Melbourne Declaration on Diabetes

Jim Shannon Excerpts

Wednesday 18th June 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak about diabetes. I am a type 2 diabetic, so the matter is important to me. I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate. I know of his passion for the subject, and it is always good to participate in a debate initiated by him. I hope that others will contribute and help him to pursue his ideas. I am fully behind the Melbourne declaration on diabetes. I am delighted at the attention the illness is receiving, and I look forward to great steps being taken to curb the effect of diabetes in our country and the world.

Many people have referred to diabetes as a ticking time bomb. We focus on many diseases, such as cancer and heart disease, in that way. Diabetes is a ticking time bomb because of the numbers of people who have it and do not know, or who will potentially be diabetic in the near future. I am sure that we are all very aware that it is estimated that there are 382 million people worldwide with diabetes, most of whom are aged between 40 and 59. Again, that middle-aged group is where the focus seems to be, and their number is expected to rise to 592 million by 2035. For one second, consider again that the figure will rise from 382 million to 592 million by 2035—another 200 million people will be diabetics by that time.

In 2013, diabetes caused 5.1 million deaths, which is one every six seconds. That is the magnitude of the issue of diabetes and what it is doing and has the potential to do. In world monetary terms, diabetes is taking up some $548 billion in health spending in 2013, right across the world. That is 11% of worldwide expenditure. Those figures get into what it means to be diabetic, and why the condition is a ticking time bomb not only for the United Kingdom, but for the world. The statistics are harrowing. It is an international problem. It is a disease that we are often too blasé about, and we must not let this dire situation continue. We must adequately assess the issue of diabetes and tackle the problem head-on.

I want to mention our colleague, Edwin Poots, the Minister for Health, Social Services and Public Safety in Northern Ireland. He has initiated a programme to bring in 400 insulin pumps to help type 1 diabetics and their families. He has also initiated training along with that, so that people who have the pumps are adequately trained in administering the insulin, and in helping the control of diabetes. Good things have been done in Northern Ireland, but good things have been done in England as well. As the Minister will know, I ask all the time about a strategy, not only regionally, but for the whole United Kingdom.

Obesity and diabetes-related illnesses combined cost the NHS an estimated £15 billion a year, and 80% of the available funding for diabetes is spent on treating preventable complications, because it is not diabetes that will eventually, to use strong terms, kill someone, but the complications. It can affect people’s kidneys, liver, circulation, heart and eyesight.

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

While my hon. Friend is on the issue of the cost to the NHS and to all of us as taxpayers, does he agree that any additional resource that is deployed in early detection, and in trying to ensure greater awareness in communities across the UK, will vastly be outweighed by the savings, in terms of what the taxpayer would have to pay out otherwise? That has been outlined by both the hon. Member for Torbay (Mr Sanders) and by my hon. Friend.

[Jim Shannon]

I thank my hon. Friend and colleague for that comment. He is absolutely right, and I will come on to some issues that I feel the Government need to address early on. He is correct to say that vast savings will be made if there is early detection. The need for early detection was mentioned by the hon. Member for Torbay, and other Members will make the same comment.

Although it is great that money is available to treat this illness, we must not merely chase after it, putting a plaster on it after it has inflicted damage. That is clear. We need to ensure that money is spent not only on treating it, but on prevention methods—which makes me wonder whether my hon. Friend the Member for East Londonderry (Mr Campbell) was looking over my shoulder at my notes, because he made the next point that I was coming to. We cannot allow ourselves to accept the fact that 3.2 million people in the UK have been diagnosed with diabetes. Again, that is the magnitude of the problem. We must look to the causes and stamp them out at the root.

One thing that we can address is the preventive measures that need to be taken. We have talked many times in the House about the sugar content in food. The right hon. Member for Leicester East (Keith Vaz), who is not here today, introduced a measure, which I was happy to put my name to, addressing the issues of sugar in manufactured products that we eat. We need to take that issue forward, and in the future, I hope we will be in a position to take legislation on that subject through the House with the support of food manufacturers, so that we can address the issue of the food we eat. We do not need all the sugar or salt that is in food. There is a way of addressing issues outside the Chamber—issues that are outside Government control—but something needs to be done at a manufacturing level.

Our annual intake of sugar is 33.7 kg per capita. To put that in perspective, it is equivalent to eating nearly 34 average-sized bags of sugar each year. Imagine if the sugar was piled up on the table here; it would block my hon. Friend the Member for East Londonderry from sight completely. That is how much sugar we are all eating every year, and some people even eat more. Surely when discussing the Melbourne declaration on diabetes, the Government need to take another look at sugar levels in our food. What steps are the Government taking on diabetes prevention to ensure that the next generation is not blighted by diabetes in the way that this one is? Projections show that if current trends continue, in 2025, 5 million people in the UK will have diabetes. Again, the magnitude of the issue is clear, so what are the Government doing to ensure that that does not happen? What preventive measures are they putting in place to decrease that number?

The correlation between weight and diabetes has been made clear: 80% of people with type 2 diabetes are overweight or obese. The Government need to do more to increase education on the danger of being overweight or obese and tighten controls on how much sugar goes into our food. Those are all issues that I feel we need to take on board.

What is so frustrating is that up to 80% of type 2 diabetes could be delayed or prevented. I am not saying that in any judgmental way, because many in the Chamber will be aware that I am a type 2 diabetic, as I declared at the beginning of my speech. The truth of the matter is that I have to blame myself and my lifestyle choices for the onset of the disease. It was the Chinese carry-out five nights a week, with two bottles of Coke—not a good diet for anybody. That is the reason why I was almost 18 stone and had to lose weight very quickly. Aside from that, it was also a lifestyle with high levels of stress. When the two are combined, diabetes will knock on the door of nearly everybody, as most of us know.

While I am on the subject, many people can be diabetic even though they are not necessarily overweight. It can happen through them having a stressful lifestyle. How many others living the same lifestyle are not aware of the damage that they are doing to their bodies in the long term, and how can we do better in highlighting that? I have to take two Metformin tablets in the morning and two at night. That dosage could have to be increased; a doctor could come along, as he often does, and say “By the way, you just need a wee blood pressure tablet now to keep you right as well.” People wonder just how many tablets they will have to take before they reach the age of 65 and retire, if they are spared until that age.

What are the Government doing to diagnose diabetes early and treat it effectively, preventing or delaying the complications that cause so much human suffering, require costly treatment, and reduce life expectancy? Only one in 10 people who are newly diagnosed with diabetes are offered education on how to manage their condition, despite strong evidence that education is a cost-effective way of giving people the knowledge that they need to manage their condition. On managing diabetes, after someone is diagnosed as diabetic, what help is given to them to ensure that they manage that in a sensible way? I accept that the person also needs to acknowledge that they have to manage the condition. I remember Dr Mageean, my doctor, telling me when I was first diagnosed, “Jim, it is up to you what you do.” He was very clear and said, “You must manage this yourself,” but at the same time, I think we need a wee bit of help, perhaps from Government and from the health service in particular, just to ensure that we know what that all means for everyone involved.

It is estimated that in my small Province of Northern Ireland, 80,000 people have diabetes. That awful statistic worries me very much.

[Mr Sanders]

The point about education is interesting. According to the National Audit Office, the estimated amount that the NHS could save annually through people better understanding and managing diabetes is £170 million. That is just from improved awareness and education.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. That reinforces the point made by my hon. Friend the Member for East Londonderry and by me: prevention saves money for the NHS. I accept that the Minister’s budget is restricted, and that we cannot spend outside of that, but if there are ways and means of reducing the money that is spent and ensuring that we can still deliver the NHS that we are all very proud of, we should try to do that as well.

On 12 February 2014, I asked the Minister what discussions had been had with the Health Minister in Northern Ireland on UK-wide strategies for diabetes, obesity, heart disease and rare diseases. The Minister said that there had been no discussions with the Northern Ireland Executive on those issues. I am asking that question again, as she is here. I respect her greatly—she knows that—and I value the work that she carries out in this place, but I honestly believe that a UK-wide strategy is needed. We had one until 2013, but then it was not carried on. I believe that it would be to the benefit of all the regions of the United Kingdom of Great Britain and Northern Ireland if that UK-wide strategy was started again, so I ask the question again.

There is cross-House approval of and support for the Melbourne declaration on diabetes, which pushed for an international effort in the fight against diabetes, and that is what this is all about. Are the Government willing to work with the devolved Administrations of Northern Ireland, Scotland and Wales to use resources wisely and create a UK-wide strategy against diabetes? They have done it before; let us do it again, and do it even better this time.

The director of Diabetes UK Northern Ireland, Iain Foster, has said:

“We are in the middle of a diabetes epidemic…With the numbers rapidly increasing it is now more important than ever that everything is done to prevent serious complications which cost the NHS millions”—

as the hon. Member for Torbay said—

“and are absolutely devastating for the individuals and families involved.”

Let us never forget that it is not just those with diabetes but the families around them who are affected by the debilitating effects of diabetes on the individual.

Will the Government commit to implementing fully the NHS health check, which should be offered to everyone aged 40 to 74, to help identify people at high risk of type 2 diabetes? I say with respect that that programme has been patchily introduced so far, so there could be a lot of improvement. The Government need to do more to ensure that those at high risk benefit from lifestyle interventions to help to prevent the disease. The National Institute for Health and Care Excellence has recommended increasing the proportion of people with diabetes who get the nine annual checks. That should happen as a matter of course when people are in their GP surgery, or in hospital for whatever reason.

Those checks help people to manage their condition and to identify any signs of complications early. However, there is a large geographical variation in the proportion of people getting them. Again, if we had a UK-wide strategy, we could ensure that there were no differences geographically in who gets the nine annual checks and who does not. Will the Government commit to increasing the number of people who receive the checks? That is a positive way forward. It is another way of doing the preventive work that we need, and will ultimately lead to the savings that we need.

In 1922, insulin was discovered by John Macleod, Dr Banting and Charles Best, yet 92 years later, in 2014, we are still fighting against the dreadful disease of diabetes. In the UK this year, 59,000 people will die unnecessarily from diabetes. I strongly urge the Government, in the wake of the Melbourne declaration on diabetes, to take serious strides in the UK in preventing and controlling diabetes.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Thank you, Dr McCrea. I am aware that some colleagues who would normally be with us for a debate on this important topic have been speaking in the main Chamber. No doubt they will catch up with the debate online, at some point. I thank my hon. Friend the Member for Torbay (Mr Sanders), who opened the debate, and all those who have spoken. It has been another thoughtful debate on a topic that is very important, as he said. I congratulate him on his recent election as the first president of the Global Parliamentary Champions for Diabetes Forum. I am not sure whether he modestly did not mention that, but I give him credit for it. It is a tribute to his effective championing of the issue, and the global initiative is important.

As my hon. Friend said, we must not underestimate the global threat posed by diabetes. Other hon. Members have mentioned the numbers involved; the International Diabetes Federation estimates that by 2035 there will be 600 million people with diabetes worldwide, which is about one in 10 of the planet’s population. I think that the hon. Member for Strangford (Jim Shannon) described that as a ticking time bomb, but the debate has drawn out the fact that for the most part we do not have to accept that as inevitable. There are things that we can do, and it is right that we are beginning to talk about the issue as a global community, in global health terms.

In the UK, 3 million people are affected by diabetes. It is estimated that by 2025 the figure will be 4 million if we do not make progress. We estimate that around 850,000 people have undiagnosed type 2 diabetes. Diabetes is a priority for the Government. We have set clear objectives for the NHS and Public Health England to do more on prevention and to improve the care and management of people with diabetes. I accept that there is a challenge about the need for a national action plan. I have had meetings with Diabetes UK and it is one of the things mentioned in its briefing. We have set up clear objectives for the NHS and Public Health England and we ask them to deliver against those, so my contention is that we do indeed have a national plan, but that we may be carrying it out within a slightly different framework from the one advocated. The degree of priority we give it, and the importance that the Government accord to ensuring that the health and care system work together at all levels to give people with diabetes the care and support they need, should not be underestimated.

I hope that while I have been the Public Health Minister I have reassured colleagues about the personal priority that I give to the issue of diabetes. Indeed, my first public outing, slightly terrifyingly, was to speak to a meeting organised by my hon. Friend the Member for Torbay. Almost certainly, everyone in the room knew more than I did about the subject, but I attended to show, very early in my ministerial role, how important the issue was to me.

I have met the national clinical director. I try to have reasonably regular meetings with him, because the issue is such an important one. I have a continuing relationship with the all-party group on diabetes and the other diabetes campaigning groups and Members in the House. With respect to type 1 diabetes, I met my and other Members’ constituents at the JDRF event, which I have attended several times. It is always humbling to meet those fantastic young people who have learned very young to manage and live with a difficult condition.

What is NHS England doing to improve the management and care of people with diabetes? As I mentioned, I have several times met Professor Jonathan Valabhji, the NHS England national clinical director for obesity and diabetes. He has been generous with his time in attending parliamentary events, and is a great supporter of the work of groups and Members in the House. He regularly attends events focused on diabetes and is focused very much on improving outcomes for people with all types of diabetes.

Earlier this year “Action for Diabetes” was published, which describes the actions that NHS England is taking to improve diabetes care. It covers many areas, some of which have been highlighted during the debate, including developing GP contracts and incentives; working with primary care services to trial and roll out case-finding; and decision-support tools to help to detect and diagnose diabetes earlier. A national conversation is also going on about obesity and taking care of one’s own health. Hon. Members have touched on that with regard to the prevention of type 2. Every member of the public is a part of that conversation. We did not talk much about individuals during the debate, but I think we would all agree that we need constantly to emphasise personal responsibility in relation to preventable or avoidable type 2.

I sometimes worry—I talked about this with the head of Diabetes UK shortly after becoming a Minister—that, because few deaths are recorded as being due to diabetes, rather than its complications, there may be a slightly more relaxed attitude among people who think they might develop diabetes, which they would never in a million years have towards a disease such as cancer, which they would immediately identify as a threat. Through debates such as today’s, and the work that we all do, we can emphasise the fact that, although people may not know many people who can be said to have died of diabetes, they will know many whose diabetes contributed to premature death or a long period of ill health. There is more work for us to do, to get that message out. That is how we can empower people to help themselves.

[Jim Shannon]

The Minister could not have said a truer word, because many people see diabetes as a disease that they can manage—one that is not too bad. However, she is right: the complications are far reaching and can lead to consequences that are final. In my speech I talked about education, because people must manage the condition themselves, but they need to know what they have to manage. That is my point: some people need the information reinforced, with the seriousness that the Minister expressed.

[Jane Ellison]

That is right. We need to make sure of that. People cannot be empowered without information. We also know, having a duty to address health inequalities, that some people and groups in the community find things much harder. I was taken by some of what the shadow Minister, the hon. Member for Copeland (Mr Reed), said about deploying technology more. Work is going on, but I agree with him that we could go further faster with that, to find ways to empower people who may not have a good sense of what to do to take care of their health, and who find it harder than others to obtain the available advice. We must work harder to reach them and I shall talk about NHS health checks in relation to that.

As to the commissioning of integrated care, NHS England is working with other organisations to help to promote services that are integrated around patients’ needs across all settings. There has been much emphasis on that. That body is implementing what it calls a customer service platform to allow patients with diabetes to self-manage, through booking their own appointments, managing their prescriptions, monitoring the care they have received and being able to view their personal health records. That picks up on some of the shadow spokesman’s points.

NHS England has also produced a sample service specification for the management of type 1 and type 2 diabetes that is based on National Institute for Health and Care Excellence standards. It provides a model for commissioning integrated care for those with diabetes, and also highlights the specific needs of those with type 1 diabetes, where they differ from the needs of those with type 2. If the current trial of the service specification is successful, it will be offered as a tool that all clinical commissioning groups can choose to use to deliver high-quality care. That is therefore an important piece of work in progress.

There is always a challenge for any of us in making sure that the rest are as good as the best. Occasionally when we talk about the challenges of our current health infrastructure I worry about the assumption that there is a model out there, somewhere, that would absolutely guarantee the delivery of completely consistent care in a given area, across the country. In a country such as ours it is not possible to give such a top-down guarantee. Yes, we must find a way to drive care from the top, with a clear sense of direction from the strategy and mandate that we have given the NHS and Public Health England, but we must also put the tools in the hands of the clinicians, as I have been discussing. Most importantly, we must empower individuals and patients to know what they can expect and to demand good care. Nevertheless, I genuinely do not think that we could devise any system in which we could just issue a notice from the centre to say exactly how care will be delivered consistently across the country. We must find other ways to do it.

--- Later in debate ---

[Jane Ellison]

I agree. The Government, NHS England and Public Health England are all looking at how we drive that consistency. How do we drive consistent excellence? What tools can we use to do that?

Perhaps it would be helpful if I gave an example. Public Health England is developing a tool to drive improvements in diabetes care and iron out variation. It will be launched later this year, and although I am not able to give much detail now, I am sure that my hon. Friend the Member for Torbay will be interested when it is launched. It will provide a clear picture of how diabetes care and outcomes vary across the country and among practices, which will support decisions on how to make improvements.

The Government have made transparency of data a real priority, and being very transparent about what is being delivered and identifying variation is one of the ways in which we can drive the rest to be as good as the best. I suppose I am trying to explain that, although I could send out a memo tomorrow outlining my national diktat on diabetes, that is not how we drive change. It is crunchy, it is detailed and it is about getting to that local variation and ensuring that we drive up standards in every way possible. That is one of the tools we are developing, but there are others as well.

[Jim Shannon]

In my speech, I called for a strategy that was not just regional but UK-wide, and I hope the Minister can respond to that. Other Members have spoken about the need for an English strategy, but there must also be one for Wales, one for Scotland and one for Northern Ireland. All four must work together so that we can address the issue together. The Melbourne initiative is very much worldwide, so although people refer to England, we must go further. What are the Government doing to initiate a UK-wide strategy?

[Jane Ellison]

As the hon. Gentleman knows, health is a devolved matter. That is not to say that I am not at all interested in what is going on in Northern Ireland—far from it—but it is nevertheless a devolved matter. As I have said to him in other debates, there is clearly an awful lot that we can learn from each other. People can learn from everything that I report to the House on innovation and the progress that we make in England, as well as, indeed, things that other Health Ministers report from other parts of the United Kingdom. Nevertheless, I currently have no plan for a UK-wide strategy because health is a devolved matter.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

If the hon. Gentleman does not mind, I am going to make some progress.

Of course, the fact that health is a devolved matter does not mean that we cannot find areas of joint working, and the Melbourne declaration shows us the way forward on that. That is probably where we end up—the fact that it is devolved does not mean that we cannot share learning and knowledge, learn from one another’s initiatives, or operate in that global context.

--- Later in debate ---

[Jim Shannon]

I hope that the Minister will accept that I am not being argumentative, but we had a UK-wide strategy until 2013—last year—so we have shown that we can work together. All I am asking really is: why do we not initiate a similar plan to what was there before 2013—a 10-year plan that started in 2003—and have the four regions work together? That is exactly what the Melbourne initiative is about, and we could do it because we have done it before.

[Jane Ellison]

I will reflect on the hon. Gentleman’s comments and perhaps we will discuss the idea again.

[Jim Shannon]

Thank you.

[Jane Ellison]

I want to discuss another area in which we can make a difference by empowering patients. Colleagues might be interested to hear about the patient experience of diabetes services survey, part of the national diabetes audit, in which I know there is always great interest in the House—we regularly answer a number of parliamentary questions about it. The survey measures the health care experiences of people with diabetes in England and Wales. It collects information online from people with diabetes by asking questions about their care using a short, validated questionnaire, and it is being tested.

Any diabetes service in England and Wales should be able to use the survey to get feedback from patients. We want to publish the first results this month or this summer. That is going to be an interesting extra tool in the box, not only to help to drive excellence and drive out variation, but to empower local services to understand at a local level what is going on and how satisfied their patients are with the service being provided. That can lead only to upward pressure to improve services, not least from patients.

Let me talk a little about the NHS health check programme. Alongside the work being done by NHS England to improve the management and care of people with diabetes, the Government are working on prevention and earlier detection, which all Members mentioned. We are continuing to roll out the NHS health check programme, which identifies those aged between 40 and 74 who are at risk of diabetes and other vascular diseases and helps them to reduce that risk. More than 15 million people are currently eligible for an NHS health check. Our economic modelling has shown that the programme has the potential to prevent more than 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is all about helping people to better manage and improve their quality of life.

In the past year, almost 3 million NHS health check offers were made and almost 1.5 million appointments were taken up, during a time of great change across the health system. We are now looking to challenge the system to go further and faster and to continue to increase the number of people who participate in the programme. I have been out and about and seen some great local initiatives. I visited an NHS health check team in Southwark and witnessed the important conversations they were starting with people in their local area.

Another example is Bolton, where health trainers have worked with 134 people identified as being at risk of diabetes through the NHS health check. The health trainers have supported people to make lifestyle changes such as eating more healthily and increasing physical activity levels, and they have helped almost half the group to return their glycaemic level to normal. That is really good evidence of effective intervention.

In Tower Hamlets, where more than 50% of the population are from ethnic minority groups, the prevalence of type 2 diabetes has been growing rapidly. To help to combat that, Tower Hamlets has incorporated the health check programme into its managed practice network scheme. I have talked to staff about that and heard about how they are approaching it. Tower Hamlets has worked hard to ensure that all diabetic patients have a care plan, and that focus has resulted in a 70% increase between 2009 and 2012. There has also been a lot of focus on the take-up of retinal screening for people with diabetes, and, again, there has been a significant rise.

We are seeing that such local interventions can really work. I firmly believe that a localist approach is important in some of these areas, because there is no one-size-fits-all approach that we can devise in Westminster that will work for every community. Such local innovations are important. I constantly challenge myself to think about how we can ensure that we spread the word about some of this great local action. We have started initiatives in that regard, but Parliament has a great role to play, and I encourage Members to tell us of effective local initiatives, so that we can spread the word.

Research on the NHS health check programme carried out by Imperial college London and Queen Mary university of London is under way. That research will improve our understanding of who is taking up the opportunity, their risk of cardiovascular disease and the incidence of diseases such as diabetes in those groups. When that work comes back, it will help us to understand how we can make those interventions count more.

We have already talked a little about obesity and sedentary lifestyles. Physical activity is a big priority of this Government, and I have had a couple of meetings in the past couple of days alone on the cross-Government action we are taking to try to hardwire physical activity into all aspects of life. We have a long way to go yet because, for too long, physical activity was left in a silo marked “health” when it is more important than that. We know that all parts of local and national Government need to address inactivity; that is one of the factors that can help to prevent diabetes.

I also want briefly to address the responsibility deal. The Government have been working with business—the hon. Member for Strangford mentioned this—on its responsibility to consider calorie reduction and clearer labelling of food. We are starting to see calories and other contents displayed on the packaging of many more foods, as we roll out consistent food labelling on a voluntary basis across the country.

The Change4Life social marketing campaign, which is one of Public Health England’s flagship programmes, is encouraging individuals to make simple changes, and it is trying to work with people in the way that the shadow Minister mentioned. The campaign is trying to talk to people in language that makes it straightforward and easy for them to understand the good choices they can make for the health of both themselves and their family.

The national child measurement programme’s findings on childhood obesity are encouraging. We know that far too many people are overweight and obese, but we are seeing signs of encouragement. In 2012, childhood obesity rates fell for the first time since 1998, so we must not despair over the actions we have all taken and advocated over many years. We are beginning to see that such action can have an effect, but we must never underestimate how far we have to go.

In 2013, the global burden of disease study showed that the UK has the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis. The last data on diabetes care showed a 60% completion rate for all eight care processes recommended by the National Institute for Health and Care Excellence, which is a five percentage point improvement on 2010. We see progress, but we know there is much more to do. The Melbourne declaration is a timely reminder of the serious threat posed by the disease across the world, as well as here in the UK. I assure the House and my hon. Friend the Member for Torbay, who led this debate and leads the all-party group in such an exemplary way, that diabetes is a priority on which we continue to work hard. We are pleased to see progress, but we do not underestimate how much more there is to do. Such debates are welcome opportunities to keep the issue firmly on Parliament’s radar.

Organ Donation Register

Jim Shannon Excerpts

Tuesday 17th June 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Burton (Andrew Griffiths) on securing this debate. Without doubt, this is an important issue. In his brief speech, he outlined the importance of organ donation to us all.

Some of us come to this debate with personal knowledge, and other Members with a very personal understanding will speak shortly, too. I will speak not only about cold facts but as a first-hand witness who was emotionally involved with a family member in need of an organ donation. Twenty-three years ago, my nephew, Peter, was born with one kidney that was not working and another that was the size of a peanut—I think that is how the doctor described it. That clearly inhibited my nephew’s quality of life. For many years, until he received an organ donation, he was unable to have the quality of life that everyone in this Chamber today is privileged to have.

My second son and my nephew were born at about the same time, so I was always able to compare their quality of life—my son, who was perfectly healthy, and my nephew, who unfortunately was not healthy as he awaited a kidney transplant. My nephew was restricted in height and in energy, and he was always a yellowy colour. That is hard for a family, but it is much more bearable when they know that kidneys are available in the organ bank ready to be transplanted. Peter was able to get that transplant, and it literally saved his life. That underlines the importance of organ donation to every member of my family and my family circle.

I do not want any parent or family member to be dealt the blow of knowing that a relative is in need of a transplant but there are currently no organs available. I do not want anyone to experience that, but that is what is happening in the UK today. That is why I feel so passionately about this debate. It will come as no surprise that I, as a Member of Parliament and as an individual, am a registered organ donor. Registering as an organ donor is much easier in Northern Ireland because whenever we apply for or renew our driving licence, we tick a box on the form to show whether we want to be an organ donor. Those who say yes will automatically become an organ donor should their time in this world come to a tragic end.

In Newtownards in my constituency of Strangford, a garden has been constructed for people who are having dialysis and renal treatment at the Ulster hospital in Dundonald. It was felt that we needed a garden in which people could have tranquillity and peace, and to thank people who had donated their organs over the years. The council and local representatives were both involved. Rather poetically, perhaps, just two miles from that garden, a young man—I knew his father well—died some years ago. After being injured in an accident, his organs were donated to save other lives, which shows that there is an opportunity to save lives. As the hon. Gentleman said in his introduction, we can give an opportunity to those who have not had the quality of life that we have but could have it with an organ donation.

Despite all of our medical advances, some 1,000 people die each year in the United Kingdom waiting for an organ transplant, which is shocking. We desperately and urgently need to increase sign-ups to the organ donation register. With that harrowing statistic before us, what can we do, and what do the Government intend to do, to increase sign-ups? I am pleased that the Minister is in her place. I have asked her questions on this previously, and some of the answers are in the Library debate pack. There have been positive responses from the Government, and I have no doubt that we will get such a response at the end of this debate, too. We seek to add further contributions and evidence to the debate, and perhaps the Minister will be able to respond.

It is pleasing to read that, in the past five years, the number of people in the United Kingdom of Great Britain and Northern Ireland who donate organs after death has increased by 50%. That is good news and it matches a target set by the Department of Health’s organ donation taskforce in 2008. I suppose we are asking how we can do more. How can we make organ donation more appealing or more real to people?

[David Simpson]

We heard earlier that some 7,000 or 8,000 people are waiting for an organ transplant. Does my hon. Friend agree that, if we could dramatically increase the number of organ donors, a knock-on effect might be that it would end organ farming and the sale of organs on the black market?

[Jim Shannon]

That is a pertinent issue. I understand that organ farming is not the Minister’s responsibility, but we are aware of parts of the world where people are given a great deal of money to donate an organ for use elsewhere in the world. That is a travesty and an injustice for poor people who find themselves in financial difficulties and see this as a way out. My hon. Friend is right that that needs to be seriously addressed.

NHS figures show that there were almost 4,700 organ transplants in 2013-14, which is an amazing figure compared with 3,717 organ transplants in 2009. That is an increase of almost 1,000, which is a clear indication that Government policy is starting to take effect, with the general public’s co-operation. That is good news. It is about how we go over fences to get a wee bit extra and do more.

We must not praise ourselves too much, however, and settle for the progress that we have made. There is still a long way to go. NHS statistics show that on 31 March 2014, as my hon. Friend said, 7,026 people were on the transplant waiting list. Although that number has been decreasing for the past five years, it is still much too high. The Government must do more to cut those waiting lists dramatically. What new targets have been set by the organ donation taskforce, and how does it intend to raise the public’s awareness of the great importance of this issue?

During May and June 2013, Optimisa Research conducted market research on behalf of the NHS blood and transplant service to measure public awareness, attitudes and behaviour towards organ donation. The findings of that research highlight how much work the Government have to do to increase sign-ups. We must all energetically encourage those around us to sign up, but the Government need to lead, too. Some 54% of those questioned had not seen any recent publicity about organ donation. What is being done to highlight organ donation? The hon. Member for Burton referred to that, too. It is clear that, as a result of poor publicity, organ donation is not currently in the public consciousness as it should be. What steps have the Government taken to improve that and change the perception that organ donation is the exception rather than the norm?

Of those people questioned, 31% would consider donating some or all of their organs, but are yet to be fully convinced. Again, that indicates that there is a swathe of people who are susceptible to persuasion, which could lead us to the next stage for organ donation. Why are the Government not engaging with those people as they should? The research also found that the key personal barriers to donating include mistrust of medical professionals and discomfort in thinking about death. Death is a subject that we sometimes do not want to think about, but it is one that we must all consider. There is no better way of setting the scene than Mark Twain’s comment that the only two things in life we are sure of are death and taxes. Death is an issue for us all, and we must consider it.

It shows that the public are not sufficiently well informed. If the Government better presented information on organ donation, it stands to reason that the barriers preventing people from signing up would ultimately be removed, the number of people on transplant waiting lists would fall dramatically, the number of transplants would increase and, most importantly, the number of people in the UK who die while waiting for a transplant would fall significantly. We must consider that issue as well. We see so many stories in the press and on TV about those who are desperately waiting for a transplant and have a very short time between life and death. Every effort must be made to ensure that we can save the British lives of those whom we represent. Why is more not being done?

It is clear from the research that public awareness must be raised, and it therefore follows that the Government should focus on that, but there are also other means of increasing sign-ups. Although opinions are mixed on the issue of express or presumed consent, I would like to present my personal view. I encourage the Government to consider legislating for a soft system of presumed consent. Although some might disagree, I believe that such a system is right because it gives life. Perhaps the best time to ask a relative to consider organ donation is not when somebody is lying on their deathbed. Emotions take over. I am not saying that they should not; I am just saying that it is a reality of life, and we must address it. Personally, I believe in a soft system of presumed consent that allows relatives of the deceased to object to donation if the deceased died without expressly electing whether to donate their organs. Such a system is in place in Belgium, where the family’s prerogative is a legally defined right. I suggest to the Minister that we should at least consider it, debate the issue and put it at the centre of the organ donation debate.

Introducing a system of presumed consent would greatly boost the number of organs available for transplant. A 2006 study by Abadie and Gay found that countries with a presumed consent system had 25% to 30% higher donation rates than those with an opt-in system, which is a significant difference. If taken on board in the United Kingdom, such a system would cut the number of those waiting for a transplant and save lives.

I have asked the Minister what she is doing to encourage more older people to become kidney donors. She responded that there is no barrier preventing elderly people from being organ donors if their organs are healthy. It is not out of the question for those with a few more years on the clock to consider organ donation as well.

In my home province of Northern Ireland, only 32% of the population are registered organ donors, the lowest percentage of any area in the United Kingdom. That is unacceptable. Our devolved Assembly is currently processing a private Member’s Bill to increase awareness of organ donation, which proposes to provide people with an opportunity to sign up for organ donation when applying for a driver’s licence. The question will allow people to answer yes or no—they can make up their own minds—but it will be compulsory to answer; the question cannot be ignored. I am fully behind the Bill, as I feel that it will greatly boost the number of people who sign up for the organ donor register. How do the Government intend to work alongside Mr Poots, the Minister with responsibility for devolved health matters, to increase much-needed awareness in Northern Ireland? It is clear that a UK-wide strategy is the most effective way of dealing with the matter. The Minister will know that I often say here in Westminster Hall and in debates in the Chamber that it is important that the United Kingdom regions learn together and bring together all our knowledge so that we can present it.

Time has passed by, but my final point is to highlight the fact that research has found that if organ transplantation rates could be increased by 50% across the UK, the NHS would save money. The hon. Member for Burton mentioned a saving of more than £300 million. The figures depend on who is on the list, but the saving to the NHS would be significant. That cannot be ignored or denied. If we had that in place, it would help the Minister and this Government to manage their health budget better. In essence, if the Government save more lives through organ donation, they will have more money to spend on saving the lives of others. The Government and we as Members must not rest on our laurels and be happy with the progress made. The Government must take steps to ensure that the public are fully aware of the issue, and to save more lives.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Ambulance Resources and Response Times

Jim Shannon Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Wright]

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

[Jim Shannon (Strangford) (DUP)]

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

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

[Mr Wright]

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

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

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

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

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

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

Cervical Cancer Screening

Jim Shannon Excerpts

Thursday 1st May 2014 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

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

Type 1 Diabetes (Young People)

Jim Shannon Excerpts

Wednesday 30th April 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

[Mr Gregory Campbell]

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

[Jim Shannon]

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

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

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

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

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

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

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

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

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

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

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

--- Later in debate ---

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

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

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

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

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

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

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

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

[Jim Shannon]

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

[Dr Poulter]

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

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

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

Abortion (Disability)

Jim Shannon Excerpts

Wednesday 9th April 2014 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

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

[Fiona Bruce]

The hon. Gentleman makes a relevant point.

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

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

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Stillbirths and Infant Mortality

Jim Shannon Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Loughton]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Tim Loughton]

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

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

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

NHS Funding (Ageing)

Jim Shannon Excerpts

Tuesday 25th March 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

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

[Dr Coffey]

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

[Jim Shannon]

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

[David Simpson]

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

[Jim Shannon]

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

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

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

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

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

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

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