Cancer Treatments

Jim Shannon Excerpts

Tuesday 19th June 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Southport (John Pugh) on bringing this matter to Westminster Hall.

There is not one of us who has not personally been affected, or who does not have family members affected, by what is referred to as the dreaded big “C”. Last year, my sister, who lives in England, had kidney cancer. The medical services here were good in addressing that and she is on the way to recovery. My father had cancer on three occasions and, due to the skill of the surgeons, his faith and the prayers of God’s people, he got over those cancers and is still here coming up to 83 years old—or young, perhaps, which is another way of looking at it. Our health care system is good at what it does. I want to make that clear.

We have the best palliative care in the whole of Europe. That matter has been debated previously in the House. However, that does not always mean that we have the best cancer treatment in every category and sector. We must look at that.

The hon. Member for Southport spoke about pancreatic cancer. Recently, I met representatives from Pancreatic Cancer UK, who gave me some shocking figures, which are available to all hon. Members. Survival rates for pancreatic cancer have not improved for more than 40 years, making it the most deadly of all cancers diagnosed in the UK, with fewer than 3% of patients surviving beyond five years. Some 8,000 people are diagnosed with pancreatic cancer every year and it is responsible for 5% of deaths from cancer, yet it receives only 1% of research funding. There was a debate on pancreatic cancer in Westminster Hall a month or two ago. It is often regarded as a death sentence—if people get it, their chances are minimal. Perhaps the Minister can tell us what has been done to address that matter in particular.

[John Pugh]

I am glad the hon. Gentleman mentioned that, because two close friends of mine died rapidly of pancreatic cancer. One point made by the people in Liverpool to whom I spoke was that, given the almost invariably fatal outcome from this cancer, it would not be a bad idea if some of the rules regarding drugs approval were relaxed a little bit, so that people could find out what worked, because in this case there is very little to lose.

[Jim Shannon]

I thank the hon. Gentleman for that valuable contribution and agree wholeheartedly. If it comes to the stage where people’s life expectancy is minimal or reduced, I believe that they would be quite happy to take advantage of new drugs, if those were available.

All hon. Members know that finances are finite in the health budget. That being so, we are grateful for the many charities that do such magnificent work, including Cancer Research UK, Macmillan Cancer Support and Marie Curie Cancer Care. However, we must get a handle on our treatment process and outcomes, which can only come through the correct use of funding. I hope that the Minister will tell us how that will happen.

In the NHS document, “Improving outcomes: a strategy for cancer”, published in January 2011, it is clear what the Minister regarded as the way forward:

“In order to achieve these principles we must also ensure that every possible penny of money the NHS has is spent improving the quality of care and outcomes that patients experience. The Government protected the NHS in the Spending Review settlement, with cash funding growth of £10.6 billion (over 10%) by 2014/15. Compared to many other government departments, that puts us in an incredibly privileged position but this is the toughest settlement the NHS has faced in a long time.

At the same time, we need to respond to the longer term pressures the NHS faces; of an ageing population and the new demands created by new treatments and technologies. That means that, as set out in the Spending Review and the 2011/12 Operating Framework, over the next four years the NHS will need to achieve up to £20 billion of efficiency savings. These savings will be reinvested back in continuing to give patients the care that they need.”

Will the Minister say whether we are on target to make those savings? If so, when will that money go back into the system?

The document contains many examples of cost-efficient care, such as people having certain treatments as day procedures and then care at home, which makes a lot of people feel more secure as well as being cost effective. We understand the reasons and the thinking behind that: it is essential that the patient is at the heart of any decision made and any strategy must incorporate this.

I am not an argumentative person—far from it, I try to get on with most people in this world—but the hon. Member for Southport commented on the advertising campaign “Have you had a cough for three weeks or more?” We do not know how successful it was. The campaign has a role to play, and those who have had a cough for more than three weeks might well have a problem. We do not know how many people went to see their doctor and, as a result, have been made aware of problems. That is perhaps a different opinion from that expressed by the hon. Gentleman.

[John Pugh]

I said that all those things need to be reviewed in the light of evidence, that there were good campaigns and bad campaigns, and that evidence decided which category they fell into.

--- Later in debate ---

[Jim Shannon]

The facts will be the number of those who take up the campaign and see their doctors, perhaps ending up with the diagnosis of a problem.

I have read different consultation responses and have seen how different cancer organisations respond. All have been positive that, to improve patient experience outcomes, it will be important for patient experience to be measured and bettered throughout the entire patient pathway. Bowel Cancer UK points out that it is important that patient conditions are not ignored by an overarching patient experience indicator. For example, the overall patient experience reported by patients at a particular provider is likely to be less relevant than the specific experience reported by patients with the same condition. Thus, bowel cancer patients should be consulted about their treatment and given the necessary support and tools to make informed decisions about their care.

I will quickly outline seven suggestions that might lead to improvements in patient experience and care. Steps need to be taken to ensure continuity of care throughout the patient pathway. Key workers and clinical nurse specialists should play a central co-ordination role to achieve that—their involvement is critical. The meaningful data on service performance should be provided, to allow commissioners to make informed choices on the services that they commission and to inform patients about the services that they might wish to access.

Sometimes it is about knowledge and patients’ understanding of how the system can work to their advantage. Tailored patient information should be provided to guide patients through their care, in the form of information prescriptions; that should also include support to self-care, because that is sometimes the best way to deal with their problems and medical condition.

Symptom management should be offered to ensure that patients have the knowledge and tools to look after themselves when they can, but also so that they know when they need specialist support. In other words, when they need to call on the specialist support, they should have the chance to do that.

Patients should be given access to treatments in the most appropriate location for them, whether surgery, radiotherapy or chemotherapy—again, knowing the full choice.

Patients should be offered signposting and support to help them return to work, as well as ongoing support to manage continuing symptoms and the side effects of treatment. We might not always see such things directly, but they are important: trauma, the effect on the patient and their families, the financial implications and knowing about rights to benefits to get through that period, such as an application for disability living allowance.

Palliative care pathways should be considered alongside active treatment and not simply at the end of life. For many of us, palliative care is end-of-life care, but it has another role as well.

Lastly, the end-of-life care strategy should be rapidly implemented. Those seven suggestions are a method for the health system to address the care needed for those who have cancer.

I shall make a quick plug for those who do the experimentation and whose task is to find new drugs, which the hon. Member for Southport mentioned in relation to pancreatic cancer care. Queen’s university Belfast is at the forefront of experimentation in the investigation of new drugs—renowned the world over—and I commend the people there for what they do, and what many others do, because we cannot do without that experimentation to find the new drugs. Nearly every other month a new drug is announced—okay, there might yet be three or four years of experimentation and investigation, but the work of the researchers is tremendous and I commend them for it.

All the responses have been noted and the document that the Minister released is precise, yet more than a year later some feel that we have not moved forward as much as we should have done. Are we achieving better patient-focused care and outcomes? I am not so sure about whether that has been achieved, but the Minister will indicate where we are. That is why I am particularly thankful for the opportunity to debate the issue here in Westminster Hall. We do not need pretty words in a document—if I may use that terminology, and not facetiously—we need action. The Minister must turn all the words into action, and that is why I support the hon. Member for Southport and thank him for bringing the matter before the Chamber today.

Mental Health

Jim Shannon Excerpts

Thursday 14th June 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I am privileged to be in the Chamber to hear some of the speeches that have been made, including those by the hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones). It is a great privilege to hear what they said. I congratulate the hon. Member for Loughborough (Nicky Morgan) on raising the matter in the Chamber. She said that everyone has mental health issues; I suppose it is a matter of how they deal with that and control it. We all have a breaking point. I hope that I never reach that breaking point, and that others do not do so either.

As an elected representative, in my interaction with constituents in my office, I see very clearly how people deal with depression. As the hon. Member for Strangford, I wish to express views on behalf of my constituents, ever mindful of the fact that health in Northern Ireland is a devolved matter. However, the debate is on mental health generally, so the issues in Northern Ireland are every bit as relevant as those in Broxbourne, North Durham, Loughborough and anywhere else in the United Kingdom. Every day I deal with those issues, whether through employment and support allowance appeals or disability living allowance appeals, or by interacting with people and the way in which they deal with their benefits.

An issue that has been highlighted in the Chamber is the difficulties that can arise. That was an issue before the economic downturn, but it is a bigger issue today, because people find it harder to deal with the economic and financial realities that face them, which compounds their problems. In all honesty, over the past year or 18 months, I have seen greater need in people who suffer from depression, as they have had to deal with issues with which they have never had to deal before. We have debated many great issues in the Chamber in the two years in which I have been an MP, but this issue is certainly one of the most important.

I want to deal with two issues. I want to talk about mental health from the perspective of Northern Ireland, and I also want to touch on an issue the hon. Member for Loughborough mentioned when she talked about the armed forces. There are problems for our soldiers and service personnel returning from the battlefield, whether Afghanistan or Iraq, because their memories of those conflicts do not finish when they get off the plane or boat after returning home; they are still with them many years after the conflict. I feel strongly about that for those who returned from both Iraq and Afghanistan.

Good mental health should be a priority for us all, as every Member who has spoken so far has indicated. In Northern Ireland we have also made it a priority. However, Northern Ireland—I say this with respect—has been underfunded for many years, owing to direct Government reasons and others. The figures show that mental health is a greater issue in Northern Ireland than it is in other parts of the United Kingdom. People would say that that is perhaps because of the 30 years of the troubles, which I think is probably true. When someone is under pressure or stress and worried about whether they will live or die, they turn to drink, drugs or other things, and that affects their lifestyle. Ultimately, a great many people in Northern Ireland suffer from depression and mental health issues because of our country’s past. I am glad to say that we have moved on. We now have a partnership Government and we are working together to ensure that there is a future for everyone, and that in the future there is a lessened threat of terrorism.

The British Medical Association in Northern Ireland has done significant research on mental health there. When the hon. Member for Loughborough introduced the debate she mentioned a number of the points that are also in the BMA’s report, so I could not help but wonder whether she had perhaps seen the same report. It contained a number of points that she referred to and commented on. I think that the reason those points are so similar to what she said is that the same issues are just as relevant in Northern Ireland as they are in Loughborough and the rest of the United Kingdom.

I would like to touch on how we can improve the situation. I know that the Minister will have a detailed and helpful response to the debate. To start with, it is a taboo subject. I think that the Government and policy makers must strive to ensure that the stigma, which Members have talked about, and the clear discrimination and fear that surround mental health are eliminated or addressed by focusing on promotion, education, prevention and early intervention. Those are the four headlines the BMA puts forward in its suggestions. There is clearly a work force planning problem that, in some occasions, occurs simply because of reductions in staffing levels. There are a number of things we need to do, and perhaps the Minister, when he responds, can tell us how the issue of mental health will work within the staffing restrictions and assure us that that concern will be taken on board.

The Northern Ireland Executive’s programme for government made a commitment to work for a healthier people and identified mental health as a priority. It also set out targets to try to address the issues. The person who suffers from mental health problems is only part of the problem. When a constituent with mental health problems comes to my office, as they do to the offices of other Members, there is not just one person sitting in a chair in front of me, because they are usually accompanied by someone else; there is a family circle, children, mums and dads and everyone involved. While one person might suffer from mental health problems, half a dozen people could be affected by the ripples.

I am also concerned about teenagers who suffer from depression. Between 10% and 20% of our teenagers will suffer from depression at some point in that short period of their life. I believe that there has to be recognition of mental illnesses, notably depression, and it means that we need to look beyond good mental health and at preventing mental health problems and ensuring early intervention. Many personal issues affect mental health, including drink, drugs, working conditions, homelessness, poverty, unemployment and risk-taking behaviour, whether smoking or unsafe sex, and those issues affect many of the people who come to my office with these problems.

Let us address these problems first by strengthening individuals, by addressing emotional resilience and by promoting self-esteem, life skills, coping skills and communication skills. We also have to strengthen communities. Those are the issues I feel are important. That means addressing the issue of social inclusion, improving neighbourhood environments, which make a difference. In relation to teenagers, we also have to try to address the anti-bullying strategies in schools. Those are important because bullying is one of the things that lead to young people having these depression issues.

We also have to reduce the structural barriers to mental health, which means access to education and meaningful employment. I know that that everyone will agree with that, but at the end of the day we need to have a strategy in place to address mental health issues, and that is what we are seeking to do through this debate. We all agree that there is absolutely no doubt that we all support the issue and the vulnerable people affected, people who we meet every day and who need real help.

Suicide in the community is a great worry for us all as elected representatives. Every one of us will have dealt with families, with people whom we know personally or with people from families that we know personally who have lost loved ones—who took their own lives because they felt that there was no way forward. They were coming off the back of terrible depression or terrible pressure, and did not know where they could go next.

[Mr Kevan Jones]

We have been talking about the voluntary sector, and in my constituency there is a very good organisation, which also came about as a result of a personal tragedy for the individual—a woman called Shirley Smith, who runs If U Care Share. Her 19-year-old son died, and it is about young people and talking about those issues. She goes into schools, youth groups and football clubs to do so. Does the hon. Gentleman think we should have a national strategy on that to ensure that it is part of the curriculum as well?

[Jim Shannon]

Yes, I do. When a constituent of mine died in a car accident on a Sunday night, I went to her house on the Monday night, and her father just wanted to speak and to talk about his daughter. That is the issue. On many occasions, it is just a matter of having someone to talk to, someone who can lend a sympathetic ear when it is needed most, so I wholeheartedly agree with the hon. Gentleman on that matter.

Back in 2005, the then Secretary of State for Northern Ireland, who had some responsibility for health, the right hon. Member for St Helens South and Whiston (Mr Woodward), set up a task force to develop a suicide prevention strategy for Northern Ireland. It is paying some dividends in relation to a decrease in the number of suicides, but the number is still at a very high level.

Other Members have touched on dementia and Alzheimer’s, and after wearing my hat as a councillor for 26 years and as an Assembly Member for 12 years, before being privileged to enter this House, I must note that the number of people with Alzheimer’s and dementia is greater today than ever before. I do not know the reasons why, but they are real, the statistics prove it and we have an issue there as well.

On employment support allowance appeals, the hon. Gentleman made an interesting point about those who have mental health issues, because when they go to an ESA appeal the issue is clearly not a physical one, because physically they can walk about, move their hands, brush their hair—if they have any, unlike me—or put a hat on their head. They are asked whether they can do those things, but those are not the questions that a person with mental illness needs to answer. They need to answer the questions, “Are you moody?”, “Do you fall out with people?”, “Are you aggressive?”, “How do you cope with difficult situations?”, “Do you start a task that you cannot finish?” Those are the questions for a person who is depressed, and I agree with the hon. Gentleman, because the appeals panel—the chair and those who deal with such tribunals—need to understand those issues better, so that an appeal can be presented in a way that people understand.

It has been stated that everyone has mental health issues. No one is immune, and although stress is greater among the poor and the unemployed it applies throughout society. Good mental health is crucial to the overall well-being of an individual, of societies and of countries.

In Northern Ireland there are about 150 suicides each year: 41% are single males, and 22% are males between 25 and 34-years old. Some 50% of suicides in the UK involve psychiatric patients, and one reason is a loss of contact; in that context I want to talk about soldiers, about a loss of contact by the health service and about treatment non-compliance, whereby people do not take the medication that doctors give them.

Figures for the United Kingdom as a whole indicate that depression accounts for about 60% of the country’s main health problems, alcoholism about 10%, Alzheimer’s about 8% and severe stress about 6%. That leads me on to that second issue, which is to do with our soldiers.

The week before last I had the opportunity to go to Cyprus with the armed forces parliamentary scheme. Some MPs in the Chamber will be members of that great scheme, some will be aware of it and some will have been members in the past. We have an opportunity to meet soldiers and to hear about strategic issues so that we can present them to the House in an informed and knowledgeable way.

When we were in Cyprus two weeks ago, we noted its importance from an Army and a strategic point of view, but we had not realised that it is halfway to Camp Bastion in Afghanistan. There is a new scheme in Cyprus whereby soldiers returning home from Afghanistan come through a so-called decompression centre in Akrotiri; last year 30,000 did so. They call it decompression because it helps them to unwind after what they have experienced in Afghanistan over the previous few months. The sun is usually shining, which makes a big difference. They have a chance to shower, to have their kit completely dry-cleaned, and to have a good meal. They have access to mobile phones, and they are able to speak to their doctor, padre or commanding officer. They have a chance to get back into normal life—to step down and get themselves ready to go back home to their family. The work done for our soldiers in the Akrotiri centre, which cost £4.5 million to build, gets them ready for life back home.

Those soldiers have seen in Afghanistan the most horrific things that we cannot begin to visualise. They have seen friends and colleagues killed or injured, some with life-changing injuries. We know of those people because we have met some of them, and we are humbled when we do so. The bullets and the bombs are intermingled with the stress, the trauma, the bad memories and the nightmares—those are all part of the things they have to face long after they leave the Army. While the Army, the Royal Navy and the Royal Air Force look after their personnel, the forces associations do likewise. We recognised from our time in Akrotiri, as we have in our constituencies, that once soldiers are out of the Army they are often distanced from those associations too. The Royal British Legion might not always be at hand for them. They might have no friends or their marriage might have split up. They might turn to drink and drugs, but that will give only temporary relief and they are still on their own. I am mindful that defence is not the Minister’s portfolio, but I hope that when he replies he will consider the welfare of our soldiers who have returned from Afghanistan, who are not in the forces any more because they have left or retired, and are now apart from the ritual and discipline that they were once very much part of.

Every one of us will be aware of constituents who have lost control because of the memories and nightmares of what they have seen. Whenever the memories flood back and the flashbacks reappear, they relive what they have come through, and then they face their demons alone. We need to face up to this issue confronting those who have served, and are serving, in the Army, the Navy and the Air Force. The health service needs to address it UK-wide, in England, Wales, Scotland and Northern Ireland. The plight of our soldiers should be a priority for this Government, as I know that it will be. I commend the motion to the House and hope that Members will support it.

Pancreatic Cancer

Jim Shannon Excerpts

Wednesday 23rd May 2012 Westminster Hall

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Eric Ollerenshaw]

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

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

NHS (Foreign Nationals)

Jim Shannon Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

and that freedom of information requests showed that

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

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

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

Those are worrying figures. The article continued:

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

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

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

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

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

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

I hope that that will be the case.

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

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

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

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

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

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

--- Later in debate ---

[Anne Milton]

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

[Jim Shannon]

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

[Anne Milton]

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

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

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

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

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

Rare Disease Strategy

Jim Shannon Excerpts

Monday 30th April 2012 Commons Chamber

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

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

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

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

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

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

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

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

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

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

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

affecting fewer than one in 2,000 people—

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Mr Timpson]

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

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

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

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

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

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

Selective Dorsal Rhizotomy

Jim Shannon Excerpts

Wednesday 18th April 2012 Commons Chamber

[Chris Heaton-Harris]

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

To return to the diary:

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

The next point is very important:

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

[Jim Shannon (Strangford) (DUP)]

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

[Chris Heaton-Harris]

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

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

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

Mental Health Care (Hampshire)

Jim Shannon Excerpts

Wednesday 18th April 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

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

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

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

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

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

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

[Dr Lewis]

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

[Jim Shannon]

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

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

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

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

Cigarette Packaging

Jim Shannon Excerpts

Tuesday 17th April 2012 Commons Chamber

[Mr Robinson]

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

[Jim Shannon (Strangford) (DUP)]

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

[Mr Robinson]

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

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Burns]

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

[Jim Shannon (Strangford) (DUP)]

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

[Mr Burns]

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

Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 20th March 2012 Commons Chamber

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

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

“provide or secure the effective provision”

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

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

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

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

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

[Jim Shannon (Strangford) (DUP)]

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

[Grahame M. Morris]

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

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

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

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

“have regard to the desirability of securing”

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

--- Later in debate ---

[Paul Burstow]

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

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

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

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

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

[Jim Shannon]

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

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

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

[Paul Burstow]

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

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

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

“to provide goods and services for the purposes”

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

--- Later in debate ---

[Stephen Pound]

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

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

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

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

[Jim Shannon]

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

[Stephen Pound]

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

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