111 Telephone Service

Jim Shannon Excerpts

Wednesday 5th June 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I had not expected to be called quite so early. First, I should like to put on the record that health in Northern Ireland is a devolved matter—I understand that—but I am observing the 111 system from my position as a parliamentarian. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate. She has encapsulated many people’s concerns. I appreciate the Minister’s efforts on health issues. I am sure that she will, in her response, deal with some people’s issues.

I support the idea behind this phone call triage, as it is called, and its being free to contact, bearing in mind that many GP surgeries have an 0844 number, which costs a great deal from mobiles—we have discussed that in Westminster Hall previously on many occasions, and will continue to do so—but there are clearly major issues with it. Although I accept that sometimes the girls in my office have to stay on the phone for an hour or more to fix some computer glitch with the printer or scanner, we are talking about lives in respect of this service. There have been too many difficulties to ignore.

We have background information on many areas, including those the hon. Lady touched on. Yorkshire and Humber provide examples of the figures and information, which state that there were three deaths and 19 potentially serious incidents coming through the system, clearly underlining the problems.

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

Does my hon. Friend agree that NHS 111 should immediately answer the phone to all those who contact it—that is obvious—offer direct, accurate communication and provide people with reassurance that they are getting an accurate diagnosis? Those things will be the judgmental touchstones upon which people will base the success, or otherwise, of 111.

[Jim Shannon]

I thank my hon. Friend for his intervention, which clearly outlines exactly what the 111 system should be trying to achieve. Sometimes, when hon. Members ask if I will take an intervention, they are looking over my shoulder to see what I am going to say next. My hon. Friend made exactly the point that I was going to make.

There have been lots of complaints about calls going unanswered and poor advice being given, which reiterates the point made by my hon. Friend. That follows concerns prior to the national roll-out, after pilot schemes showed disastrous results, with tales of patients waiting hours for advice and others being asked to call back later. That situation is quite unsatisfactory and must be addressed. NHS England stated:

“The safety of patients must be our paramount concern”.

So it should be, and if it is not, we want to ask why. It also said:

“NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service to the public, but one which is also safe.”

Examples mentioned by all hon. Members—we have them in front of us—provide information that contradicts that. In Greater Manchester, the 111 service was started and then abandoned. Dr Mary Gibbs, a GP providing out-of-hours cover when the system crashed there, said:

“Calls just weren’t coming through.”

Quite clearly, that is the issue. She stated:

“It was totally inadequate. Patients’ health was put at risk.”

The 111 service tends to be busiest when local surgeries are closed. Dr Laurence Buckman, chairman of the British Medical Association GPs committee, stated:

“We are still receiving reports that patients are facing unacceptably long waits to get through to an NHS 111 operator and suffering from further delays when waiting for calls back with medical advice should they manage to have their call answered… The quality of some of the information being given out appears, from anecdotal sources, to be questionable in some instances.”

The advice that people are being given does not always seem to have been up to scratch and is not of the quality that it should be. He added:

“If any area of the country is failing to meet high standards of care, then its NHS 111 service needs to be suspended.”

This is what the experts in the field are saying. NHS England needs to be more transparent about how the system is functioning across the country.

[Andrew Percy (Brigg and Goole) (Con)]

I met one of my local ambulance service chief executives just last Friday, who told me that, in his experience, the implementation of NHS 111 was going well and was helping to reduce demand on the ambulance service locally—and they were quite happy with the service. Although there have been problems, which the hon. Gentleman is right to highlight, plenty of people have been treated well and professionally by this service, and some health service professionals think that the service is working okay.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I have stated that the focus of the new system was on trying to make it better. Every hon. Member accepts that. The idea behind it is great, if it works. We elected representatives will always get the complaints. Not often do we get the wee card saying, “Thank you very much for what you’ve done for us,” but we always get the ones saying, “It’s not working well.” The hon. Gentleman is right. I accept that there will be many examples throughout the United Kingdom where the system has, perhaps, worked, but equally there are a lot of examples of where it has not worked. That is the point that I am trying to make.

We highlight such issues for a purpose, not to be dogmatic, angry or always to be negative in our comments, but to try to look towards improvement. I always try to think that my comments will be constructive criticism, which can be taken on board to make things better. My idea as an elected representative over the years, as a councillor and a Member of the Legislative Assembly in a previous life, has always been to try make comments in that way.

I am conscious of my position as a Northern Ireland Member of Parliament, because health is a devolved matter and I am ever mindful of the cuts in funding faced by all Departments in an effort to reduce the deficit—every pound spent must be well spent—but, from my perspective, I urge that the Northern Ireland Direct system continue until the kinks are ironed out here. On health, we will follow, as we often do, what happens here on the UK mainland, so, from a Northern Ireland perspective, I want to make sure that the system’s fall downs and problems are ironed out and sorted out before we take on the system—if we take it on.

I have been looking at the system with great interest, because one of my jobs here as MP for Strangford and my party’s health spokesman is to consider the systems across on the mainland. Many of my queries to Ministers here in questions on health and to my Health Minister back in Northern Ireland come from what colleagues say to me and from what these debates bring out. I am interested in seeing how this system works or will work, or does not work. If it does not work, I will convey that to my Minister in Northern Ireland, to ensure that when making a decision there we will look at how it can happen. I will certainly not be urging our Health Minister in Northern Ireland to use his precious funding to implement this scheme as it stands.

A and E Departments

Jim Shannon Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

We absolutely need better alternatives to A and E, but let me remind the hon. Lady that if we followed her party’s Front-Bench policy of cutting the NHS budget from its current levels, many more urgent and walk-in centres would have to be closed.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland as in England there have been lots of problems with increasing numbers presenting at A and E. The Northern Ireland Minister of Health, Social Services and Public Safety introduced the triage system, which enabled more effective processing of patients and allowed people to get the level of care and medical attention they needed. Will the Secretary of State agree to discussions with that Northern Ireland Minister to see what can be learned from what has been done in Northern Ireland?

[Mr Hunt]

I always welcome discussions with the devolved Administrations to see what we can learn. Better triaging at the point of entry to A and E is certainly one of the things that makes a difference between A and E trusts that are managing to meet their targets despite very high pressures and those that are not.

Health and Social Care

Jim Shannon Excerpts

Monday 13th May 2013 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Will you confirm, Mr Deputy Speaker, that I may speak until 9.40?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

The hon. Gentleman has eight minutes, and if two interventions come along that will give him 10 minutes.

[Jim Shannon]

I am sure that my colleagues will intervene.

I thoroughly enjoyed the opening of Parliament. It always fills me with a sense of optimism to look forward to another Session and what we can do. As the DUP Health spokesman, that optimism was dulled when I noted, with some dismay, that the Government had not included standardised cigarette packs in the Queen’s Speech. It would have been great to see essential measures on that.

I am reminded of the dance, the hokey-cokey: they are in for packaging, they are out for packaging, they are in for packaging, they are out for packaging, and they swing it all about. I cannot do the hokey-cokey, but I know who can. The Government can do the hokey-cokey and nobody can do it better. Bruce Forsyth often says, “Didn’t they do well?” If he ever retires, there are two hon. Members who will be vying for his position.

I am encouraged that some hon. Members have had the courage of their convictions. The hon. Member for Salisbury (John Glen) has taken a clear stance on plain packaging, as have other Members. I appreciate that.

I have received many e-mails from constituents on this issue. One stated:

“Since tobacco advertising became illegal in the UK, the tobacco companies have been investing a fortune on packaging design to attract new consumers. Most of these new consumers are children with 80% of smokers starting by the age of 19.”

Other Members have made it clear that we must stop smoking being an attraction for young people. About 200,000 children as young as 11 years old are smoking already and the addiction kills one in two long-term users. A recent YouGov poll showed that 63% of the public back plain packaging and that only 16% are against it.

Last week, I asked the Prime Minister whether he would introduce plain packaging. He said:

“On the issue of plain packaging for cigarettes, the consultation is still under way”.—[Official Report, 8 May 2013; Vol. 563, c. 24.]

That is not exactly accurate because the standardised packaging consultation started on 16 April last year and ended nine months ago on 10 August 2012. I am keen to hear from the Government just what is happening.

[Chris Ruane]

I am just doing Mr Deputy Speaker’s bidding by intervening to give the hon. Gentleman an extra minute. When plain packaging was introduced in Australia, the tobacco industry fought the longest, dirtiest battle it had ever fought against any Government proposal to curb smoking. Why does the hon. Gentleman think that was? It threatened that triads would come over from China and take over Australia, but that never occurred. Why did it threaten so much and fight so hard? Is he pleased that it lost?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I perceive and am of the opinion that companies saw such measures as a loss to their profit margin, and we would like to see what happened in Australia happen here.

The former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley),was quoted in the media saying that the Government did not work with tobacco companies as they wanted them to have “no business” in the UK. Has that changed? The current Health Secretary stated that one of his key priorities is to reduce premature mortality. His call to action on premature mortality commits to a decision on whether to proceed with standard packaging. He also stated:

“Just because something is not in the Queen’s Speech doesn’t mean that the Government cannot bring it forward in law.”

Even at this late stage, may we hear a commitment to bringing forth such a measure in law? If we do, that will be good news and we will welcome it.

Some 10 million adults smoke in the UK and more than 200,000 children start smoking at a very early age. More than 100,000 people die from cancer-related smoking diseases across the UK, which is more than from the next six causes of preventable death put together. The immensity of the number of deaths from smoking cannot be underestimated. Many Members have spoken about that, and I believe the fact we are all saying the same thing is something we should underline.

We cannot remove people’s choice to smoke—that is a decision to be made by any adult—but we can, and must, ensure that everyone knows they are doing harm to themselves and those around them. Evidence that standardised packaging helps smokers quit and prevents young people from taking up the habit and facing a lifetime of addiction is clear, and we should encourage more people to stop smoking and not to become addicted.

[Frank Dobson]

Does the hon. Gentleman agree that the argument sometimes put by defenders of the tobacco industry—usually paid defenders—is that people are exercising free choice? In fact, they are not exercising free choice because they are addicts who took up the addiction when tobacco companies persuaded them to smoke when they were teenagers.

[Jim Shannon]

I thank the right hon. Gentleman for that intervention and for clearly underlining the stand we are all taking on this issue. We hope that Ministers will respond positively. I believe that plain packaging is a major step in this informational and educational journey to end smoking, and I ask the Minister to commit today to begin that journey that has been planned for so long.

Another disappointment in last week’s speech was the lack of reference to the minimum pricing of alcohol, although there has been some indication that there may be a change of heart, which we hope will be the case. Last week I was sent a copy of a study containing numerous sources, and there are certainly some shocking statistics. Its findings, among other pertinent points, demonstrate that alcohol is 45% more affordable today than it was in 1980. Men and women can currently exceed the recommended low-risk daily drinking guidelines for £1. That is hard to believe in this day and age, but it is the truth. Data from Canadian provinces suggest that a 10% increase in the average minimum price would result in about an 8% reduction in consumption, a 9% reduction in hospital admissions, and—this is the big one, Mr Deputy Speaker—a 32% reduction in deaths caused wholly by alcohol, which is even higher than the figure suggested in the Government’s impact assessment.

Alcohol Health Alliance UK stated:

“The case for introducing minimum unit pricing is clearer than ever, yet despite committing to the principle of minimum unit pricing, it appears that the Government are going to drop the measure from their alcohol strategy.”

Perhaps Ministers will comment on that, but I sincerely hope it is not the case. Minimum pricing of alcohol is not to ensure that those on low incomes cannot have a drink, but to ensure that people of all incomes are aware how much they are drinking and conscious of the health implications of excessive or binge drinking. When it comes to minimum pricing for alcohol, we can all take note and take advantage of it.

Every year there are 1.5 million victims of alcohol-fuelled violence in the United Kingdom, and it is clear that community safety is threatened by the misuse of alcohol. Police superintendents have advised that alcohol is present in half of all crimes committed, and a 1990 study for the Home Office found that growth in beer consumption was the single most important factor in explaining the growth in crimes of violence against the person. The figures are clear. Statistics show that 37% of offenders had a current problem with alcohol; 37% had a problem with binge drinking; 47% have misused alcohol in the past; and 32% had violent behaviour related to their alcohol use. When we mix young people, who have not had time to develop their moral standards and ideals, with alcohol, we have a generation who are fuelled by the desire to live in the moment, with no thought of the consequences. Alcohol changes personalities, and young people are only learning who they are. Adding alcohol to the mix means that they will never have a good understanding of who they are. A minimum price for alcohol will lessen the number of young people who drink copious amounts of it. Hopefully, it will also mean a lessening of crimes that are aggravated or exacerbated by alcohol.

My third point is on diabetes, which is a ticking bomb in our society. We had a debate on it in Westminster Hall, when the right hon. Member for Leicester East (Keith Vaz) made the point about diabetes and obesity among children. The figures are overwhelming. The United Kingdom of Great Britain and Northern Ireland diabetes strategy ended in April, but perhaps the Minister can tonight commit to its continuation. I believe the strategy was working. Had it not had an effect, the figures would be much worse. Even given the strategy, the number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland, 25% in England, 20% in Wales, and 18% in Scotland. The numbers are rising. A commitment to the continuation of the strategy would be helpful. The statistics are scary—3.7 million people in the UK are diagnosed with type 2 diabetes. However, we are talking not only about statistics, but about people’s lives. We need to prevent and control as well as we can.

I am aware that the health portfolio is not an easy one. Everybody needs something urgently. I understand the restrictions that apply, but does the Minister understand that the three issues that I and others have raised affect every corner of the United Kingdom of Great Britain and Northern Ireland? I believe we could have reform on those issues if the Government put their hand to the plough and disregard all but the health and safety of our population.

Childhood Obesity and Diabetes

Jim Shannon Excerpts

Wednesday 24th April 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to take part in the debate. I have several things in common with the right hon. Member for Leicester East (Keith Vaz), not least that we support the same football team. I have done so since 1969, and I hope we shall be in the premier league next year. The second thing is that we are type 2 diabetics, as a result of our lifestyle—from about the same time, as I became a diabetic some five years ago.

I acknowledge that I am a diabetic because of the lifestyle I had. Hon. Members may know the experience of being offered a well man check by the doctor, who always says there is good news and bad news; we say, “Tell me the bad news first.” The doctor five years ago told me, “The bad news is you are diabetic. The good news is you can manage it if you really want to.” That was the thrust of it. He said “You can ignore this, and shortly you will be on tablets, and then on injections.” He was not scaremongering, but just wanted me to know exactly what the condition meant. He said, “Your diabetes will not kill you, but what will kill you will be all the things that come from it: your blood pressure and heart, or amputations and stress levels.” I know fine rightly that I became a diabetic because of my lifestyle five years ago. The fact is I love Chinese food; five days a week I had a sweet and sour pork and two bottles of Coke. It never changed—I like it, and so that was what happened. As well as that there was all the stress of the job—previously I was an Assembly Member in Northern Ireland, and a councillor. I love long hours, and they do not bother me at all—and that probably applies to every other hon. Member; the hours were not an issue, but the stress is.

Clearly I had to make changes. Looking back into my ancestry, no one—not my mother, father or grandparents—had diabetes. I was the first in my family, so the cause was clearly my lifestyle. I make that point because of the question of heredity and the hope that I would not pass on my difficulties to my children or my wee granddaughter, four-year-old Katie-Lee. The question is how to instil in children and grandchildren the necessary control, so that they eat the right food, in the right way. I was on diet control in January, and am now on two Metformin tablets in the morning, and two at night; there is nothing graceful about growing old. We may need tablets to keep us going, and probably most of us in the Chamber are of that ilk. The question for me is what I can do as a grandfather, and as an MP, to protect my granddaughter and children, and everyone else, from becoming diabetic.

The UK has the fifth highest rate in the world for type 1 diabetes in children. That can lead to serious health problems such as blindness and strokes, to name but two. Some 24.5 children in every 100,000 aged 14 and under are diagnosed with the condition every year in the UK. Statistics are real to those of us who are focused on the disease and how to deal with it. The UK’s rate is about twice as high as the rate in Spain, which is 13 in every 100,000, and in France, which is 12.2 in every 100,000. The league table covers only 88 countries where the rate of incidence of type 1 diabetes is recorded. There are around 1,038 children under the age of 17 living with type 1 diabetes in Northern Ireland, and almost one in four of those reached diabetic ketoacidosis before a diagnosis was made. DKA can develop quickly and occurs when a lack of insulin upsets the body’s normal chemical balance and causes it to produce poisonous chemicals known as ketones. If undetected, those ketones can result in serious illness, coma and death. We all know people who have come through that, and I am aware of people who have succumbed to diabetes.

The number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland during the last five years; that is the largest increase in the United Kingdom, compared with 25% in England, 20% in Wales and 18% in Scotland. The total number of adults with diabetes—those aged 17 and over—registered with GPs in our small part of the UK is just shy of 76,000, and 1,038 young people under 17 are known to have type 1 diabetes, which is another significant rise. Prevalence in the Northern Ireland population is now more than 4%. Some 10,000 people have diabetes without having been diagnosed with the condition. It is scary stuff, when we realise what is happening in our region. I had occasion to speak about that with the right hon. Member for Leicester East before the debate.

Through my colleague, the Northern Ireland Health Minister, I encouraged the purchase of insulin pumps for type 1 diabetics, which was done last year; we have also encouraged the provision of training for family members, guardians and health staff in the use of the pumps. When a Minister is committed to the issue, things can happen.

I have every confidence in the Minister who is present for the debate. In my short time here I have witnessed her contribution in her role, and her commitment to change and to taking hard decisions. I do not agree with everything that she does, but I admire her commitment to the job, and many things that she has done have not gone unnoticed.

Approximately 90% of the 3.7 million people in the UK diagnosed with diabetes have type 2. I have brought that issue to the attention of the Northern Ireland Health Minister, as I am very aware of the ticking time bomb that diabetes is, and the key initiatives in operation in Northern Ireland. He is clearly doing a great job, including setting aside funding to employ additional diabetes staff—specialists, nurses, dieticians and podiatrists: all help that a diabetic needs, but perhaps not enough. All the hon. Members who have spoken have done so with honesty; if we put all the ideas together in a big pot, perhaps we will find a way forward. We need to instil good eating habits in children that will not lead to diabetes later in life.

Rates of obesity—because that is the twin thrust of the debate—tend to rise with increasing disadvantage across developed countries, particularly among women. In 2006 in Northern Ireland, 18% of children aged between two and 15 years were reported to be obese. In 2008-09, the child health system reported that 5.3% of primary 1 children surveyed were obese. The hon. Member for Southport (John Pugh) said that when we were young, many years ago, for someone to be of a certain size was unusual. It is not any more. In the survey I mentioned, 22.5% of the children were described as overweight or obese. That is a massive number.

We need to educate parents on what they are teaching their children through their lunches and dinners. Some schools in my area implemented a healthy snack policy, where twice a week children were not allowed to bring in crisps or chocolate, but had to bring in fruit or a healthy option. That is fantastic, and it is good that it happens, but some parents pointed out how much more expensive it was. We should consider how to make healthy food more affordable for young families in the present economic difficulties.

[Mr McKenzie]

On that issue, is the hon. Gentleman concerned, as I am, about supermarkets that employ the tactic of making their fruit ripen as early as possible, so that families have to make several trips to purchase healthy options for their child’s lunch box?

[Jim Shannon]

Many parents have made me aware of that. There is a key role for supermarkets and how they do things. When we go to the supermarket—let us be honest—we can always find a multipack of crisps or chocolate. By the way, there is nothing wrong with that as long as it is done, like anything in this world, in moderation. Children love a treat, and why should they not have one if it does them no harm?

Unfortunately, it is more difficult to find a multipack of fruit juice, or bags of fruit on offer or sliced up. It is much handier for parents to pick up a bag of crisps for their child’s break than to take the time to cut up fruit when they cannot afford to buy the pre-cut fruit that they want. I believe that we need to change that by encouraging supermarkets to put regular offers on healthy options, and perhaps by looking at tax incentives to make such options a realistic lifestyle choice, and not just a fad to go for for a wee while.

One of the community groups in my area, the East End residents association, has put on a cooking class for its ladies group, which showed them how to cook healthily for the family in a quick and cheap way. Women of all ages learned how they could cook on a budget, but still provide a healthy and satisfying meal. That is also key, and I suggest that funding might be set aside for community groups and churches to put on such classes, which could make real lifestyle changes to entire households.

Unfortunately, at the moment there are few homes that can afford to have only one parent in work, with the mother at home cooking and cleaning—that now has to be fitted around another job—but we must educate people and teach them that short cuts can be made so that healthy meals and snacks for families are still provided. Will the Minister kindly address that and explain what can be done to educate and help those who simply do not know how to do the best for their families? A surprising number of families cannot do so, so we should try to achieve that if we can.

In conclusion, it is clear that something needs to be done. If there is one message from every speaker, it is that we all agree that something needs to be done; the question is how best to deliver that. Many children and adults will not be able to live a healthy life because of something that they could have made small changes to prevent. I congratulate the right hon. Member for Leicester East on bringing this matter to the Chamber. Many more hon. Members would like to make a contribution, but I can say one thing—every one of us, as elected representatives, has constituents for whom this issue is key. We look forward to hearing the response from the Minister, as well as the speech from the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott).

A and E Waiting Times

Jim Shannon Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing this important debate and on giving us all an opportunity to speak on accident and emergency provision. The last time we had such a debate in Westminster Hall, the Minister gave a positive response to our concerns, so we look forward to her doing the same again today.

Health is a devolved matter in Northern Ireland, and the Northern Ireland Assembly has full responsibility for it. None the less, I want to contribute to the debate and outline some of the important issues that we face. I preface my remarks by commending the ambulance staff and the accident and emergency staff on the long, tedious and hard work they do under intense pressure. For many of them, their job is a vocation. That is true of many of the accident and emergency staff in my constituency, especially those in Ulster hospital in Dundonald and in Ards community hospital. They should all be commended on their excellent work and commitment.

Across the UK, waiting times in A and E departments are on the increase, and Northern Ireland is no different. A report in The Daily Telegraph said:

“Data obtained from 60 NHS finance directors as part of the study revealed that 40 per cent of trusts did not meet their productivity targets in 2011-12.”

It went on to say:

“This will be a significant concern as last year was the first in a four-year spending squeeze, during which the NHS needs to find £20 billion in productivity improvements.”

Just four of the finance chiefs questioned said that their organisation was forecasting a deficit this year, backing up national figures that estimate a surplus of £1.5 billion across the NHS. That is worrying, not just for the patients coming in to A and E, but for the doctors and nurses on the front line who are bearing the brunt of the pressure along with the brunt of people’s frustration at being held waiting.

In her speech, the right hon. Member for Cynon Valley gave some examples of where A and E units have found it difficult to respond to people’s needs, and we can all reiterate such examples over and over again. However, an important point is that whenever someone is ill and in need of help, sometimes their frustration spills over towards those people who are trying to help them. We must have a system whereby those who are in need can be helped at the time they are in need.

Due to the cuts in the block grant and the need for massive savings, our Health Minister in Northern Ireland has been forced into making very hard decisions such as closing the A and E unit at Belfast city hospital, which then impacted on my constituency. Yet there was no option, because those were hard decisions that had to be made. We had to take the impact upon the surrounding A and E units into full consideration and the extra staff and resources needed to deal with that. By and large, that consideration seems to have taken place, but I want to give a few examples of issues.

The savings had to be made to meet Government cuts in the block grant. That is the position that many of our trusts are in, and the Government must decide which is more important at this time—achieving productivity targets or achieving their efficiency savings. It is abundantly clear that it is becoming harder and harder to do both, and it is grossly unfair for the trusts to have to balance what cannot be balanced. Our Health Minister in Northern Ireland is doing a good job in difficult circumstances. However, my fear is that more and more will be asked, and that it will be impossible to deliver on those extra demands as time goes on and as the savings required become more and more difficult to achieve.

I have had occasion to visit the A and E unit in my constituency, because of complaints that my constituents have made about an inability to be seen, waiting times, unavailability of staff and the cramped conditions. I have passed on those complaints to the trust and I have met the chief executive, Hugh McCaughey. I have explained to him the complaints that were made, and, in fairness, he and his staff responded by putting in place a number of measures: better allocation of staff when it comes to A and E units; access to services centrally, which is sometimes required rather than people having to go across town to another hospital to get the service they need; and a more accountable and fluent monitoring response at A and E units. The hon. Member for Stretford and Urmston (Kate Green) mentioned triage; it is so important to get that right at A and E units. As I say, those significant changes have been made at the A and E unit at the Ulster hospital in Dundonald, as a result of complaints by my constituents and the meetings that we have had with staff.

Such improvements are good news. However, as the restriction on moneys continues, we have extra pressures on the A and E units, which are now under pressure because of the changes that have taken place. I am particularly concerned about that issue. It is closely monitored in the devolved Northern Ireland Assembly, with the Health Minister receiving monthly reports and the Committee for Health, Social Services and Public Safety receiving quarterly reports. The Minister and I came into political life at the same time. We live in different parts of the country, but we are good friends and we communicate regularly on these issues. However, there is too much pressure on the A and E departments for them to be able to handle their case load, and I know that the Royal College of Nursing, among other professional bodies, has expressed concern that there is not enough cover, but once again this comes back to the age-old issue of money and how the resources can be better spent.

It is my opinion—and I believe that of many people—that the trusts are doing as well as possible, but it is clear that the efficiencies that have been required of them are too much to balance with the targets that have been set, and above all to ensure that patients receive a good standard of care, which is the standard they should expect from one of the best health care systems in the world—indeed, the NHS is the envy of many in the world. Our doctors and nurses do a fine job, indeed a great job. I know that they do the best that they can, and we must assume some responsibility in this place for the care that people receive; that care is down to decisions that are made here. For that reason, I again implore the Government to reconsider the efficiency targets that have been set. Instead, they should allow trusts to have the ability to have a good staff, on duty and on call, to handle what is required and to protect the most important thing that we possess, which is our health.

I apologise in advance, Mr Hollobone, for leaving early because there is a Public Bill Committee that I should attend.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 16th April 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. There is a misconception among some GPs that a dementia diagnosis is pointless and cannot make a difference, when we know that in fact the correct medicines can help between one in three and one in four of those who have the condition. However, some GPs also have a point when they are concerned that it is difficult to access good services for people who have dementia. The way we will change GPs’ minds is for them to appreciate that something will change if someone gets a dementia diagnosis. That is the big challenge that this ministerial team has set the Department.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that there is much to be learned from the high rate of dementia diagnosis in Northern Ireland? Is not that an example of how important it is for the devolved powers to share information and tactics for success in their own areas with the other devolved bodies?

[Mr Hunt]

I agree with the hon. Gentleman. Some of the devolved Administrations, particularly Scotland, actually do better than England in regard to dementia diagnosis, and one thing that we must learn from them is the value of a properly integrated care plan. I am working closely with the Minister of State to ensure that we deliver that in England.

Mid Staffordshire NHS Foundation Trust

Jim Shannon Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I agree with those sentiments strongly. In parallel to this process and these changes, I have asked the NHS Confederation to recommend how we can reduce the bureaucratic burden on hospital front-line staff by a third, precisely because I want to avoid the issues that my hon. Friend mentions. This is about freeing up time for people at the front line, and one way is to have an inspection system in which everyone has confidence. Once there is the confidence that problems will be identified, it becomes much easier, as has happened in the education system, to give more freedom to people on the front line.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. The public inquiry has been thorough, with new standards put in place and lessons learned from the NHS in Staffordshire. Health in Northern Ireland is a devolved matter. Will he confirm that the report will be sent to the Northern Ireland Assembly Health Minister, Edwin Poots, so that improvements and guidelines can be improved for everyone in the United Kingdom of Great Britain and Northern Ireland?

[Mr Hunt]

I am happy to do so.

Fetal Anti-convulsant Syndrome

Jim Shannon Excerpts

Tuesday 26th March 2013 Westminster Hall

[Anas Sarwar (Glasgow Central) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am delighted to have secured this important and topical debate after months of bad luck in the ballot. The House will adjourn for the Easter recess today, and I appreciate the effect of that on the number of participants. As hon. Members have other commitments in their constituencies, the turnout is lower than it would have been had the debate taken place at a more convenient time, so I am grateful to colleagues who have made it here.

Members who watched the recent BBC “Inside Out” programme will recognise the timeliness of this debate, because new expert medical research has highlighted the dangers of anti-convulsant medication to pregnant women and their unborn children. Before we get into the debate, I will provide a bit of background information on fetal anti-convulsant syndrome and the Independent Fetal Anti-Convulsant Trust.

Fetal anti-convulsant syndrome is a medical condition that arises among the children of mothers who suffer from epilepsy and take a type of drug known or used as an anti-convulsant medication to treat their condition during pregnancy. Not all children who are exposed to anti-convulsant drugs are affected. The level of risk is determined by known factors, such as the particular anti-convulsant medication used and the dose taken, as well as other susceptibility factors. Children suffering from fetal anti-convulsant syndrome suffer from a constellation of physical and neuro-developmental deficits, and so have to be diagnosed by a medical specialist.

The Independent Fetal Anti-Convulsant Trust was launched in November 2012 to gather information and provide support and assistance to those affected by the condition. It is run by a small, hard-working team of volunteers, a couple of whom are in the Gallery today. I would like to put on record my thanks to the entire team, and especially to Janet Williams, who has done a fantastic job in providing me and many other hon. Members with so much invaluable information. I would urge anyone who suffers from the condition, or who has a relative or friend with it, to contact the trust.

It is difficult to get an accurate picture of the number of people affected by the condition; in response to a parliamentary question to the Department of Health on the number of women receiving anti-epileptic drugs through the NHS, I was unfortunately told that the information was not available centrally. Things are made even more difficult by the fact that many children with the condition will not have been diagnosed with the syndrome because they do not have a major congenital malformation, such as a heart defect or spina bifida. Those children are less likely to be referred to a clinical geneticist.

Sodium valproate is the drug that reportedly carries the largest risk of causing fetal anti-convulsant syndrome. According to prescription records, there were more than 21,500 women taking sodium valproate in 2010 in England and Wales alone. A range of scientific studies conducted over the past couple of decades have demonstrated that some 10% of children exposed to sodium valproate will be born with a major congenital malformation. Their IQ is likely to be lower than it otherwise would have been, with 29% requiring additional educational support and 6% being diagnosed with significant social communication difficulties, such as autism.

More broadly, there have been numerous case reports in medical journals of children born with one or more major birth defects when the mother had been taking anti-convulsant drugs. Those children include not only those born with spina bifida and heart defects, but those born with cleft palates, limb malformations, neuro-developmental delays and learning difficulties. There are therefore likely to be tens of thousands of children affected by the condition.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman is making his case very well. Fetal anti-convulsant syndrome is an unknown quantity that affects children. I am aware of a family in my constituency with children who suffer from it. The hon. Gentleman has not yet mentioned that children may also suffer from autism as a result of fetal anti-convulsant syndrome. Is he aware of that? Does he feel that more research is needed to find the necessary treatment, and that the Government should respond by encouraging, and making moneys available for, a treatment to be found for those young people and their parents?

[Anas Sarwar]

I did in fact mention autism, but the hon. Gentleman is absolutely right that we need direct support from the Government to help families affected by this condition.

The campaign has identified 500 families, but there are likely to be thousands of families across the country who do not know that their child suffers from this condition, and who do not have support from an organisation such as the trust. We therefore need Government action to support those families at this difficult time. The Organisation for Anti-Convulsant Syndromes—of which Janet Williams, who I mentioned earlier, was a founder—has been contacted by more than 500 families, with nearly 700 individuals affected by the condition.

The drug sodium valproate, which is manufactured under the name of Epilim by Sanofi, has been prescribed in the UK since the 1970s. Despite the drug’s efficacy in treating certain types of seizure, research has demonstrated that it carries a higher risk to the exposed foetus than other drugs. The first case reporting the effects of sodium valproate during pregnancy appeared in 1981, and it grew to be a hot topic within the medical profession in the 1980s, with numerous reports appearing in the medical journals. The report, however, was never investigated in the review of medicines from 1971 to 1990. The then Medicines Control Agency, which became the Medicines and Healthcare products Regulatory Agency in 2004, did not pursue the claims made by the medical research community. The MHRA “Current Problems in Pharmacovigilance” reports addressed the effects of sodium valproate in January 1983 and continued to do so intermittently. No action was taken, however, to convince Sanofi to recall the drug, improve it, or provide comprehensive warnings to patients and their doctors.

Medical Implants (EU and UK)

Jim Shannon Excerpts

Wednesday 6th March 2013 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I do not serve on the Committee and I do not have the knowledge of the hon. Members for Ellesmere Port and Neston (Andrew Miller) and for Southport (John Pugh) on this subject, but I want to bring a couple of matters to the House’s attention, including some that are of importance to my constituents.

My first point relates to recommendation 29 on transparency of evidence. It is very important to have that recommendation in the report for the sake of those who have had breast implants over the years. Some of my constituents unfortunately found themselves on the wrong side of the PIP scandal when the companies that had been involved in doing the operations then went bankrupt or disappeared from the market. There were also some cross-border issues in relation to the border between Northern Ireland and the Republic of Ireland. Ladies who had put aside substantial amounts of money for the operation, which in many cases they probably could not afford, found themselves at the cold end, if I may use that terminology, of what happened. I am very pleased to see in the report the transparency that the Committee has sought to achieve.

Will the Minister confirm for the record that all the proposals in the recommendations will apply to Northern Ireland? I am ever mindful that health is a devolved matter in Northern Ireland, and I want to make sure that the recommendations, which are very well put, will apply there in the same way as on the mainland. I am ever mindful, too, that in many parts of the world people can buy almost any items online—not implants or hip replacements, but almost every drug for almost every condition, including cancer, heart conditions, epilepsy and depression. There is always someone out there who will try to take advantage of someone else’s unfortunate health issues.

My second point relates to help for small companies. Recommendation 12 is very important, and I quote it for the record:

“We are not fully convinced by assurances provided by the Government or Commission that this would not hinder small companies bringing products to market. The Commission and Government should explain how they intend to support small, innovative companies in the medical services sector if pre-market approval becomes prohibitively costly.”

Small companies in all parts of the United Kingdom hold the key to the employment opportunities that arise, as the Minister and, indeed, the Prime Minister have said. That is certainly true in my constituency. T. G. Eakin is a pharmaceutical business outside Comber that produces some of the most excellent medical products, including a high-quality skin protection product for use in stoma and wound care that it exports all over the world and for which it has received numerous awards. The company is renowned for its quality and expertise.

I want to underline the point that we should import such products only when it is not possible to produce them ourselves. We must fight for the United Kingdom of Great Britain and Northern Ireland. When we do import such products, it should be highly regulated. Perhaps the Minister could indicate how we can provide more opportunities for small businesses to manufacture these types of products in the United Kingdom. T. G. Eakin provides jobs for some 80 people in my constituency and is planning a factory expansion that will produce about 20 more jobs.

In conclusion, there is a high level of expertise in some companies in the United Kingdom. Recommendation 12 of the report plays up that point. Perhaps the Minister could respond to that recommendation. There are massive opportunities for the United Kingdom to do more in this area. Why do we import when we can produce quality products at home and produce jobs off the back of it? That is what we should do. We can lead the world with our expertise not only in the manufacturing of products such as those produced by T. G. Eakin, but in our universities. Queen’s university Belfast and other universities across the United Kingdom explore all the medical matters and ailments that affect society. That provides opportunities. Recommendation 12 could perhaps help us to make the most of those. I would like to know how we can do that across the United Kingdom. If we can do more, let us do it.

Home Care Workers

Jim Shannon Excerpts

Wednesday 6th March 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I, too, thank the right hon. Member for Oxford East (Mr Smith) and congratulate him on bringing this matter to the House for consideration. There will not be one person in the House or outside it who is unaware of the importance of home care workers and what they do. Unfortunately, we can all tell horror stories like those that the right hon. Gentleman told at the start of the debate, but we also have many good stories of care workers who do tremendous work. Where would we be without the good work that they do?

Thanks to medical innovation, people have a longer life expectancy now than they had in the past. As a result, people are trying to live at home just a wee bit longer before they go into a residential or nursing home. A great many people now retire to my constituency of Strangford, because it has the seaside and is also a lovely place to be, and we are very pleased that they are coming to live in our area. However, they are people of a certain generation, and the expectation of people in Northern Ireland is the same as that of people in the rest of the United Kingdom—that they will live that wee bit longer. I believe the Government have been encouraging families to help at home before turning to residential nursing care.

There must be robust regulation of care workers to ensure safety and value for money. In the news, we often hear horror stories of someone taking advantage of the elderly or vulnerable. Hearing such stories concerns and annoys me, but it is not the case in the vast majority of circumstances. There should be regulated training and assessment as well as funding and help, to ensure that we get things right, which is the gist of the debate today.

In the past I have spoken about the difficulties that welfare reform will bring for carers. I shall use the example of my brother, who had a motorbike accident approximately eight and a half years ago that left him with some brain injuries. My parents are well into their 80s—81 and 83, mum and dad—and their ability to cope with my brother and his particular circumstances lessens as every year passes, because the nature of life is that the older we get, the less physically able we are. We are very pleased and blessed to have my brother able to speak and converse with us; the difference is that our Keith will never be able to work again or, as he would love to, ride a motorbike again—that will never happen. He is able to keep his independence due to the carers who come to see him, and they are tremendous. There is perhaps not as much funding as there should be in the NHS for carers; Keith is reliant on his disability living allowance to pay for the help he needs. If that were to change, he would have to be placed in a facility with full-time carers, which would adversely affect his mental health and cost the Government a lot more to provide. That is my honest-to-goodness, personal opinion in the case of someone close to me.

Such situations are replicated across my constituency and in constituencies across the UK; there are many cases. It is essential that home care continues. If people cannot afford to pay for reputable carers, it is more likely that they will look for carers who are less expensive and perhaps less qualified. That is why the Government must regulate more now.

I make a plea for Crossroads Caring for Carers Northern Ireland, which primarily provides domiciliary respite care. It has offered that service for carers in Northern Ireland since 1984, and provides in excess of 200,000 hours of respite care to more than 1,200 families per year. It does tremendous work, as do many others. The service is unique, because it is aimed specifically at the carer. Crossroads is committed to providing a quality, flexible home-care service; its care attendants enable the carer to have a break, by carrying out whatever tasks the carer would normally do. Carers can take a break from caring, in the knowledge that those they care for are receiving quality care from Crossroads. In other words, every bit of quality care will be provided by Crossroads. A break from caring is invaluable in reducing the psychological and emotional stress that many carers face. Crossroads domiciliary respite care helps carers to continue to provide the support they give to a sick, disabled or elderly person.

The care provision is tailored to each caring situation; everyone is unique and the service adjusts to the unique circumstances. Individual care plans are agreed between Crossroads, the carer and the person with care needs. People decide for themselves what help and support they need, and Crossroads responds. Care attendants help with a range of personal care tasks, ranging from bathing and personal hygiene to complex care needs. Through their families, I regularly meet many constituents who have complex care needs. Crossroads adopts a flexible support approach, with care attendants helping with almost any task that is part of everyday living.

Funding for Crossroads is under stress, as I said, so less and less help can be given. That brings us to the thrust of the debate: people are left in situations where they must look to cheaper alternatives, which are not always better. It bears repeating that the Government must address care in the home needs. Too many people are living in dirty homes and not being fed enough. There is only so much that families can do. Although we are trying to save money, care in the community cannot bear the brunt of what the changes will bring. Crossroads Caring has lost the bulk of its funding due to cuts. That will mean more elderly people living in unfit conditions because too much is required of their carers. With respect, the Government do not seem to understand that if they put a little into respite help for carers now, it will mean that carers can continue to care rather than giving up and putting their loved ones into state-sponsored homes, which are more expensive and where issues with carers are more apparent. Saving a penny now will soon mean spending thousands later. I hope when the Minister responds, he will give some indication of the Government’s strategy.

Those advertising care at the moment can do so while providing little training or checks on their staff, as hon. Members have indicated, and that must end. There must be regulation, qualifications and a set standard to which all carers and service providers adhere. When the Government set that in place, we will hear fewer horror stories and more feel-good stories, of which there are thousands and thousands. They are not the stories that make the press; they are about the many carers who go above and beyond their calling to provide care.

As an elected representative—as an MP and a former Assembly Member and councillor—I know of the good work that carers do. They come to me regularly, in their own time, to seek help for those for whom they care. I am always impressed by the fact that carers spend additional time on those for whom they care—above and beyond what is expected. We hear the negative stories, but the good ones always make us feel much better about the good work that carers do in our constituencies.

I am sure that, like me, colleagues feel there must be proper training and monitoring and that it must be put in place in a timely fashion. As each day passes, more people are being cared for at home. We have a duty to ensure first, the regulation of all carers; secondly, the safety of those being cared for; and, thirdly, and most important, peace of mind for the family of the person who needs care. I congratulate the right hon. Member for Oxford East on securing the debate. I look forward to a good answer from the Minister and to his support.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner, and to follow my hon. Friend the Member for Nottingham South (Lilian Greenwood) and all other hon. Members who have spoken.

I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing today’s debate. Home care workers often work in isolated environments, and the people who receive care are isolated. Too often, they do not have a voice, and one of our jobs as Members of Parliament is to provide a voice for the voiceless. My right hon. Friend has helped us to do that today.

The issue is extremely important. More than 800,000 people provide home care in the UK. Some 80% of them are women, and their median age is about 40. They provide vital, intimate and personal services to more than 1 million of the most vulnerable people in society. If any other policy area had that scale of figures, this debate would be on the Floor of the House, with many other hon. Members present. It is good to have hon. Members here in this debate, but the issue that requires addressing is a huge one.

The help that home care workers provide is crucial for older and disabled people, because it helps them do what they want, which is to stay living independently in their own homes. It is crucial for families, who often have to go out to work and cannot provide support and care for their elderly relatives. Also, they might not live nearby, as I know well myself. Home care help is crucial also for the public finances and taxpayers, because if we can keep more people living healthily and independently at home and not going into hospital, taxpayers will receive better value for money.

Like other hon. Members who have spoken today, I have been concerned about the issue for a long time. Last May, I held a domiciliary care summit in Parliament with the United Kingdom Homecare Association, with 50 providers coming along. I have work-shadowed home care workers in my constituency, including Amanda White. Going out on an early-morning shift with her was an eye-opening experience. I also speak to many older and disabled people and care workers in my constituency and across the country. Many of the points that I have heard have been repeated by right hon. and hon. Members today.

There are many examples of excellent, decent and respectful care. The home care workers to whom I have spoken, including Amanda, love their job. They feel that they are doing something important for vulnerable people, helping them to live the kinds of lives that they want. However, the overwhelming picture is of a vicious downward spiral, with ever-increasing demand and ever-decreasing budgets, poorly paid, motivated and trained staff, and poor-quality care. Just to summarise, I will go through five issues that many hon. Members have raised today.

The first issue is low pay. Many people do not get even the minimum wage at the end of the week, because they are not paid travel times. Unison’s survey, “Time to care”, which hon. Members have mentioned, found that half of those who responded said that they did not get paid travel time, rising to more than 80% in the private sector. King’s college London has found that between 150,000 and 220,000 people working in the social care sector get paid less than the minimum wage. I will ask the Minister some questions about that towards the end.

The second issue concerns shorter and shorter visits for people with higher and higher levels of need. It is important to remember that as budgets are squeezed, councils raise their eligibility criteria, so people who need care and support at home have greater needs but get shorter and shorter visits. According to the UK Homecare Association, three quarters of visits are for 30 minutes or less, and one in 10 visits are for only 15 minutes. As several hon. Members have said, that is completely inadequate to get someone up, washed, dressed and fed, particularly if they have dementia. Anyone who knows someone or has a family member with dementia will know that they often struggle in the morning, which is a really disorientating time.

[Jim Shannon]

One thing that carers provide to those on whom they call is a wee bit of a chat in the morning—someone to speak to—because many people have no one at all to speak to. When they come in, they light the fire and do all the things that the hon. Lady has mentioned, but communication between carers and those they visit is important. Does she think that that should be given more time?

[Liz Kendall]

Care and communication is vital for people with all sorts of frailties and conditions, but particularly for those with dementia, as carers try to keep their memories and brains going. Those people often feel lost in a fog, and having some kind of contact is vital to keeping them going, so it is important.

We have heard about the problems of call cramming, with carers being rushed, getting late to one client and leaving early for the next. Older people are worried when they are left waiting on their own, and staff are frustrated that they have to rush in and out.

The third issue that has been raised is zero-hours contracts. As hon. Members have said, such contracts are very bad for workers, because they find it difficult to budget and plan their lives. Zero-hours contracts make it hard to attract people to the sector. They are also terrible for the users—older and disabled people who do not get continuity of care. I cannot imagine someone coming round to get me out of my bed and take me to the shower. I would be naked and they would be washing me, but I would not know who they were, because they would often be different people each time. We would not put up with that for ourselves, and we should not expect it for older people either.

The fourth issue is the lack of training, which is a real problem in dementia care. It is only since having known people with dementia that I have fully understood why they are seen to get aggressive: they do not, but they are frustrated because they cannot remember things. Carers need detailed training for that.

The fifth issue is the vicious downward spiral or vicious circle that leads to poor care for users of services and real problems for staff. The last UK Homecare Association report states that vacancy rates are at 21%, so we are simply repeating the problems.

In my remaining time, I want to make three comments about why that is all happening and what we need to do. Clearly, demand has increased in recent years. However, as my hon. Friend the Member for Wirral South (Alison McGovern) said, when local councils’ budgets are being cut by a third, when adult social care is 40% of their budget on average and their biggest discretionary spend, and when the money that the Government say they have transferred from the NHS has not been ring-fenced, it is inevitable that care budgets are being cut. Figures from the Department for Communities and Local Government—the Government’s own figures—show that more than £1.3 billion has been cut from older people’s social care budgets since the coalition came to power.

There are a few deeper things going on. First, the caring profession is mostly delivered by women and is low-skilled. Such professions have always been neglected in the past, so that is a concern. Secondly, the problem is invisible: it concerns isolated staff and isolated, frail older people who do not have a voice. In talking about the care crisis, I always tell people that I have received five letters about the care crisis in my constituency and 99 about saving forests. I am passionate about forests, but getting only five letters on the care crisis shows that this is an issue of isolation and we should stand up about it.