speaker. I congratulate the hon. Member for Nottingham South (Lilian Greenwood) on securing the debate and championing this cause. I will state at the start that I am very happy to maintain a dialogue with her on this, because she has made a powerful case and clearly a lot of progress could be made not only by the Government, but across the health and care system. I am happy to assist in that regard. I also pay tribute to my hon. Friend the Member for Eastbourne (Stephen Lloyd), who has done a lot of work in championing this cause, as the hon. Lady mentioned, and the Ear Foundation for its work on this important issue.

The hon. Lady made a good case for why this is so important. She talked about the importance of basic communication and the fact that hearing loss can affect mental health as well as physical health and lead to withdrawal from social activities. She talked about the cost to society, the impact on employment and the fact that there is poor deaf awareness among health professionals and that better training is needed. I absolutely agree with her on all those points.

Over 10 million adults in England are living with hearing loss. Some of them will have been among the one in 700 babies in England born with hearing loss, but many will be among the growing number who develop a hearing impairment during their lifetimes. For some people that will be the sort of age-related hearing loss that many of us will experience as we grow older and that will become increasingly common because of our ageing population, but for many others hearing loss is acquired and should therefore be avoidable.

The World Health Organisation considers half of all cases of hearing loss to be preventable—for example, by immunisation, early treatment or reducing exposure to noise. In fact, it identifies exposure to excessive noise as the major avoidable cause of permanent hearing impairment worldwide. In developed countries, it is at least partially responsible for more than a third of all hearing impairments. As a result of the UK’s ageing population, the impact of working with noisy machinery and exposure to loud music and other loud noises, the World Health Organisation predicts that by 2030 there will be an estimated 14.5 million people in the UK with hearing loss, and adult-onset hearing loss will be among the UK’s top 10 disease burdens. That demonstrates the scale of the concern.

We have to take hearing loss seriously, which is why we are currently looking to develop the action plan on hearing loss, which the hon. Lady mentioned, so that we can achieve better outcomes for all those with hearing loss and related conditions. The action plan will identify key actions that will make a real difference in improving health and social care outcomes for children, young people and adults with hearing loss and generally improving the hearing health of the population.

The Department of Health is engaging with a range of organisations in developing this action plan, and as Baroness Jolly mentioned, we aim to publish it as soon as possible. I will get back to the hon. Lady with an indication of the likely publication day. It is time that we set a target date and then focused minds on getting it published.

[Jim Shannon]

We have a UK-wide diabetes strategy, and in my intervention on the hon. Member for Nottingham South (Lilian Greenwood) I suggested a UK-wide strategy on deafness as well. Will the Minister consider that?

[Norman Lamb]

My responsibilities stretch only to England, but clear co-ordination and joint working with the devolved Administrations absolutely make sense on an issue that transcends borders, so I agree with the ambition that the hon. Gentleman sets.

This cannot just be about prevention because that is not always possible; it is also about dealing with the consequences of hearing loss. The Government are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We are developing measures to identify those with hearing loss as early as possible, including the roll-out of a national hearing screening programme for newborn babies that enables the early identification of deafness, providing a clear care pathway for services and allowing parents to make informed choices on communication needs.

Today, however, we are focusing on adults with hearing loss. I realise that there is currently considerable interest on hearing loss screening for adults, which the hon. Lady mentioned. The UK National Screening Committee advises Ministers and the NHS in all four countries on all aspects of screening policy. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. In 2009, the committee recommended that routine screening for adults’ hearing loss should not be offered because of a lack of evidence to warrant such a screening programme. However, as part of its three-year review policy cycle, the committee is reviewing the evidence for a national adult hearing screening programme. A public consultation will be held shortly and details will be available on the committee’s website. I encourage the Ear Foundation and many others to contribute to that consultation.

We welcome the recent report by the Ear Foundation, which clearly sets out the benefits of cochlear implants for children and adults. Abigail’s story, as told by the hon. Lady, demonstrates what a massive impact that can have on an individual’s life. It completely transformed her life, and no doubt that experience is repeated very many times around the country. The report will be of enormous use to NICE if it decides to update the technology appraisal that it published in 2009. I encourage the Ear Foundation to engage with NICE. I am sure that it is already in touch, but it is very important for it to provide any emerging evidence to NICE to help it to update, if necessary, the guidance provided on implants.

A large number of services are already commissioned for people with hearing loss, and a number of specialist centres in England provide implants for children and adults. It is important that GPs understand the criteria for referral, as well as the obvious benefits of this technology for people with hearing loss. That touches on the hon. Lady’s point about the importance of health professionals, whether GPs or anyone else in the health system, gaining a better understanding of the potential for this technology. There have been considerable improvements to services for people with hearing loss in recent years, including reduced waits for assessment and treatment to within 18 weeks—a significant advance.

Cancer Patient Experience

Jim Shannon Excerpts

Wednesday 30th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am grateful, Mr Owen, for being called to make a contribution to this debate. It is on cancer patient experience, but we will all have personal experience of the issues. I congratulate the hon. Member for Hertsmere (Mr Clappison) on tabling the subject for debate. In his introduction he rightly said that the debate refers to the NHS in the UK, and there are four Northern Ireland MPs here because each of us can contribute to the debate by relating our experiences. I hope that the Minister will consider a strategy that involves not just the mainland, but all four regions.

As I was saying to my hon. Friend the Member for Upper Bann (David Simpson) earlier today, when I first considered my contribution to the debate, I realised that I have never before known so many people in my age group, so many of my friends and so many of those just older than me who have had cancer, and I have never experienced so many people passing away as a result of it.

I have had a number of meetings with the Minister back in Northern Ireland, Edwin Poots, and I intend to have a public meeting in my constituency to review cancer care with the general public and the trust and look at how best we can do it. My frustration is compounded by discussions with the trust. I do not want to be critical, because that is not how I do things—I try to see how we can move forward and be more positive—but I am concerned about the magnitude of cancer cases in my area and across the United Kingdom. I suspect that other Members will confirm what I already know. A 10% increase in cancer cases in Northern Ireland is extremely worrying.

My father and sister suffered from cancer. Of the four staff employed in my Newtownards office, my parliamentary aide had two grandparents die from cancer and her father suffers from cancer, my secretary had her mother die from cancer and she recently buried one brother-in-law to cancer and has another undergoing chemotherapy. Only my office manager seems to have escaped cancer in their immediate family. Some 75% of my office staff have experienced cancer in their close family and individually.

If we look into the community, we can see that my examples provide an accurate reflection of the way that cancer affects entire communities. Someone in the United Kingdom is diagnosed with cancer every two minutes. More than one in three people in the UK will develop some form of cancer during their lifetime, which is a horrifying statistic. The risk of developing cancer before 50 is 1 in 35 for men and 1 in 20 for women, so the situation is more extreme for ladies.

As elected representatives, our constituents often come to our offices to ask how to find their way through the benefits system. They experience health pressures to start with, but financial pressures soon follow. Just yesterday, my hon. Friend the Member for East Londonderry (Mr Campbell) and I went to the Macmillan Cancer Support reception here in the Houses of Parliament and we had the important opportunity to speak to carers. I will highlight some of the issues raised as we go through this debate.

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

Before my hon. Friend moves on to discuss carers, which is an important matter, does he agree that a big issue is people’s reluctance and sometimes failure, in particular among us males, to visit the GP when there may be a problem? We should encourage everybody, but males in particular. I do not understand the logic. If my television does not work, I get a TV repair man in. If the washing machine does not work, I get the washing machine repair man in. If people have a health problem, they go to their GP. Unfortunately, however, males seem reluctant to do that.

[Jim Shannon]

I thank my hon. Friend for that contribution. The males of the species do tend to wait just that wee bit longer. I will not relate my personal case to Westminster Hall, but we do sometimes leave things a little longer than we should, which is perhaps a failing on our part. The Health Minister and his Department in Northern Ireland have run several campaigns to highlight prostate cancer in particular. It may be that MPs know more people, but I have two close friends who were diagnosed with cancer. Thankfully, in both cases, they acknowledged early that something was wrong and went to their doctors and were then referred for health checks. I am happy to say that the treatment that they are now receiving will save their lives, but if the diagnoses had been made a couple of months later, I suspect that it may have been different. My hon. Friend is absolutely right. Entire families and communities are affected by this cancer pandemic. The House must deliver an effective strategy to help those experiencing the scourge of cancer.

I read with great interest the Macmillan report and the hon. Member for Hertsmere outlined the many cancer organisations and societies that do tremendous work. Macmillan’s document, “Improving care for people with cancer: Putting cancer patient experience at the heart of the NHS”, wants patient care at the core of the NHS and I heard yesterday from carers and people involved with Macmillan how important that is. The report references England and Wales only, but the overall message is mirrored throughout the UK, and the other Northern Irish Members and I are here today to provide the experience of Northern Ireland.

I recently met Edwin Poots, the Minister of Health, Social Services and Public Safety in Northern Ireland, regarding the provision of cancer carers in my area, as it is clear that changes that could really make a difference cannot be implemented due to a lack of funding, which is part of the problem, and the lack of a strategy for the increases in demand over the next 10, 20 or 30 years. Looking at the Ulster hospital in particular—I am not going to be critical of the staff, who are tremendous and can never be paid enough for what they do—I can see greater demand and that needs to be taken on board. I ask the Minister to consider holding discussions with those in the regions, in particular with the Northern Ireland Assembly and Edwin Poots, because we need a strategy that takes into account the whole of the United Kingdom and not just the mainland. We can work together. Experiences, interests, qualifications and knowledge may differ across the UK, but it is time that we exchanged some of that in order to help each other.

Getting back to the Macmillan report, it states what I am sure that everyone here believes:

“Every person diagnosed with cancer should have a positive care experience and be treated with dignity and respect throughout their cancer journey.”

My hon. Friend the Member for Upper Bann said in his intervention that people needed to be treated as human beings and not just as numbers.

[David Simpson]

Will my hon. Friend join me in praising young carers, who look after family members until Marie Curie or Macmillan move in? Their lives are detrimentally affected by the trauma. Young carers cannot be praised enough.

[Jim Shannon]

I thank my hon. Friend for that comment. In my constituency, we have a young carers organisation that also works with adults. I have met some young carers and am aware of young sons and daughters who look after mothers, fathers and other siblings. We could not do without them. We are ever mindful of their experiences. I know young carers, my hon. Friend knows them and I suspect that everyone in the House knows individual young carers.

Some people may ask how the cancer experience can ever be positive, but although going through cancer will always be horrific, the care that is given can and does impact upon how a patient feels. The Macmillan report states:

“Good patient experience is closely connected to improving other outcomes such as recovery from an illness. However, the sad reality is that many people still have a poor experience of care.”

We can hopefully try to address that problem today. Cancer is no respecter of persons, but that does not mean that cancer treatment precludes the sufferer receiving the utmost respect and dignity through treatments that may be undignified in their essence. We have all lost a little dignity while in the doctor’s surgery and the manner of the doctor or nurse often determines how embarrassed we become. If we are treated gently and with care rather than being pushed through the process as quickly as possible to get the next patient seen, we may feel better as a result. That does not always happen and I can certainly appreciate the pressure that doctors and nurses are under to do the procedures, tick the red-tape boxes and bring down waiting lists. However, the fact that we are not dealing with lists but with people must never be far from our minds.

Again, I stress that I am not placing the blame on the providers of care, but something must be done to address the fact that, on average, only 56% of cancer patients in England said that doctors and nurses asked them by what name they wanted to be called, which was an issue highlighted by the hon. Member for Hertsmere. A little bit of consideration and allowing the patient to maintain their dignity does not take a whole lot of effort. It may seem trivial, but this is a serious point: a girl called Betty works in my office and were I to call her “Beatrice”, she would get upset and would tell me. Similarly, should I refer to the other lady in my office as Mrs Cotter when she is actually Mrs Armstrong-Cotter, she would immediately put me in my place. I use those examples because it is important that a caring bond is formed with cancer patients. A wee bit of time, consideration, humility and dignity can really make a difference. The same can be said on a greater scale when people are doing intimate things to patients while always reminding them that patients do not know them. That is a small thing that the Macmillan report highlighted that could make a patient feel that much more comfortable and indeed that much more safe.

The carers at the Macmillan reception also described some things that they thought should be happening in hospitals. They outlined the need for someone to be available to hospitals across all regions. The six people we met yesterday were all from different parts of the United Kingdom and all had different stories to tell. It seems that some trusts are responding well, but others are not. We need a universal response that encompasses all areas. The Macmillan representatives also suggested that someone should also be available to provide advice on benefits and on care and just to give support.

Another point that came out of yesterday’s discussion was about respite care. Some of the ladies we met were single carers—in other words, a wife looking after a husband, with no sons, daughters or other family members close at hand. We also need to consider the issue of respite care and how we can help such carers get a wee bit of time for themselves.

[Mark Durkan (Foyle) (SDLP)]

The hon. Gentleman said that Macmillan Cancer Support has suggested that help with understanding social security and welfare advice is important. Is he aware that, in the Altnagelvin area hospital in my constituency, Macmillan and the Western Health and Social Care Trust run the independent Macmillan/North West advice service to do exactly that? It basically navigates people through the benefits system and all the other support mechanisms. It does not expect people to be experts on such arrangements in the public administration system, but takes away an awful lot of the worry and provides pathways to care and support that they would not otherwise know was available.

[Jim Shannon]

The hon. Gentleman is absolutely right. I have such a service in my area. I am pleased that Macmillan and others provide such a level of care and support at times of great concern and worry in the Ulster hospital in Dundonald. I must say a great thank you to the volunteers—a great many of them are volunteers —who provide that service.

It is nice to see the shadow Minister, the hon. Member for Leicester West (Liz Kendall), in her place, because she and I had a discussion the other day about the report on care that is coming to the House for consideration. I hope that some of the points made by the ladies to whom we spoke will be part of our next debate on the draft Care and Support Bill, and I am sure that no one will be found wanting in responding to that.

In my opinion, the ethos of a hospital is reflected in how patients are treated. The Macmillan survey, which highlighted the priority of patient experience, has painted a picture of how each different hospital board views the importance of the patient care experience. It found that boards raised patient experience as an agenda item in policy meetings, but that only 5% of such items led to further action: boards noted the patient experience, but did not deem it important enough to follow up.

When I wore my other hat as a councillor, for some years I chaired the council’s audit and risk management committee and read the absolutely endless reports on matters prioritised as categories 1, 2 or 3: something in category 1 needed immediate attention, something in category 2 needed attention in a reasonable time, and something in category 3 needed attention just at some stage. It is safe to say that many of the category 3 priority cases remained the same and did not change from year to year, because time never permitted for making those changes, as something more urgent was always pressing. In other words, there were always category 1 and 2 priorities and, unfortunately, category 3 priorities sometimes sat on the shelf. My belief is that patient experience should not be a category 3 priority, but should be considered as a category 1 priority; it should not have to wait until everything else is fixed before it receives attention.

To conclude as I began, cancer is a wretched illness, whose deadly or grimy fingers reach out to impact on wide family circles, as well as entire communities. The experience of going through cancer has an impact on not only the individual, but the people around them. I believe that it is time to make cancer a priority, with a UK strategy for the Government here and those in the regions of Scotland, Northern Ireland and Wales. That is why I wholeheartedly support the hon. Member for Hertsmere and, in doing so, I again ask that any decision taken by the Secretary of State will look at having a UK strategy as well as additional funding. I thank the hon. Gentleman for bringing forward this debate.

Release of Bodies from Hospital

Jim Shannon Excerpts

Wednesday 30th October 2013 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

As ever, Mr Hood, it is a pleasure to serve under your chairmanship. I particularly thank Mr Speaker for granting this important debate on a subject that, had it not been brought to my attention by a constituent, I would not have believed possible outside the scripts of comedy or perhaps, more appropriately on the day before Hallowe’en, a horror film. However, the occurrence is possibly far more widespread than is known about, and my constituent fears that it is the modem equivalent of body-snatching by unscrupulous undertakers who, keen to ensure that they are subsequently contracted by bereaved families to organise funerals, take unlawful control of a body.

This situation, which the funeral industry states is rare, and the hospital concerned states arose under unusual circumstances, is none the less one raised by my constituent amidst fears that it was in fact a deliberate attempt to exploit bereaved families in the immediate aftermath of a death, and that it was made possible by a legal grey area and poorly drafted Department of Health guidelines. As a result of my constituent’s case, and after acquainting myself with the guidelines on how bodies are dealt with, I decided to seek this debate to raise two issues. The matter is clearly of limited interest to colleagues, but I welcome the opportunity to make my points direct to the Minister, and I look forward to his response.

First, the existing legislation needs clarification. There is a definite need for guidelines for hospitals and hospice staff to be revised, so that they comply with the existing law, and prevent staff from being exposed to unwarranted prosecution based on the technicalities of existing legal grey areas. Secondly, and probably more importantly, I want to highlight a culture of complicity between undertakers and hospital staff, and potentially deliberate unscrupulous practices deployed by undertakers, who get away with them not in spite of Department of Health guidelines but, worryingly, because of them.

A further point worth raising is Bristol royal infirmary’s failure in its duty of care towards the deceased and her family. On Saturday 23 March this year, Gladys Pugh, the mother-in-law of my constituent, Mr Peter Williams, sadly died in Bristol royal infirmary. Her body was taken to the hospital’s mortuary to await the coroner’s permission for it to be released. The following Tuesday, Mr Williams and his wife began the painful task of contacting undertakers to ask for quotes and to discuss possible funeral arrangements. Three funeral directors were contacted. Mr and Mrs Williams planned to travel to Bristol to register the death and to visit the funeral directors they had contacted, but with the long Easter weekend so close, they could not make the journey until 2 April. The family contacted all the undertakers they had spoken to and informed them they would come back to them if they were interested in taking matters further after the Easter break.

On 2 or 3 of April, one of the undertakers, Thomas Davis, part of Bristol Funeral Directors group and a member of all the relevant trade organisations, including the National Association of Funeral Directors, contacted Mr Williams and asked what was happening about the arrangements. Mr Williams informed them clearly that they had decided to engage the services of another undertaker, thanked them for their interest, and left it at that.

It then transpired that without the permission of the Williams family and without any form of verbal or written contract, Thomas Davis had driven to the hospital’s mortuary on 27 March, the day it was contacted by Mr Williams, and removed Mrs Pugh’s body to one of its own facilities. The situation came to light 10 days after Mrs Pugh’s body had been taken from the mortuary when the company subsequently appointed by my constituent contacted the mortuary to arrange collection of Mrs Pugh’s body, only to be told that it had been taken away some 10 days previously.

There was an understandable feeling of horror, shock and disbelief that Mrs Pugh’s body had been kidnapped by an undertaker whose sole instruction was to offer a quote, which incidentally was never forthcoming, and to inquire about available dates for cremation. I use the word “kidnapped” after considerable thought. First, I cannot use the word “stolen” as a dead body is not technically the property of anyone except the deceased. That is one of the grey areas that legal experts agree needs clarification. Secondly, as kidnapping is the removal of a person without their consent, and as a dead person is still considered a person in law but is unable to give such consent—and, as “stolen” would not be legally correct—“kidnapped” is the only suitable word that I can use to describe what happened.

I argue that Thomas Davis acted unlawfully, because all that had been requested by the Williams family was for a quote to be provided for the services, and for provisional inquiries to be made with a local crematorium. There was no contract, no formal quote, and at no time were the family informed that the body had been collected. Furthermore, at no time was any of the paperwork required under Department of Health hospital guidelines for the release of Mrs Pugh’s body handed over by the family to Thomas Davis.

It is that point—the lack of consent given by the Williams family—that makes the removal of the body unlawful. That is where the first issue arises. Ignoring the motivation for a moment, how can an undertaker take possession of a body from a hospital lawfully? The answer—for it to be lawful, the person in control of the body must be enabled by law, by dint of their status in the life of the deceased or through being appointed the agent of such a person. In the case of Mr Williams’ mother-in-law, the undertakers had not been given the legal right to take control of the body by the family and were therefore not in legal possession of it.

What checks were made by the mortuary staff to ascertain the lawful right of the undertakers to take responsibility for the body? None, it would appear. It seems that the law is at the same time both very clear and utterly confusing on that point, and furthermore, contradicts the Government’s own guidelines. I hope that my hon. Friend the Minister will bear with me while I try to explain that.

Although NHS trusts have very strict guidelines on releasing bodies, largely based on the Department of Health’s publication, “Care and Respect in Death: Good Practice Guidance for NHS Mortuary Staff”, and usually stipulate that the person collecting the body must be in possession of the relevant paperwork, often including “the green form”—an interim death certificate releasing the body for disposal—those guidelines are, I am told, probably of no legal effect. In the case of Bristol royal infirmary, its own release note, which Mr Williams was told would be essential for the release of the body, is also possibly not worth the paper it is printed on.

That is because case law dating back to 1841 states that once a person has died, unless the medical staff or the coroner order an autopsy, the deceased person’s body becomes the responsibility of—but not the property of—in the following order: the executor of the will; the next of kin; or, in the absence of the above two, a person or persons intending to pay for and arrange the funeral. Failing that, the local authority must take control. There are, therefore, a limited group of people to whom lawful control of a body can be given, which can also include their appointed representatives. That is the bit of the law that is absolutely crystal clear.

However, what follows is much more confusing. Even where guidelines stipulate which forms must be presented before a body can be released—such as Bristol royal infirmary’s own release form—in fact, once someone who can lawfully take responsibility for a body demands to be allowed to do so, the hospital is apparently powerless to prevent the release of the body, irrespective of trust or Department guidelines, and irrespective of what paperwork the person or persons may or, in this case, may not have.

That is a very important, albeit technical, point, which I wish the Minister to take note of, because if a hospital employee, following the appropriate guidelines, refuses to release the body to someone who can lawfully take control of it, honestly believing that he or she is doing the right thing, that employee can technically open themselves up to prosecution for preventing a burial or cremation—even if that was never the intention and even if they were simply seeking to establish whether the person taking responsibility was legally entitled to do so.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Lady beforehand about this issue. She has outlined technical issues about how the body should have been released and where the process has fallen down. Is she also concerned at the impact that such a situation has on the families at a time of grief and sorrow? No matter what, that cannot be overlooked.

[Caroline Nokes]

I thank the hon. Gentleman for that intervention. He is, of course, exactly correct on that point. It is a time of great grief and distress to families, and they are often not in a position either to know what the legal technicalities are or to ensure that they are properly implemented. I will come on to his specific points very shortly.

According to some legal experts, this grey area has arisen from a number of test cases—including one in 1974—that have apparently established that a person claiming lawful control does not need to provide any paperwork at all to justify their claim over a body. Furthermore, and of great concern, not only are there no stipulations in law regarding what paperwork must be presented, or what conditions met, irrespective of guidelines, it is apparently illegal to demand that anyone seeking lawful control of a body do anything to justify their claim. In other words, unless my understanding is incorrect, not only are trust guidelines of no legal effect, but they can actually put the staff seeking to implement them at a technical risk of prosecution—something that I know will be of concern to my hon. Friend the Minister.

The first issue, therefore, that I would like my hon. Friend the Minister to consider is clearing up the discrepancy between the guidelines that NHS, hospice and care home staff are given and the technical exposure to prosecution that they face if they seek to abide by them. Furthermore, perhaps the law can also, at the same time, be clarified to state what rights the next of kin have over a body, which is something that it does not clearly do at the moment, because, as I said earlier, the body is not technically considered to be the property of anyone.

I turn to the second point that has been highlighted by my constituents. The right of lawful control does not pass to undertakers unless they have been properly contracted and bestowed with the right to take the body. Furthermore, departmental guidelines clearly state that that right must be demonstrated by the production of the relevant paperwork. What we have to ask, therefore, is how did this situation arise and how widespread is the practice?

In accordance with Department of Health guidelines, Bristol royal infirmary operates a system where a body will not be released without staff being presented with one of its own release notes—something that my constituent was very clearly told. However, in this case, no such release note was presented, because the undertaker was never given it. How, then, did the body come to be given to the undertaker? In answer to that, I again draw the attention of my hon. Friend the Minister to his Department’s guidelines, which, like the law, can at best be described as vague.

For example, while the guidelines state that a body must be released to “the correct recipient”, they do not say who that is. The guidelines also say that “standard operating procedures” should be known by all staff through training, and be robustly audited. They clearly state:

“Before a deceased person’s body is released, mortuary staff should check that all necessary documentation is complete”.

Even if that was a legal requirement, which it seems it may not be, in this case there were clearly no checks of the paperwork because none can have been presented. The guidelines go on to state:

“The body of a person who has died may be collected from the mortuary by the family, but is usually released to a representative, most often a funeral director. Mortuaries should therefore ensure that they have good lines of communication and working relationships with local funeral directors.”

Here, the advice is that hospitals need good working relationships with local undertakers. It seems that that advice has been taken far too literally in this case at least, and I fear elsewhere, with the establishment of a very cosy relationship between undertaker and hospital—a relationship where it is deemed that things can be taken on trust, and contrary to guidelines, no checks are required as to the legal right of the undertaker to take control of the body. That is not a good working relationship with clear lines of communication; it is an abuse of trust.

Certainly, what is clear in this case is that Bristol royal infirmary and the undertakers did not act in accordance with the Department’s guidelines and were, in fact, acting like some modern-day Burke and Hare operation. What is abundantly clear is that Bristol royal infirmary’s response to Mr Williams is inadequate. Although some changes to policy have been implemented, those are changes that my constituent calls “minimal”, and there is no guarantee that it will not happen again. As my constituent noted in a letter to the hospital’s chief executive, Mr Woolley:

“The Post Office would appear to take more care in the release of a parcel than the BRI did in the release of a body”.

To say that my constituent is unhappy with the response that he has received from the hospital would be an understatement. He is desperate to see the changes required to prevent other families experiencing the kidnapping of bodies belonging to their loved ones, but feels that the points he has raised with the hospital have simply been ignored, with the hospital blaming a member of staff for not following procedures.

Mr Williams asks two perfectly reasonable questions in his complaint to the hospital. Those questions are, as yet, unanswered. First, why did Thomas Davis arrive at the hospital without the paperwork that the hospital itself says is essential for a body to be released? Secondly, why was the body released without that paperwork? Mr Williams is worried that the answer to both those questions is this: because the undertaker assumed that he would not need the paperwork—an assumption based on past experience of acting in a similar manner. That begs the obvious question: how many other bodies have been taken in that way? It appears that the hospital will not accept responsibility for its failure in its duty of care towards the Williams family, seeming to want to blame individual hospital employees and the funeral industry.

That is another area of concern to Mr Williams, because all that has been received from the funeral industry is a response that is, to say the least, disappointing, stating only that “these mistakes sometimes happen” and offering nothing beyond that. My constituent has rightly complained to the health service ombudsman, and we await with interest the decision on that complaint, but there is no redress against the undertakers who took the body of my constituent’s mother-in-law, held it unlawfully and refused to take responsibility for doing so, knowing that they are virtually free of any legal consequences for their unlawful behaviour.

I hope that, in his response, the Minister will touch on both aspects of this sorry tale: the lack of legal clarity, rights and protection that both relatives and NHS staff have; and measures designed to prevent undertakers from seeing distressed and grieving families as representing a lucrative opportunity provided that they can first kidnap the body by relying on the cosy relationship that they might enjoy with the local hospital, which the Department’s own guidelines encourage.

From grave robbery to daylight robbery, the funeral industry has questions to answer, as, having spoken to campaigners in preparation for this debate, I can tell the Minister that, despite the comments of the industry, this practice is said to be far more widespread than is believed or acknowledged. Sadly, I am told that people rarely complain, because they simply want to grieve and move on, and the funeral industry is rarely held to account.

I suspect that neither the Department nor the funeral industry keeps figures on how often this practice happens. It would be interesting to know whether the Department has some figures. However, my constituent fears that his experience is merely the tip of the iceberg—a view shared by campaigners in this area. I hope that now that this issue has been highlighted, the Department will seriously consider bringing clarity to what the legislation says and will offer protection to NHS, hospice and care home employees and to grieving families, protecting them from undertakers who should be there to offer a service at the time of greatest need and ensuring that bereavement and grief are not exploited.

Hepatitis C (Haemophiliacs)

Jim Shannon Excerpts

Tuesday 29th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on bringing this important matter to the House’s consideration. I will speak specifically on behalf of my constituents, as I think will everyone who speaks today, from a heartfelt understanding of the problems that those constituents have faced for a number of years. My hon. Friend the Member for Upper Bann (David Simpson) illustrated the time scale. If ever there were a powerful case for the Minister to answer, this is one. Many of the speeches made today will be impassioned. I welcome the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) to her position, and I look forward to working together on many issues in future.

The background to the case is clear. I have spoken to constituents of mine who are victims. Some of my constituents live daily with these illnesses through no fault of their own but rather as a result of the Government’s inaction at a time when action was important. My constituents have sent me a briefing, and I have relied on them for information as well as for the personal details that they have given me, although I do not intend to mention any names out of respect for confidentiality and personal issues.

The Archer inquiry investigated the fact that between the 1970s and late 1980s, 4,670 people with haemophilia were infected with hepatitis C through treatment by the NHS that they loved and respected, which ultimately, unfortunately, let them down. Of those, 1,243 people with haemophilia were also exposed to HIV, as the right hon. Gentleman said. Almost half of those infected with hepatitis C and almost three quarters of those co-infected with HIV have since died and many have tragically left families behind. When looking at the impact on the individuals, we can never forget about the effect on their families; many individuals have experienced poverty and discrimination as a result of their infections. People, either through mistrust or lack of knowledge, sometimes unfairly discriminate against those with infections. The provisions recommended by the Archer inquiry would offer appropriate support and compensation to those affected and would ensure that steps were taken to improve blood safety.

The previous Government argued that the reason why financial support was not made available at comparable levels to those in the Republic of Ireland, for example, was that the disaster affected the two countries differently. I am unsure how that was worked out. Perhaps the disaster was measured in numbers, but the disaster is the same to each individual and each family. No-fault Government payment schemes were established to provide support to those affected. The Archer inquiry, which was non-statutory and funded from private donations, reported in February 2009 on the Government’s response. Among its recommendations was a call for reform of support for those affected in line with the scheme used in the Republic of Ireland. If we had had in Northern Ireland and the rest of the United Kingdom a scheme similar to that of the Republic of Ireland, our constituents would have been much more satisfied. What does the Minister think about the Republic of Ireland’s scheme? Is it possible that we can try to match it?

Despite the Government’s announcing on 10 January 2011 an increase in payments to some of those infected with hepatitis C, what has been put in place is not adequate to support people through their illnesses. The Government’s scheme now has two stages, as outlined by the right hon. Member for Wythenshawe and Sale East. A first stage payment of £20,000 is available to eligible people. Following that, successful recipients of the first stage payment whose hepatitis C infection has led to advanced liver disease can receive a second stage payment of £50,000. Those who have received the second stage payment are also entitled to additional annual payments of £14,000, paid monthly or quarterly. The money may look good and it sounds like a lot of support, but, as always, there is more than meets the eye to the press release. As the saying goes, the devil is in the detail, and that is clearly the case here. The Hepatitis C Trust supplied an interesting briefing and is calling for a rethink of the strategy and policy. The trust, with which I certainly agree, asks that the first and second stage categories be removed. As a constituent of mine said, the payment can never compensate for what has happened, but it can offer support and help people to adjust to and live a life affected by it.

People infected with hepatitis C can experience severe symptoms, including extreme fatigue, depression, aching limbs, headaches and abdominal pains, which may mean that they are unable to work for long periods of time. The right hon. Member for Wythenshawe and Sale East referred to Atos in his speech—I think it was also mentioned in an intervention. The situation of people who are unable to work for long periods of time needs to be understood. Symptoms can lead to difficulties in holding down a job and receiving an income. Sufferers rely on help from family and sometimes from other carers, and the fact that the annual sum starts only when a person’s hepatitis C has caused cirrhosis does not take any of that into account. Understanding the problem is the crux of the issue. The briefing I received from the Hepatitis C Trust put it succinctly:

“Some patients without cirrhosis are far more symptomatic than some who have reached that stage. Indeed, some patients die whilst still in stage 1. Therefore there should be no distinction between stage 1 and stage 2 payments for people who have been infected with hepatitis C through contaminated blood. They should be entitled to the full and on-going support immediately.”

The second point raised in the briefing is that there has been no Government apology to date. The right hon. Member for Wythenshawe and Sale East referred to the Pat Finucane case and the apology that the Prime Minister made, so I urge the Minister to consider an apology for those infected, who have suffered many years of illness as a result. Having listened to some of the apologies, which should never have been uttered, that have rolled off Government Ministers’ tongues to pacify and placate people for political gain, I find it difficult to believe that there has been no Government apology. I have sometimes heard Members of this House and the Prime Minister apologising on my behalf when no apology was needed and yet here, when there clearly was a fault and when innocent people lost their lives following treatment by the NHS, mouths seem to be suddenly closed. I cannot understand that mindset. A mistake was made that has cost lives and has cost other people the price of living with horrific diseases, and if that does not deserve a heartfelt apology then I am at a loss to think what does.

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

Does my hon. Friend agree that what sufferers and their families need are empathy, an apology, to which he has alluded, and a commitment to ongoing support for the remainder of their days? If they saw that coming from the heart of Government, we would have accomplished a significant amount of what the right hon. Member for Wythenshawe and Sale East (Paul Goggins) and his predecessor have sought to achieve.

[Jim Shannon]

I thank my hon. Friend for that contribution, which refers to something that we would all want to see. I am reminded of what my mother told me as a child: “Compassion is your pain in my heart.” She was referring to an understanding of the problems facing other people, which, in a way, is why we are here. We are here not just because we want to be MPs, but because we are privileged to be elected by our constituents. We see their problems and we must illustrate and expand those problems in this great House, of which we are privileged to be a part.

[Grahame M. Morris (Easington) (Lab)]

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing a debate on this important issue.

What are the thoughts of the hon. Member for Strangford (Jim Shannon) on the role of specialist hepatitis C nurses in providing support to sufferers who are haemophiliacs and more generally? The NICE guidelines suggest a minimum of one specialist hepatitis C nurse for every 40 patients in the community and one such nurse for every 20 patients in a hospital setting. Does the hon. Gentleman think that the Government’s plans to transfer resources through the clinical commissioning group allocations will help or hinder the improvement of support for hepatitis C sufferers?

[Jim Shannon]

I thank the hon. Gentleman for helpfully highlighting the role of specialist nurses. I hope that the Minister will be able to give us an indication of the importance of the role of nurses and therefore the importance of retaining them and ensuring that the numbers are correct.

Just a few minutes spent reading the stories of victims and their families on the taintedblood.info website brings a lump to the throat. In this House, where we have the privilege to represent our constituents, we cannot continue to leave the families behind. I wholeheartedly support the removal of the two-tier system, which would entitle people to an annual sum to help them to cope with the side effects of this terrible disease and would take a little pressure off the families who are faced with watching their loved one fade away before their eyes. It is well past time that we do the right thing by those affected, and that will not be done by separating and segregating those infected by the same disease. I urge the Minister to take on board what is said today by the right hon. Member for Wythenshawe and Sale East and others and to do the obvious and right thing by providing the apology and response that we need.

Several hon. Members rose—

[Jim Dobbin (in the Chair)]

Order. I intend to call the shadow Minister at 20 minutes to 11 and five or six hon. Members want to speak, so I ask them to watch the length of their speeches before I have to impose limits.

In-patient Mental Health Services (Children and Adolescents)

Jim Shannon Excerpts

Wednesday 23rd October 2013 Commons Chamber

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Last week, Dr Martin Baggaley, medical director of the South London and Maudsley NHS Foundation Trust, said that mental health services in England are unsafe and in crisis. At the same time, BBC News and Community Care magazine printed the results of a freedom of information request to mental health trusts around the country, which revealed that 1,500 mental health beds had closed since 2011. The Royal College of Psychiatrists is among the many expert organisations that have expressed concerns about poor in-patient mental health provision, particularly for children and adolescents. In response, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb) who I am pleased to see is present, said that he was determined to end the institutional bias against mental health. This debate presents an opportunity for him to do something in pursuit of that noble objective.

There is increasing demand for mental health services, and all the research shows that early intervention is essential to prevent mental health problems developing in later life. One in 10 children aged between five and 16 suffer from a diagnosable mental health disorder, half of which, with the exclusion of dementia, start before the age of 14. Yet, although the Government claim to be increasing expenditure on health, child and adolescent mental health services in England have been grappling with unprecedented cuts to their funding over the past two years.

Many MPs will know that from their experience in their constituencies, where social care and education funding, which is such an important part of CAMHS budgets, is having to be reduced dramatically. The charity YoungMinds found that since 2010 two thirds of local authorities in England have reduced their CAMHS budget. The contrast with physical health budgets is a stark manifestation of the institutional bias against mental health.

The West End unit in my constituency was the only in-patient mental health facility for Hull and the East Riding. It closed in March while a consultation on CAMHS—which, incidentally, gave no opportunity for respondents to voice an opinion on whether the unit should remain open—was still under way. So much for “No decision about me, without me”.

Can the Minister confirm that the guidance to section 244 of the National Health Service Act 2006 concerning consultation states:

“No final decisions—even decisions in principle—must be taken until the public has been consulted and the results of the consultation have been considered by the NHS body”?

When I raised that appalling breach of the Government’s own guidance on consultations, I was told that West End was closed by the unaccountable monolith otherwise known as NHS England. It changed the specification for tier 4 services and the West End in-patient unit that provided high-quality services in Hull and the East Riding for 20 years closed as a result.

I felt sure that Hull could not have been the only area affected, so I submitted a parliamentary question asking how many in-patient mental health units had ceased to operate.

[Jim Shannon (Strangford) (DUP)]

In my constituency 33% of young people have depression. That rises to 50% among those who are unemployed. Does the right hon. Gentleman’s area have the same concerns as I have in my area? We have taken steps in Northern Ireland to address the issues, and perhaps the Government need to do the same here.

[Alan Johnson]

This debate is about services in England, but I confirm that part of the problem is the fact that there is a rising need for adolescent and child mental health services and a decreasing capacity to deal with that need.

I asked the Minister in a parliamentary question which other areas had been affected and which units had ceased to operate. I was told by the Minister that no units had ceased to operate as a result of this change and nor were any closures expected when the change was introduced on 1 October. As I said, the unit in Hull closed in March. The change had already happened. Will the Minister take this opportunity to correct that answer?

Not only did West End close in March, but we are beginning to hear of closures across the country, including in Devon and Somerset, where my right hon. Friend the Member for Exeter (Mr Bradshaw) has been pursuing this issue vigorously with the chief executive of NHS England, who confirmed in a letter to him that other units had closed as a result of the change to tier 4 specification well before the spurious 1 October date.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

I am glad my hon. Friend has raised the issue of working with schools and education, and I have already had initial discussions with my opposite number at the Department for Education. We think we have an exciting agenda to take forward, and I hear what my hon. Friend says.

[Jim Shannon (Strangford) (DUP)]

In 2011-12, childhood obesity rose by 37% across the United Kingdom. Will the Minister take into account the child marketing strategy of the fast-food industry when considering how best to address the issue?

[Jane Ellison]

I am interested in looking at what the hon. Gentleman says, and I will be happy to talk to him about that.

Psychological Therapies

Jim Shannon Excerpts

Wednesday 16th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to come here and support the hon. Member for Halesowen and Rowley Regis (James Morris), who has brought this matter to Westminster Hall for consideration. As my hon. Friend the Member for East Londonderry (Mr Campbell) said here yesterday, whenever we come to Westminster Hall, we congratulate the Member whose debate it is on bringing an important matter to the attention of the House. This is an important matter.

The hon. Gentleman clearly outlined the issues and their importance. My interest and that of my hon. Friends is in how such issues affect our young people. That will be the thrust of my speech. I also want to give a Northern Ireland perspective, which I believe is mirrored across the whole United Kingdom.

[Dr McCrea]

Does my hon. Friend agree that, for many years, mental ill health has been a taboo subject? Many of those suffering from mental health difficulties were pushed away or hidden from society. The value of such a debate is that it ensures openness in society, to deal with the important issue of mental ill health.

[Jim Shannon]

I thank my hon. Friend for raising that matter. That is exactly the problem; if I wanted to sum it up in one phrase, that is the phrase I would use. There was a taboo around mental ill health in the past, but hopefully we can discuss it now. I hate the word “mental”, because it almost puts the thought in one’s mind of someone to be kept at bay. We must be able to find another word in the English language that is more sympathetic. I am not sure what it would be, but we should give the matter consideration.

Psychological therapies are defined as an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behaviour—all issues the hon. Member for Halesowen and Rowley Regis mentioned—that have proved troublesome to the person seeking help from a trained professional. That is what we want to achieve.

The psychological therapies in the NHS 2013 event marked the halfway point of the coalition Government’s mental health strategy. Psychological therapies generally fall into three categories: behavioural therapies, which focus on cognitions and behaviours; psychoanalytical and psychodynamic therapies, which focus on the unconscious relationship patterns that evolved from childhood, which are important; and humanistic therapies, which focus on self-development in the here and now. We need to focus on those three categories.

I presume that most Members catch up on the news on BBC or Sky before they come here. A story today covered the role of carers and what they do for elderly people, but it also mentioned their role for those with mental health issues and focused in particular on the time that carers have to deliver care to people in those two categories. It underlined where we are in the debate about those who suffer from psychological imbalance and emotional issues.

The improving access to psychological therapies programme was built on evidence, produced in 2004 by the then National Institute for Health and Clinical Excellence, on treating people with depression and anxiety disorders. It was created to offer patients a realistic and routine first-line treatment, combined, where appropriate, with medication, which traditionally had been the only treatment available.

Things have changed. The Minister, whom I respect greatly, will outline the issues when he responds. The IAPT programme was dedicated to spending more than £700 million on psychological therapies between 2008 and 2014. It was first targeted at people of working age, but in 2010 was opened to adults of all ages. There has been success—it would be wrong to say that there has not.

In the first three years, 900,000 people were treated for depression and anxiety; 450,000 patients are in recovery, with another 200,000 moving towards recovery; 25,000 fewer people with mental health problems are on benefits; and the average waiting time has reduced from 18 months to a few weeks. In terms of what has been done so far, that is good news, but it is fair to say that there is a lot more to do. There has been a significant increase in the number of people with such issues, and all statistics indicate that that number will continue to grow.

People require psychological therapy for many reasons. Members have spoken about the things that lead to the position we are in today and why society and Government must respond. Reasons for therapy can be to do with home life and bereavement. On many occasions in my constituency office, we deal with bereavement and how it affects not only the partner, but the young people in the house. The hon. Member for Halesowen and Rowley Regis referred to that in his introduction. I regularly see it in my office—the frailty of life, the suddenness of death and how that affects people.

Unemployment, when young people who cannot get the jobs they need or the discipline that a job brings, and trouble in the workplace are other reasons for therapy. Another reason is childhood trauma, as we can see from the sexual abuse cases of the past few years. Many people were not aware of such trauma, but it existed. Social deprivation is another one, and all those issues contribute to where we are.

[David Simpson]

My hon. Friend mentioned young people again. Surely our schools, whether primary or secondary, need to focus on our teachers being trained to identify when a child has difficulties—the hon. Member for Halesowen and Rowley Regis (James Morris) mentioned early intervention—so that treatment can be introduced at an early stage, which could solve the problem for a lifetime.

[Jim Shannon]

As my hon. Friend and colleague mentioned, education is one of the areas in which Government can play a role, as can, I would say, Departments responsible for health, social services and welfare. They all need to come together.

Among many other factors, one comes to mind to do with young carers who look after their mum, dad, brothers or sisters. In my constituency, there are about 230 young carers, which is a massive number. They are making a contribution to society, but they are also the main carers for their adults or siblings. Again, that is a real issue.

In Northern Ireland, unemployment, too, causes problems because, among the regions of the United Kingdom, it has the highest percentage of working-age population not in paid employment—the figure is 30% higher than the UK average, which is 19% of individuals receiving a form of out-of-work benefit. The highest rates are recorded in Londonderry with 29%, Strabane with 29% and Belfast with 26%. Some 9% of the working-age population receive disability living allowance, including the 3% who receive DLA for mental health reasons. That proportion has risen by 25% since 1998, and is more than the UK average, while 70% of those registered with a disability are not in paid work.

Incidentally, am I the only elected representative to have had an increase in referrals for those who have served in the forces suffering from post-traumatic stress disorder? I know the answer: no, I am not. In all my years as an elected representative, I cannot recall having so many referrals of soldiers, male and female, for emotional, mental-health trauma suffered as a result of their service.

The Prince’s Trust, which many of us have knowledge of and great faith in, has found that one in four young people at work are down or depressed “always” or “often”—for people of that age to be downhearted or depressed is incredible. Unfortunately, that leads to an increase in the suicide rate among young people. In parts of our Province, suicide is at frightening levels. A few years ago in my constituency, there was a spate of suicides by young people, which was saddening for the people of our area, because we knew most of them—young people who did not feel that there was much for them in the future. We must address that issue.

The figure for young people who are down or depressed always or often, but are unemployed, is 50%. That is a massive figure. Clearly, a large section of people are at risk and, in my opinion, early intervention can and will make a difference. However, to establish it, there must be funding. My hon. Friend the Member for Upper Bann (David Simpson) referred to those in education diagnosing cases early, and that is one thing we can do. Our own Health Minister in the Northern Ireland Assembly, Edwin Poots, has taken steps to address the issue, but a UK-wide strategy would be useful and must be considered. I am keen to hear what the Minister will say.

Improving access to psychological therapies in all areas such as health and employment for individuals, families and carers in Northern Ireland could relieve anxiety, depression and distress. The long-term benefits would be more than worth any initial cost. The funding has to be in order, but it has to be there to discharge effectively what has to be done.

In addition, improving mental and social well-being can help to prevent antisocial behaviour and family breakdown for children and young people—again, in my constituency, we regularly witness the effect on people of family breakdowns. It also might make a positive input into the rehabilitation of offenders and assist in the maintenance of independence, reducing reliance on residential and hospital care. The benefits are numerous and clear.

Due to the years of suffering through the troubles, many people in Northern Ireland have poor physical, emotional, behavioural and/or mental health conditions. Dr Nichola Rooney, chair of the division of clinical psychology in Northern Ireland, said that there is

“historical underinvestment in psychological therapy services for people suffering from mental health difficulties in Northern Ireland”.

I am sure that is replicated UK-wide.

Clearly, we must continue to invest and see the rewards of such therapy, not simply as a method of cutting the costs of help in the future, but because it changes the quality of people’s lives and—a knock-on effect— the lives of the people around them. Everyone benefits.

Accident and Emergency Departments

Jim Shannon Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has campaigned regularly on this subject and there is a lot of merit in what he says. We do need more young people to know the basics of first aid, and that can be extremely important—even life-saving. But we also need to ensure that the NHS is there when we need it, 24/7, and that is why we need to make some important changes to the way in which A and E departments operate, in both the short term and the long term.

[Jim Shannon (Strangford) (DUP)]

Twenty-four thousand elderly people died last winter due to cold-related illnesses, and many of them had been referred to A and E departments. What specific assurances will the Minister make to vulnerable elderly people, who really dread the onset of winter?

[Mr Hunt]

That is what today’s announcement is all about. We are trying to reassure them that we are leaving no stone unturned, and where there are things that we can do in the short term, we are doing those things because we want every older person to feel confident that their NHS will be there for them—that their local A and E department will be able to cope with the additional pressures that develop every winter. But I would also say to them that where there are alternatives to A and E departments, people should consider those as well. That is why some of the measures that we are investing in are good alternatives to A and E, which can often give more appropriate treatment.