Pancreatic Cancer

Jim Shannon Excerpts

Wednesday 23rd May 2012 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Scott, for calling me to speak; it is a pleasure to serve under your chairmanship. I am pleased to have secured this debate, as it is on a subject of huge importance to thousands of families across the UK. It is also a subject that is close to my heart.

This debate was originally scheduled for the last week of the previous parliamentary Session. However, the cause of Prorogation it was cancelled, so I am particularly lucky to have been drawn again so quickly. Whether that was because of pure luck or the Speaker’s Panel taking pity on me, I do not know, but I am grateful none the less.

As it happens, the timing for this rescheduled debate could not have been better, because last week we established the all-party group on pancreatic cancer. It is chaired by Lord Patel, the Cross-Bench peer, who has huge experience of the medical profession, and it has a most fantastic treasurer in the hon. Member for Scunthorpe (Nic Dakin), who is here in Westminster Hall today. The all-party group aims to work with Pancreatic Cancer UK, Cancer Research UK and others to increase awareness of pancreatic cancer, and to help campaign for better care and treatments, which will lead to improved outcomes.

The simple fact is that we need better care and treatment. The number of people diagnosed with pancreatic cancer is rising. In 2008, around 8,100 cases were diagnosed—about 22 cases a day. Compared with other types of cancer, those numbers are quite low. However, there is a very poor prognosis in pancreatic cancer cases, with only 3% of patients surviving for five years or more. In my own particular case, my partner survived for only seven weeks after being diagnosed.

Despite advances in technology and improvements in survival rates for other forms of cancer, that figure of 3% has remained unchanged for 40 years, which is quite incredible. There are also wide regional variations in UK survival rates, the so-called and much cited problem of “the postcode lottery”. On a national level, that survival rate—only 3% of pancreatic cancer patients in the UK survive for five years or more—is the worst in the developed world. To put it into context, it is half the survival rate of the US, Australia or Canada. Those countries’ survival rates are obviously still low, but they are much better than the British survival rate.

There have also been reports from people with pancreatic cancer that the care provided in the UK has fallen below expectations. The 2010 NHS national cancer patient experience survey found that pancreatic cancer patients fared significantly worse than patients diagnosed with other cancers. That needs to change. Some things will be easier to rectify than others. For instance, improving the patient experience seems an obvious and relatively easy thing. However, we can and should work on improving awareness, diagnosis, treatment, care and—ultimately and most importantly—the survival rate across the board.

One can look at the impact of the advertising to increase awareness of bowel cancer, which is a difficult cancer to deal with. We are looking to achieve a similar impact in terms of increasing awareness of pancreatic cancer. Increasing awareness is vital, because too often pancreatic cancer is diagnosed at far too late a stage. Although symptoms may have manifested themselves for several months, many people do not visit their doctor until it is too late and the disease is quite advanced. In fact, 50% of pancreatic cancer patients are diagnosed only as a result of an emergency hospital admission and more than 80% of pancreatic cancer patients are diagnosed only once the tumour is inoperable. Those are startling, sobering and depressing statistics.

Let me refer again to my personal situation, in which the pancreatic cancer was diagnosed only after a series of what were just stomach aches, and tests were carried out only after those stomach aches and after a number of visits to the GP.

For the record, the symptoms of pancreatic cancer can be quite vague and varied. They can include weight loss and pain in the stomach, which both appeared in my particular experience of the disease, as well as back pain and jaundice. But if someone does not have any knowledge of the disease—neither I nor my partner had any such knowledge at the time—how would they realise that, because one is feeling tired every day there is something particularly wrong, until the stomach aches develop? Even then, in my personal experience the stomach aches were not significant in terms of pain. We had no awareness that that feeling of tiredness was anything to do with cancer.

We need to ensure that doctors are making the right diagnosis. Nearly 30% of pancreatic cancer patients will have visited their GP five times or more before being properly diagnosed; that was true in my situation. So we need to make sure that GPs are provided with the proper tools and training to recognise the symptoms of pancreatic cancer. Moreover, we need to ensure that GPs are able to refer their patients swiftly to hospitals for further tests when they suspect a case of pancreatic cancer.

As part of that process, Pancreatic Cancer UK is holding an early diagnosis workshop next month. Hopefully, that workshop will help to come up with more concrete actions that could be taken. I understand that the Minister’s colleague, the hon. Member for Sutton and Cheam (Paul Burstow), has agreed to support that workshop, which is an encouraging sign.

Put simply, late diagnosis means that the few treatments available might not be an option, so it is absolutely imperative that we improve awareness and diagnosis.

Let me turn to treatments. The uncomfortable fact is that few options for curative treatments exist. One of the reasons why survival rates for pancreatic cancer are so low, compared with those for other types of cancer, is that pancreatic tumours are relatively highly resistant to chemotherapy. Having said that, I note that Cancer Research UK has said that it believes there is some kind of breakthrough in terms of a new class of drugs, details of which it announced in April; that new class of drugs looks quite promising in terms of being able to improve treatment.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate on a very important issue; every one of us will have constituents who will be affected by it. Does he share my concern—and, I suspect, the concern of many people—that pancreatic cancer is the fifth most deadly cancer in the whole of the UK and yet only about 1% of cancer research is on pancreatic cancer? Also, does he feel that it is now time for the Minister to work with all the regional bodies across the UK—the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly—to introduce a UK-wide strategy to reduce deaths from pancreatic cancer?

[Eric Ollerenshaw]

The hon. Gentleman can obviously read minds, because that point about research is in my next paragraph. His other suggestion about a UK-wide strategy is a really interesting and positive one, because pancreatic cancer obviously does not respect any boundaries, or any devolved Government or national Government. So he makes an interesting point, which the all-party group can perhaps consider.

Effective cures for pancreatic cancer remain stubbornly elusive, but we need to try to find ways to prolong patients’ lives and to ease their pain and suffering, while always remembering that, with cancer, it is not only the patient who is affected but the people around them, including their family. Cancer affects not just one person; its effect spreads to other people. I had not entered the cancer world before my own personal experience—I call it a separate world, because it is like entering a separate universe that has never been experienced before. Patients’ loved ones also experience suffering.

NHS (Foreign Nationals)

Jim Shannon Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Kingswood (Chris Skidmore) on securing this debate. He tried hard to keep a balance—it is important for us to do so—as did the hon. Member for Ealing, Southall (Mr Sharma) during his interventions. However, whenever I read the background information, I cannot but feel shocked. On 3 May, an article in The Daily Telegraph on the foreign national debt stated that official figures suggest that

“more than £40 million is owed to NHS hospitals by foreign patients who were not eligible for free care”

and that freedom of information requests showed that

“the average unpaid debt for the provision of care to foreign nationals was £230,000 in the 35 trusts which responded.”

The article went on to note the doctors’ trade magazine Pulse’s claim:

“If this figure was the same across all 168 English acute trusts, the total debt would be almost £40 million”.

Those are worrying figures. The article continued:

“The FoI requests showed St George’s Healthcare Trust in South London had the largest outstanding debts, totalling £2 million from £3.55 million invoiced to foreign nationals for health treatment from April 2009.”

Everyone present is proud of our NHS and of the high esteem in which it is held, not only in this country, but throughout the world. I do not want to be a scaremonger. I want to keep my comments balanced. It is not in my nature to stir up angst or discontent. As the hon. Member for Kingswood has mentioned, we do not want xenophobia or discrimination, but the figures are unsettling and there are concerns that our health system is being taken advantage of by some people, which is to the detriment of British people who are waiting to be seen and receive treatment.

Anyone who knows me either inside or outside this Chamber will know that I often put my hand in my pocket to help those in Africa, India and other parts of the world. The same is true of other Members and of our great nation, because we are a nation of givers. Our charity contributions in a time of economic restraint are still above the norm—we are holding our own. In Northern Ireland in particular, our charity giving per head of population is second to none. I am all for international development and believe that we as a nation have a role to play in helping others who need it. The UK makes a significant contribution to third world aid, and we continue to do so—our commitment is to give—while other countries are cutting back. We as a nation are making a significant contribution and will continue to do so. I and other Members support the Government entirely on that issue.

I am also a constituency man and know that people are becoming discouraged. I am conscious that I am speaking as a Northern Ireland MP and that health is a devolved matter. Cancer patients talk to me about new treatments that cannot be paid for on the NHS because of lack of funding. I have asked questions on the Floor of the House about whether new treatment will be made available for those constituents of mine who clearly need it. In the past few days, we have heard on the news about the postcode lottery—that terminology is often used—whereby the treatment depends on the funds available where someone lives and the demands on the system. That is not necessarily a criticism—it is a fact of life. My constituents deserve to have the best treatment in the world and I will work as hard as I can to ensure that that happens.

The fact that £40 million is owed by some foreign nationals needs to be addressed. The Minister and the Home Office have indicated that they intend to introduce a £1,000 threshold to

“capture 94 per cent of outstanding charges owed to the NHS.”

I hope that that will be the case.

I hear that people now believe that we have a lax system. Again, we need to keep a balance. We cannot provide a world health service—it just cannot be done; the moneys are not there. We need to draw the line, and I believe that we should draw it in this place and that it should be a straight, firm line. Will the Minister indicate whether there will be a review or a reassessment of the six-month visa that allows GP registration and access to NHS care? That needs to be clarified, so that we can see where we are going.

There is a clear difference, as the hon. Member for Ealing, Southall has mentioned, between those who are taken ill on holiday and those who come here directly to take advantage of our health system. Again, it is about balance.

I have been encouraged to hear the Government’s proposals, but as a Northern Ireland MP I am concerned about whether they will make their way over to Northern Ireland. I will chat with my colleagues at home to ensure that we implement like-for-like proposals. Health is a devolved matter in Northern Ireland and the Health Minister is a member of my party. I will certainly have some discussions with him. The hon. Member for Kingswood has touched on this issue, but will the Minister explain what interaction there will be with the regional Assemblies—the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly—so that we have a UK-wide policy? It is important that all of the devolved Administrations have a similar policy to that on the mainland in England.

There are so many people in need of our health system at home that if we were to take in every sick person who was able to travel to the UK, it would not take a week until we imploded because of the demands on our system. We have to be realistic about what is expected of us and how we can help others. It about getting the balance right. The NHS is our national health service and one into which we have paid over many years through our tax system.

I had the privilege—some would say that it was not a privilege—of serving on the Health and Social Care Bill Committee, on which both Government and Opposition Members discussed the figures and tried to devise a reorganisation that would save money and still provide a good service. As well as delivering what is best for our citizens in the United Kingdom, it is important that we are able to help those who need it and who come here not with any specific intention to take advantage of the NHS, but who find themselves in need of it due to ill health. Any of us can be taken ill on holiday, so we take out insurance, which covers us for so much. It does not cover for circumstances in which ill health might result in a longer stay than anticipated, but it does help part of the way.

Some have taken advantage of the system. The Government are right to tighten the system and to ensure that there is a good NHS for the whole of the United Kingdom. The hon. Member for Kingswood referred to the term “health tourism”, which others have used and which sends out signals. Whether that term is correct or not, some people are doing it. We need to make sure that we have a system that can help those when they need it. We are a caring nation—we do not want to turn people away—but our system needs to ensure that that is done correctly. As I have said, this is all about balance. It is about ensuring that we, as a caring nation, can offer help to those who need it. No one who needs help should be turned away—that is clearly where I am coming from—but at the same time we need to tighten the criteria, close loopholes and at least ensure that the £40 million drain on NHS care is restricted or comes to an end.

--- Later in debate ---

[Anne Milton]

It will bring the focus closer to home. I would expect the shadow Minister to welcome this change, because GPs will now be much more acutely aware that registration with them should not automatically entitle people to NHS acute trust care. We are undertaking a review that I will mention in my concluding remarks. It is early days in respect of the UK Border Agency and the change in the immigration rules, so we do not have sufficient information adequately to evaluate how effective they are, but I think that we will see a significant impact. The shadow Minister asked specifically about the Olympics.

[Jim Shannon]

The Minister said that £14 million in debts was written off by the Government. Do the Government contact the countries that people have come from to try to recover some of those debts, or is it too costly administratively to do that? Is it cheaper to write off debts than to chase them up?

[Anne Milton]

That is true of all debts. Trusts are not always aware of the rules and the obligations placed on them. Sometimes, they do not have the infrastructure in place to chase such debts and sometimes the costs of chasing debts are greater than the debts themselves, so they write them off. Either way, it is clearly not fair on the taxpayer. West Middlesex is an exemplar. We in the NHS are not good at sharing best practice, but practice at West Middlesex should be spread more widely.

Back in 2005, when the Labour Government were in power, as part of the UK’s successful bid for the 2012 Olympics they committed to provide games family members with free medical care. The games family is a tightly defined group of people—athletes and their support teams, officials, accredited media and IOC members—who are directly involved in taking part in or supporting the games. We have introduced a specific exemption for those people in respect of hospital treatment that might otherwise be chargeable, which will last for only nine weeks around the time of the Games and will be limited to treatment, the need for which arises here, so pre-planned or routine ongoing treatment that can wait will not be free. Normal charging rules will apply to all other visitors, including those coming to see the games.

The NHS has been briefed to be particularly vigilant in screening visitors who seek treatment and in applying the charging rules, given the large influx of visitors to the country. Let me reassure the residents of Hackney—the shadow Minister rightly said that Homerton is one of the designated hospitals—that treatment will be given on the basis of need. Local people should not suffer at all as a result of these rules which, as the shadow Minister will be aware, were an important part of the previous Government’s bid.

My hon. Friend has mentioned some of the details of our review. It is important that there should be qualifying criteria, a full range of other criteria exempting services or visitors from charges, and criteria for charging for services outside hospital, as we move towards more care being delivered outside hospitals. We need to be mindful of costs that could be incurred, thereby ensuring that we have more efficient and effective processes throughout the NHS, including the ability to screen eligibility. Let me reassure the hon. Member for Strangford (Jim Shannon) that it is important that we work closely with the devolved Administrations, and have close discussions with them, to ensure that there are not unforeseen and unintended consequences.

Once again I thank my hon. Friend the Member for Kingswood for introducing the debate, and I thank hon. Members for the balanced, moderate nature of the discussion. It is important that we set an example—all parties desire to do so—and demonstrate to the public that such difficult issues, which can involve distinct communities, can be discussed and considered in a fair and balanced way and are matters of cross-party concern, with all political parties working together. It is not becoming for any politician to score party political points on an issue of such fundamental importance to the taxpayers of this country.

Rare Disease Strategy

Jim Shannon Excerpts

Monday 30th April 2012 Commons Chamber

[Mr Edward Timpson (Crewe and Nantwich) (Con)]

As ever, I am grateful, and indeed delighted, to have the opportunity to address the House in this timely and much-needed debate. Just eight days ago, along with 37,000 other hardy souls, I stood, full of trepidation and excitement, at the start line for the 2012 London marathon. I was running with my wife, Julia, and am pleased to report that we finished the course together in just under four hours. Far more importantly, our run raised over £6,000 for the national charity CLIMB.

That is all very interesting, you might say, Mr Deputy Speaker, but what has this rare accomplishment for a Member of Parliament got to do with a rare disease strategy for the UK? To explain, CLIMB stands for “children living with inherited metabolic diseases” and is a charity based in Crewe in my constituency. It is one of an important network of rare disease charities that strive to raise awareness of rare diseases, not least through Rare Disease day, which takes place on the last day of February each year. Under the stewardship of Steve Hannigan, CLIMB provides vital advice and support to many children and families affected by one of the around 730 known metabolic diseases. One of those children is my nephew Leo.

Leo was born in 2001 with an inherited metabolic disease known as MCADD. Approximately one in 10,000 babies born in the UK has MCADD, which means that they are missing an enzyme that helps break down the fats that provide energy for the body, particularly after long periods without food. This inability to break down fat leads to the build-up of medium-chain fats that can produce toxic substances and lead to severe symptoms, including seizures and possibly coma and death. As Leo was born before the introduction of routine baby screening for MCADD in 2008, neither medical professionals nor his parents knew that he had the disease.

For Leo, all was well until he was 10 months old, when he contracted pneumonia that was coupled with three days of severe hypoglycaemic episodes. Because the knowledge of rare diseases among medical staff was and, indeed, remains limited, and because he had not been screened for MCADD, no one picked up on this underlying rare condition and the need to treat him accordingly. More by luck than by informed professional judgment, thankfully Leo survived.

When Leo suffered a further hypo episode at 14 months, triggered by nothing more than a routine cold, the doctor on duty, who had some knowledge of MCADD, realised that his low blood sugar was unexplained, and subsequent relevant tests revealed a diagnosis of the metabolic disease.

Leo is now 11 and living a full and active life, but, with the mortality rate of children under the age of one who have undiagnosed MCADD being approximately 25%, the routine screening that CLIMB long campaigned for, and which is soon to be introduced throughout all four nations of the UK, is a vital tool in saving lives.

In the past year alone, more than 80 newborn babies have been diagnosed with MCADD—80 babies whose disease would otherwise have remained undetected and who would have been at significant risk. That is why I wanted this debate: to be able to speak up for all those, like Leo, with a rare disease, to put a proposition to the Minister and to question him about, how we can improve the services, information, treatment and support that those with rare diseases receive in order to ensure that we maximise their quality of life.

We are not talking about a handful of isolated cases. With close to 7,000 distinct rare diseases having been discovered, and with five new diseases described every week in medical literature, rare diseases are collectively far from rare. In the UK it is estimated that 3.5 million people, or one in 17, will be affected by a rare disease at some point in their life, with 30% of patients dying before their fifth birthday.

So what is a rare disease? The European commission on public health defines rare diseases, sometimes known as “orphan diseases”, as

“life-threatening or chronically debilitating diseases which are of such low prevalence”—

affecting fewer than one in 2,000 people—

“that special combined efforts are needed to address them.”

About 80% are genetic in origin, but many are auto-immune, such as Crohn’s disease, and others are infectious in nature.

Motor neurone disease, cystic fibrosis, muscular dystrophy and Huntington’s disease may be some of the more widely known rare diseases, whereas acquired non-histamine induced angiodema and Adair-Dighton syndrome are just two of the many thousands of others that I have come across in my own research.

[Jim Shannon (Strangford) (DUP)]

One rare disease that I am aware of is Prader-Willi syndrome, which affects the muscular build-up, eating habits and sleep patterns of some 2,000 people in the United Kingdom and 50 people in Northern Ireland. Does the hon. Gentleman feel that, if there is to be a strategy for the United Kingdom, it must involve all those regions where health matters are devolved to the Administration? Does he feel also that along with such a strategy and, given all the different areas that there are, we need to have something for respite care, because parents, and the way in which they play their part, are vital?

[Mr Timpson]

I am grateful to the hon. Gentleman for raising a particular issue in his constituency in Northern Ireland. He is absolutely right that we need to ensure that the strategy we develop for rare diseases supports not just those who suffer from the disease, but the families who every day, for every hour, have to cope with it and support them. We need to ensure that that is a central part of the strategy.

Such diseases—especially those, including the one to which the hon. Member for Strangford (Jim Shannon) refers, that are particularly rare—are no less important, however, and therein lies the problem. Most rare diseases are under the medical and public radar—too exceptional to attract the attention, recognition and resources required and, above all, the coherent plan needed to tackle the fragmented, inefficient and often inequitable services on offer.

That is why I welcome the Government’s current consultation on the development of a UK strategy for rare diseases and why this debate is so apt. For too long, rare diseases have been placed in the “too difficult to do” pile, but with the onset of changes to health care commissioning and the refocus on putting patients at the heart of the NHS, there is a real opportunity to do things more effectively and much smarter. That means that the consultation must be ambitious, provide strong leadership, and be unambiguous about how the core vision that it reveals can be successfully implemented practically and realistically on the ground across all four home nations.

I have taken the time to read the consultation document, and although it makes many of the right noises, there is a nagging doubt as to whether it meets all the challenges faced by those with rare diseases. I am told by those working in the field of rare diseases that Lord Howe, the Minister who, together with his colleagues in the devolved nations, is responsible for the document, genuinely appears to understand the importance of getting this right. I trust, therefore, that he and they will listen carefully to the submissions they receive, including mine this evening and those of other hon. Members.

So what needs improving? It is clear from my many conversations and my correspondence with clinicians, patient groups and charities working on and living with rare diseases that the ad-hoc nature in which services have developed has led to the principal problems of delays in diagnosis; misdiagnosis; lack of information, communication and awareness; limited research; scarce and unequal access to orphan medicines; poor commissioning and care co-ordination; and a failure to monitor outcomes.

That is not to say that it is all bad news. There is, as ever, some fantastic best practice already taking place. The TREAT-NMD—Translational Research in Europe: Assessment and Treatment of Neuromuscular Diseases—network for neuromuscular diseases, the European Huntington’s Disease Network’s REGISTRY, and the Tay Sachs walk-in clinic at Guy’s hospital are all good examples of innovative, effective and efficient service delivery on which any strategy should seek to build.

Selective Dorsal Rhizotomy

Jim Shannon Excerpts

Wednesday 18th April 2012 Commons Chamber

[Chris Heaton-Harris]

I happily commend their work. I have met Dana and her mother—a very powerful lady who has fought hard for her daughter’s rights and saved a lot of money so that she could have the procedure.

To return to the diary:

“Just these last couple of days she has started to learn to run. Prior to SDR her running technique was no faster than my normal walking pace and she had a swing to her hips that made it look like she would trip at any moment. I now need to walk very fast and sometimes even jog to keep up with her run and she has less swinging of the hips. She is still a long way off the speed and ability of her friends when it comes to running but she is definitely getting better at it.”

The next point is very important:

“Holly has also grown in confidence. She speaks out at school, joins in with activities more and is a nightmare at the park. She climbs up climbing frames that even her 7 year old sister would be wary over. It really is hard to believe that without the operation she would not be able to do these things.”

[Jim Shannon (Strangford) (DUP)]

I am very pleased about the successful outcomes for the hon. Gentleman’s constituent and for the constituent of the right hon. Member for Carshalton and Wallington (Tom Brake). Billy Douglas is three years old and lives in the village of Ballygowan in my constituency. Unfortunately, he has not yet had the operation but is trying to get it. Does the hon. Gentleman agree that it is not just a question of the operation, but the physiotherapy as well? It is a nine-month process and it is very important. Does he think that the NHS ought to make provision not only for the operation but for the physiotherapy? Families are asked to provide £50,000 for the operation and the physiotherapy, but that is beyond the budget of many people. Even with fundraising events it is almost impossible to reach that amount unless the Government or the NHS are prepared to help. Does he agree that we need compassion and financial help for many families across the whole United Kingdom?

[Chris Heaton-Harris]

I absolutely concur. Indeed the final paragraph I wanted to read from “Holly’s Diary” states:

“Finally—we are continuing with Holly’s strict physio programme. She has 1 hour a week from the NHS and we pay privately for a further 2 hours a week from different therapists.”

As we have just heard, for the best results from SDR the operation must be followed by intensive physiotherapy. As an aside, one thing that all the parents who have raised the money for their child’s operation have in common is the basic lack of interest in the patient from the NHS when they return home from abroad, especially when they try to get regular physiotherapy to ensure that their children benefit from the operation to the maximum extent possible. Essentially, the more physio a patient receives in the first years after the operation, the greater the level of ongoing success and the level of manoeuvrability in the patient. Can the Minister help to remedy the situation?

Mental Health Care (Hampshire)

Jim Shannon Excerpts

Wednesday 18th April 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for New Forest East (Dr Lewis) for securing the debate. Health matters are devolved in Northern Ireland and I do not have a direct input into them, but I do have compassion for those who are less well off and that is why I am here as an MP. I want to try to change lives for the better. I recognise the issues that affect the hon. Gentleman’s constituency. He outlined clearly where the process works and where it has not worked, which is what we are debating today. As MPs, we look at the grand scheme of politics—we are all drawn to do that—but today I want to support the hon. Gentleman on the issue specific to his constituency and give an example from my area to illustrate the importance of acute mental bed provision.

As we all know, acute mental health bed provision is vital. Those who use it do so because they have to. The reason such provision is made is to ensure that they receive all the care they need in the best place for that care to be given. The hon. Gentleman outlined how and why the 56 acute mental health beds in his area were removed. That that should happen without full and open consultation with the MP who represents the area or with the many people who are affected greatly by the removal is nothing short of scandalous.

In my constituency, I am aware of the care that is needed for those with acute mental health problems. As you will know, Dr McCrea, the Bamford review raised awareness of mental health issues in Northern Ireland and the importance of having provision for them. It stated that nothing should happen until all the parts were in place, and that if something was to be removed there had to be something else there to take its place. The Bamford review was very important for Northern Ireland.

It has been suggested what the bed closures will mean. According to the background information, if someone is not in hospital, they will be at home. If so, has provision been made for them? The hon. Gentleman described how the system worked and how the consultation process did not involve everyone. Perhaps it did not look fully—it should have done—at how those at home, receiving care in the community, will be affected. Is that care of sufficient value and weight to fit the gap that has opened because of bed closures? I do not know whether it is or not, but back home, when there were changes, we also had to ensure that there was provision for care at home. That is important for those with acute mental health issues. I am not sure, from what I have heard so far, that that has been done in the case the hon. Gentleman has raised. I hope that the Minister can give us some idea of how that will work out.

The hon. Member for Romsey and Southampton North (Caroline Nokes) mentioned another problem. Sometimes, Members of Parliament think that they represent problems specific to their constituency, but they are not really, because all hon. Members represent people similarly and similar problems occur in Hampshire, Dorset, Scotland, Wales and in my constituency of Strangford in Northern Ireland. Last year, after changes were made, one of my constituents affected by mental health issues would have had to travel some 40 to 50 miles on a bus, because there was no car provision. To illustrate the point, we got on the bus and did the whole journey together, me and her, to the destination. There and back, the journey took seven hours and cost £39.40, not to mention the annoyance, hassle and problems that occurred. Whenever people talk about removing beds, they have to consider what happens outside that, including the effect on provision of care packages at home and on the families, and how they get from their home to the hospital whenever a person needs care. I am not sure that, when decisions are taken, people understand that families are also involved. It is not just about the person with the acute mental health problems, but about the families as well. When a stone is thrown into the water and it hits the centre, the ripples spread out: the centre is the person with the acute mental health needs, but the ripples spread out to the family, the community and everywhere else.

The hon. Member for New Forest East mentioned a petition with 1,000 names. I do not agree with Councillor Pat West, who commented that 1,000 names is only a small portion. A thousand names on a petition is a very great number and, I believe, represents a large part of the community.

[Dr Lewis]

For the sake of fairness, let me say that it was the chief executive of the NHS trust, Miss Percy, who sought to dismiss the petition in that way. The trust said that it had tried to validate it and said that a number of people professed not to know about having signed it. How big or small that number was, I have yet to discover.

[Jim Shannon]

I thank the hon. Gentleman. The name stands corrected in Hansard for us all, including me. I still say that 1,000 names can never be ignored. Ignore them at your peril, because those 1,000 people have families and so on, and the numbers are important.

The loss of beds puts pressure on a great many people. The hon. Member for Burton (Andrew Griffiths) spoke about the practicalities. It is important that we consider those, because before anything is done, people have to look at their effect further on. From what I have heard today, it is clear that this process has not been truthfully, honestly and fairly carried out.

To illustrate my point further and give examples, back home there has been pressure on mental health and acute mental health beds. I have pressed in this regard, as have other hon. Members—you have been involved as well, Dr McCrea, and the end result is a new 30-bed unit in Templepatrick, in your constituency. That is a £10 million to £15 million project undertaken in partnership with the health service, private enterprise and private monies as well. The unit is for acute mental health issues. I have become aware of some mental health issues over the years. People who have anorexia and bulimia have acute mental health issues to address; they feel that, no matter how thin they are, they are not thin enough. The 30-bed unit in your constituency, Dr McCrea, is there because of the vision of some of those in private enterprise, and individuals, who have worked with the Minister, Edwin Poots, to ensure provision.

I commend the hon. Member for New Forest East for bringing this matter to the House. Any closure or removal of mental health beds impacts not only on those who need them, but on families who have to live with their family members’ trauma and, wider afield, on the whole community, which also shoulders the burden. I look forward to the Minister’s response, which I am sure will be full and helpful. Again, I hope that we will get the answer that the hon. Member for New Forest East needs, confirming the retention of the beds, because that is the best way forward.

Cigarette Packaging

Jim Shannon Excerpts

Tuesday 17th April 2012 Commons Chamber

[Mr Robinson]

I am grateful for that intervention. The concern about jobs in the printing and packaging industry will be shared by many, particularly Members from Northern Ireland, who still have a fairly large tobacco-related industry in their constituencies. We can come to that in due course, but the fact is that none of us wants to stop the progressive reduction in smoking, and if it seems a reasonable presumption that reducing the attractiveness of the packaging will help, we must face up to the jobs implications. However, I hasten to add that, having considered the issue in the round, I do not think that the implications will be so severe, because after all, as I have pointed out already, we are not talking about “plain” packaging. The same inventiveness and printing of graphic images that have already been brought to bear will continue; indeed, they will be put to much better use than trying to encourage youngsters to try smoking because it seems attractive or because cigarettes are packaged as lipstick, or any of the other advertising gimmicks that have been used.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the Floor of the House this evening, as many people are concerned about it. Cancer Research UK has been working with its campaigning partners to explain why plain packs are needed and to rebut the myths circulated by the industry. Does he feel that plain packaging will reduce the number of deaths resulting from smoking? If it saves lives, the Government need to introduce plain packaging legislation as soon as possible.

[Mr Robinson]

The cancer campaign’s research to which the hon. Gentleman refers has come out strongly in favour of the proposal, as have Action on Smoking and Health and most other related parts of the health industry, in the public sector and the NHS in particular. They have all made the case that the proposal is plausible and that it should represent the next push in a campaign that has been effective but has now faltered. Since 2007, the figures have levelled out; there has been no further reduction in smoking. I think that that will come as a surprise to many people, and it makes the next step an important one. In my view, the next useful step would be plain packaging.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Burns]

I am extremely grateful to my hon. Friend, given his past association as a constituency MP with this subject, because of the problems in his constituency. I believe that we have a strong system of general practice in this country, but I am afraid that more can be done to address variations in aspects of the quality of provision by some general practitioners. As I have said, the NHS Commissioning Board will adopt a single, consistent approach, allowing an overview of performance, which is not currently possible, and ensuring that interventions occur at an early stage. I think that will go a considerable way towards helping with the problems that have been experienced.

[Jim Shannon (Strangford) (DUP)]

As an elected representative for a great many years, I have often been made aware of issues relating to GPs and patient lists. Does the Minister agree that there should be greater co-operation between the Health Department and GPs with regard to their patient lists, and specifically with regard to the transfer of patients?

[Mr Burns]

With regard to the transfer of patients, we are seeking to give greater choice to patients under the modernisation programme so that they can move from one GP, or one GP practice, to another in a way that they cannot do at the moment. That will help to enhance the power of patients to get the GP of their choice and preference.

Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 20th March 2012 Commons Chamber

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

I want to make a few points on Lords amendment 2, which deals with the Secretary of State’s duties. This has been the subject of one of the most fundamental debates during the course of the Bill. The Lords still have grave concerns about whether the Secretary of State does indeed have a duty to

“provide or secure the effective provision”

of health services in England. In addition, concern remains over exactly what the Secretary of State will remain accountable to the House for.

In Committee, the Lords agreed not to amend clause 1, or clause 4, in regard to the duty to promote a comprehensive health service and the Health Secretary's accountability to Parliament. Instead, they preferred to engage in negotiations with the Minister with a view to bringing back proposals before the Report stage. The Lords Constitution Committee also proposed amendments on ministerial accountability for the NHS. The Committee’s concern was that, even after the months of debate here and in the other place and the amendments that had already been tabled, the Bill still posed an undue risk to maintaining adequate ministerial and legal accountability for the NHS. Given the number of amendments that had been tabled, it was a remarkable achievement still to have such uncertainty.

The wording of amendments remained an issue, and on 2 February 2012, the Government tabled 137 amendments to the Bill covering a range of areas, including changes to clarify the responsibility of the Secretary of State for the health service. There were two key amendments: one sought to ensure that the Secretary of State

“retains ministerial responsibility to Parliament for the provision of the health service in England”.

The other sought to place the duty to promote a comprehensive health service and to exercise functions to secure the provision of services above that of promoting autonomy.

[Jim Shannon (Strangford) (DUP)]

The hon. Member used the term “comprehensive health service”. Does he feel that the changes to the NHS will deliver a comprehensive health service, or does he feel that what we will see is some people being able to access services while others are not? Is that not the sort of health care service that he would be against and to which the people of this country would object?

[Grahame M. Morris]

I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.

The point about autonomy is relevant, because Lords amendment 2 reiterates that

“The Secretary of State retains ministerial responsibility to Parliament for the provision of”

health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only

“have regard to the desirability of securing”

autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.

--- Later in debate ---

[Paul Burstow]

No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment.

On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State’s duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers.

On the detail of Monitor’s specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them.

I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor’s role is to support it.

Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.

[Jim Shannon]

Many hon. Members will probably have received correspondence from the Nuffield Trust saying that

“much of the behaviour of providers will in practice be shaped by detailed guidance and the work on pricing conducted by both Monitor and the NHS Commissioning Board. The two organisations have a major task ahead of them to ensure there is the necessary information, data exchange, contracting and payment tools to support patient choice, integrated care, efficiency and quality.”

How would the Minister respond to the Nuffield Trust on that question?

[Paul Burstow]

What I heard the hon. Gentleman set out was a rehearsal of the interrelationship that exists between the NHS Commissioning Board and Monitor, particularly in the area of setting NHS tariffs and prices. For the first time, as a result of this legislation, there will be greater transparency and requirements about consultation in the design of those tariffs. At the moment, that process is obscured within the bowels of the Department of Health without accountability or public scrutiny. For the first time, this Bill puts that on a footing that ensures that transparency. As a result, it will produce much better tariff design for the future.

On Monitor’s role as the regulator of foundation trusts, it is important to be clear about this important part of the legislation. Foundation trusts will remain the principal providers of NHS services. The Government do not expect that to change. Monitor must therefore be able to continue operating a compliance regime transparently to assess and manage the risks, intervening proactively to address problems where necessary. The Bill is designed to reflect this and for Monitor to protect patients’ interests by regulating foundation trusts so that they continue to be able to provide NHS services in line with their principal purpose. Where Monitor identifies significant risk to a foundation trust’s continued ability to provide NHS services, the Bill provides Monitor with powers to intervene proactively to ensure that the risk is addressed. The Government agreed amendments in the House of Lords to clarify that further. In particular, the amendments clarify that Monitor’s powers to direct foundation trusts to do, or not to do, things to maintain essential standards of governance, or to ensure their continued ability to provide NHS services, will not be transitional powers. We accept that that previously was not as clear as it needed to be and we have made it clear.

We think that the Bill has been improved as a result of the amendments that were made in the House of Lords in that regard. Under clause 94 in the latest version of the Bill, Monitor’s enduring powers will include the power to set and enforce requirements specifically on foundation trusts to ensure that they are well governed. Monitor does that now and those requirements will need to be differentiated for foundation trusts to reflect their unique role and legal status as public benefit corporations financed by the taxpayer with a principal purpose defined in statute as being

“to provide goods and services for the purposes”

of the NHS. Monitor will also have enduring powers to set and enforce requirements on foundation trusts to ensure that they remain financially viable and to protect NHS assets. These measures deal with one of the concerns that has often been rehearsed about the privatisation of the NHS. The Bill does not provide that opportunity, but it provides for the protection of NHS assets. Those are necessary conditions of a foundation trust’s continuing ability to provide NHS services; they are not transitional issues.

--- Later in debate ---

[Stephen Pound]

I yield to no one in my admiration for my hon. Friend and her knowledge of the slightly occult religious practices of south Spain—and possibly of parts of St Helens for all I know.

But we did not expect the Spanish inquisition. We expected a valid, proper, sensible voice to enable the people to engage with their national health service. The NHS must not be an isolated ivory tower dominated by the old consultant gods who used to run it. It must not be a matter of non-responsible bureaucrats in quangos sending letters of suggestion. The NHS must contain a proper mechanism for the people’s voice to be heard and, above all, for the involvement of the wider community. The NHS cannot be a stand-alone organisation; it has to be involved with local councils and local communities, but everything in the proposals for this mealy-mouthed, milquetoast healthwatch nonsense dilutes and destroys that.

All the proposal does is create a false illusion—a falsity; the suggestion that somehow the voice of the people will be heard through this mere sub-committee of the Care Quality Commission, a committee whose mighty weapons arrayed against the forces of reaction and conservatism consist of the ability to write a letter. Such a letter would have to be vast, powerful and extremely effective, and would have to do what no letter has ever done in the history of epistolatory warfare. It would somehow have to persuade people on this gentle nudge—I appreciate that there are those on the Government Benches much given to the modern, modish philosophy of the nudge, but there is nudging and there is fudging, and what we have heard tonight is a fudge-nudge.

Above all, however, there is a crucially significant and important point here.

[Jim Shannon]

Do the hon. Gentleman’s exhortations mean that the pen is not mightier than the sword?

[Stephen Pound]

I am not entirely sure, Mr Speaker, whether you would allow the debate to go down that line, but were anyone in Northern Ireland to suggest a model such as that being proposed tonight, they would get a very dusty answer—it might not be replied to with sword or pen alone, but it would certainly be responded to.

The NHS is not something that we choose to buy into or out of. It is something that we all subscribe to. For many people—I should think everyone in this Chamber except me—it is a part of their birthright. People have been born under the NHS, have lived with the NHS, have funded the NHS and have supported it, and their voices must be heard. What we have tonight does not represent a valid mechanism for people to engage with the NHS. That is the key point. It is simply not good enough to set up a sub-committee of a quango and imagine that it has any force. We must realise that, yes, people may have different political opinions and there might be different priorities, but we do not have differential rates of national insurance. We pay national insurance because it is our national health service, and we have a right to have our voices heard.

Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 13th March 2012 Commons Chamber

[John Healey]

Sadly, Ruth Murphy’s experience is more and more common. By the end of last year, the number of people having to wait more than 18 weeks to get into hospital for the operation they needed was up 13% since the previous year.

[Jim Shannon (Strangford) (DUP)]

Like many in the House, the right hon. Gentleman will have received a lot of correspondence from professional bodies, such as the British Medical Association, the Royal College of Midwives, the Royal College of Nursing, the Chartered Society of Physiotherapy and many, many others, and they all say that these changes will lead to an unsafe foundation for the NHS. Does he feel that they all want change, but the right change, and the right change is not what will be delivered by the Government here?

[John Healey]

The hon. Gentleman is right. One of the great tragedies here is that the Government have squandered the good will and confidence of NHS staff that is necessary to make the changes to the NHS that it must make. This health Bill will make making those changes more difficult, not easier.

The Government could have built on the golden legacy and the great improvements that patients saw under 13 years of Labour investment and reform: hundreds of new hospitals and health centres; thousands more doctors, nurses and specialist staff; and millions of patients with the shortest ever waits for tests and treatments. Instead, we have a Tory-led Government, backed by its Lib Dem coalition partners, who have brought in the chaos of the biggest reorganisation in NHS history; wasted billions of pounds on new bureaucracy; and betrayed our NHS with a health Bill that will, in the long run, break up the NHS as a national health service and set it up as a full-blown market ruled, in time—for the first time—by the full force of competition law.

Everything about this NHS reorganisation has been rushed and reckless. This has been a master class in misjudged and mishandled reform—implementing before legislating, and legislating before being forced to call a pause to listen and consult on the plans already in hand. This health Bill was introduced last January. What was a very bad Bill is still a bad Bill. Make no mistake: this legislation will leave the NHS facing more complex bureaucracy and more confusion about who decides what and who accounts for what, and mired in more cuts and wasted costs for years to come.

Risk has been at the heart of the concern about these changes from the outset. There has been a lack of confidence and a lack of evidence, yet the Government are ready to manage the risks of introducing the biggest ever reorganisation in NHS history at the same time as the biggest financial squeeze since the 1950s. These risks were the reason for the growing alarm among the public, professionals and Parliament in the autumn of 2010, when I made my freedom of information request for the release of the transition risk register.

Last Friday the courts dismissed the Government’s efforts to keep secret the risks of their NHS reforms. Apocalyptic arguments were made in court, in defence of the Government, about how releasing the register would lead to the collapse of the Government’s system for managing risk. That did not happen when the Labour Government were forced to release the risk register for the third runway at Heathrow. Nor will it lead to the routine disclosure of Government risk registers, because the tribunal’s decision, like the Information Commissioner’s decision before it—both saw the transition risk register—was based on my argument that the scale and speed of these changes was unprecedented, and therefore that the public interest in their being disclosed was exceptional.

The Government have dragged out their refusal to release this information for 15 months. That is wrong. They have now lost in law twice. This is not a political argument but a legal and constitutional argument. It is about the public’s right to know the risk that the Government are running with our NHS, and about Parliament’s right to know, as we are asked to legislate for these changes.

--- Later in debate ---

[Rushanara Ali]

Yes, thousands. I have had thousands of letters and e-mails from constituents—members of the public, as well as professionals—who oppose the Bill.

[Jim Shannon]

Will the hon. Lady give way?

[Rushanara Ali]

I am sorry, but I will not be able to give way.

Those people are opposed to the Bill. They have been campaigning and have joined the 170,000 people who have signed up to oppose the Bill. They oppose it because they know that it will damage health care. This Bill will damage life chances; it will destroy the NHS.

In Tower Hamlets we had the first clinical commissioning group calling on the Government to drop the Bill, led by the respected Dr Sam Everington, who said:

“Your government has interpreted our commitment to our patients as support for the Bill. It is not.”

It is shameful that the Government carried on trying to use his name in support of the Bill. Those in the clinical commissioning group are concerned about the unnecessary bureaucracy that the changes will create and about the impact on patient care. They know that top-down reforms and restructuring will detract from their ability to care for their patients. That is what they have said. I hope that the Government will listen today, because in areas such as my constituency, where child poverty is higher than elsewhere—half the children in my constituency live in poverty—and where there is an inextricable link between poverty, health and life expectancy, it is vital that we have a health service that delivers for people on the ground. This Bill will not do that—Ministers know that, so they should do something about it. [Interruption.]

--- Later in debate ---

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

I want to pay tribute to all the hard-working individuals who work in the national health service, and to Dr Éoin Clarke and Dr Clive Peedell, who have been supportive of the coalition, for highlighting the dangers of the Health and Social Care Bill. I suspect that this will be my final opportunity to speak up on the Bill. I understand that there are only about seven days before its Third Reading debate in the House of Lords. It terrifies me that the Bill, which I have studied intently during its 40 Committee sittings, is going to become law. The Secretary of State is introducing a new health system. It is a system that no one voted for, and it will be unrecognisable in comparison with the NHS that cared for an entire population from the cradle to the grave.

[Jim Shannon]

Does the hon. Gentleman share the concerns of many Members on the Opposition Benches—and, I suspect, many people outside the House—that the Government will create a two-tier health system consisting of those who can afford to pay and those who cannot? Does not that fly in the face of what the NHS was originally set up to do?

Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is right, not least on his point that the coalition Government are investing in the NHS, with real-terms increases each year. That contrasts with the Labour Government in Wales, who in the course of this Parliament intend to reduce spending on the NHS by more than 6% in real terms.

[Jim Shannon (Strangford) (DUP)]

At a very lively Conservative away-day last Friday, a document was issued that stated:

“If we changed or altered the bill now, we would end up in a no man’s land, and chaos.”

Four days later, can the Secretary of State confirm the Government’s position?

[Mr Lansley]

The Government’s position is that there has been very constructive debate in Committee in the Lords, and I look forward to that being reflected in equally constructive debates on Report.