Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 13th March 2012 Commons Chamber

[John Healey]

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

[Jim Shannon (Strangford) (DUP)]

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

[John Healey]

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

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

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

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

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

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

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[Rushanara Ali]

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

[Jim Shannon]

Will the hon. Lady give way?

[Rushanara Ali]

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

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

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

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

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

--- Later in debate ---

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

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

[Jim Shannon]

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

Health and Social Care Bill

Jim Shannon Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

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

[Jim Shannon (Strangford) (DUP)]

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

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

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

[Mr Lansley]

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

NHS Risk Register

Jim Shannon Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

As a Northern Ireland MP, I will give a Northern Irish perspective. The need for the publication of the risk register is clear in my mind and in the minds of my constituents. My constituents tell me that they have concerns over the reform of the NHS and how it will affect them. It is therefore important for the risk register to be made public.

When one inquires into what a risk register entails, one is pointed to the guidance in the NHS paper, “Making it Happen: A Guide for Risk Managers on How to Populate a Risk Register”. A telling paragraph states:

“Managing risk effectively and embedding internal control into the processes by which objectives are pursued is extremely important for the NHS. The external driver in the form of a Statement on Internal Control, places a public disclosure obligation on individual boards of directors. That responsibility includes ensuring that the system of internal control is effective in managing risks. The production of a ‘live’ Risk Register is considered to be an integral element of good risk management practice by the Controls Assurance Team and NHS Litigation Authority and is a key feature of the Australian/New Zealand Risk Management Standard. It is hoped that this document will help NHS organisations progress this agenda.”

What has changed in that need to ensure that good risk management practice is carried out by the NHS for the benefit of the organisation? Why is this risk register not being published so that front-line NHS workers can understand the risks and give their input?

I want to give an ordinary perspective on this matter. One of the major hospitals in Northern Ireland, the Ulster hospital, is on the border of my constituency. Its catchment area includes some 200,000 potential patients. It is a fantastic hospital with friendly and helpful staff, from the porters up to the consultants. I have been in contact with a large number of its staff who have concerns over this matter. They are clamouring for openness and transparency. People from my constituency work in that hospital every day in their various roles. They want to ensure that they are part of any decision-making process, because they know that their experience and expertise should be considered in any debate. They are not being given such an opportunity at this time.

I and many Members on the Opposition Benches—and, I suspect, some Government Members—believe that there must be transparency so that people know whether the savings are worth the risk. Our health service is a priority. For many people it literally means the difference between life and death. It is essential that those on the front-line of the service are aware in advance of what the changes could bring so that they can prepare for them.

I have been contacted by the British Medical Association and many other bodies that have asked me to speak on their behalf and on the behalf of doctors, midwives and staff in the NHS. The letter from the BMA, which I am sure all Members have received, bears repeating:

“Health professionals are already seeing fairly chaotic and complex implementation of the reforms ‘on the ground’ which has already begun within the NHS. The challenges and potential risks identified with this process should be contained within the register. Furthermore, the staff currently trying to balance the implementation of the reforms with the drive to find £20 billion of efficiency would benefit greatly from the Government’s view of the risks associated with this difficult twin challenge.”

That must be put on the record in this House, as it has been by many Members today, to bring clarity on this matter. The opinions of those who are working on the ground must at least be considered, but they cannot give a full opinion without possessing the full facts.

I am not someone who believes that every aspect of public service should be disclosed. Defence matters clearly should not be disclosed, because it would put the lives of soldiers at risk. As a Northern Ireland MP, I know that from the time of the troubles up to the present day, there have been security matters that cannot be disclosed and that should be kept secret. However, it is my opinion that the reverse could happen if we do not release the risk register. I believe that not releasing it could cause danger and harm. I therefore support the disclosure of the risk register.

The NHS, although far from perfect, is something that we can have pride in because of the dedication of those who work in our hospitals: the doctors who take on extra shifts to ensure that every patient has access to care, the nurses who stay for an extra 10 minutes or more to finish changing people’s dressings, the auxiliary workers who ensure that the elderly patients eat all of their dinner, the porters who transport patients slowly enough so that they are not hurt, and the cleaning staff who work later than necessary to ensure that the wards are clean. Those people are part of the NHS, have knowledge of the NHS and have an interest in the NHS. My constituents tell me that they want the publication of the NHS risk register. I urge Members to consider that very carefully. The publication of the risk register is a single issue. I ask Members to support it tonight.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 21st February 2012 Commons Chamber

[Paul Burstow]

I am grateful to my hon. Friend. Training is certainly one of the issues highlighted by the audit. We are taking a number of steps. We are working with the Royal College of Nursing, which has developed an online dementia information resource; we have been working with Skills for Care and Skills for Health to provide a series of training workshops for staff; we have been working with Oxford Deanery to trial a new approach to dementia education and training for GPs; and we are funding another audit to make sure that we keep track of the improvements that we expect to see across the NHS.

[Jim Shannon (Strangford) (DUP)]

What discussions has the Minister had with universities such as Queen’s university in Belfast with regard to new treatments and medication for those suffering from dementia, and when will those advances filter through to patients?

[Paul Burstow]

I have not had such conversations with the university to which the hon. Gentleman refers. However, this Government, right from their first Budget, have indicated their commitment to prioritising research into dementia—both the basic research that gives us the targets for detailed research and the translational research. We have put in place all the building blocks that will allow this country not only to maintain its pre-eminence but to accelerate the pace of research.

Stereotactic Body Radiotherapy

Jim Shannon Excerpts

Wednesday 8th February 2012 Commons Chamber

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

I pay tribute to and congratulate the hon. Member for Wells (Tessa Munt) on securing this important debate. I want to put on the record the appreciation of myself and the whole House for the work that she has done in this important area.

Last August, the Department of Health released the first ever England-wide analysis of patient access to radiotherapy treatment. For those of us who represent constituencies outside London and the south-east, the results were shocking. The disparity in treatment levels for cancer patients living in and around London, compared with the rest of the country, is nothing short of disgraceful. Access to advanced radiotherapy should not be a postcode lottery. The data on each of England’s 28 cancer networks show that the further someone moves away from London, the smaller their chance is of receiving radiotherapy. North-west London tops the list, with radiotherapy provision at 94%, whereas the north-east—my region—came last, at 27%. In fact, the bottom five networks were all north of the River Trent.

[Jim Shannon (Strangford) (DUP)]

The benefits of SBRT are well proven in many cases and clear in numerous cases. Does the hon. Gentleman agree that it should be available more extensively across the whole of the NHS, and that it is time for the Minister to work alongside the devolved Administrations to ensure that the treatment is available for patients in Northern Ireland, as well as other parts of the United Kingdom?

[Grahame M. Morris]

Absolutely. I thank the hon. Gentleman for that intervention, and I agree completely. All 28 cancer networks should have equal access to this advanced radiotherapy.

In practical terms, cancer patients in the Minister’s London constituency are three times more likely to receive the radiotherapy treatment that they need than those residing in northern England and twice as likely as those living in the south-west of England. Believe it or not, however, when the general radiotherapy dataset is analysed further—by that I mean looking at radiotherapy centres offering conventional radiotherapy and those offering the more effective SBRT—the picture is far worse.

The conventional method of radiotherapy delivery is unable to distinguish between healthy and unhealthy tissue, so the treatment is delivered in short doses—often every day for four or five weeks—to avoid too much damage to the healthy tissue. As the hon. Member for Wells said, SBRT uses small, multiple and highly focused beams of energy to deliver radiation directly to the tumour, ensuring that a minimal dose is received by the surrounding healthy tissue. Consequently, there are little or no treatment-related side effects. SBRT allows the patient to be treated over five days, as opposed to five weeks, as with conventional radiotherapy. Because of its accuracy, SBRT can be used to treat tumours that might be surgically inaccessible or in close proximity to critical organs of the body, such as the heart.

When we look at the postcode lottery that the dataset report presents, we should also ask where SBRT is available and where it is not. The Minister must understand how important the comparison is. For cancer patients in my constituency, the difference between having access to SBRT and having access to conventional radiotherapy—for prostate cancer, for example—is a 50-mile car journey every day for five weeks and the treatment lasting just five days, with a rapid return to normal life. As well as the benefits to the individual, the cost savings to the NHS of using SBRT compared with conventional radiotherapy are obvious for all to see.

Like the hon. Lady, I, too, was approached, just before Christmas, by a constituent whose cancer needed SBRT. His tumour could be treated only using the accuracy of the robotic CyberKnife system, but there are only three CyberKnife systems in the NHS, and they are all in London. However, thanks to the incredible co-operation of my constituents’ clinicians and the clinicians from St Bartholomew’s hospital in London, as well as the understanding of County Durham PCT—the commissioners, who, in a timely fashion, agreed funding —he starts his treatment here in London in two weeks. My constituent is very happy that he is set to receive the treatment in an NHS hospital, but is it not a scandal that he has to travel more than 260 miles to do so? What is equally scandalous is that the reason why there are only three CyberKnife systems in NHS hospitals is that those hospitals needed to raise the money to purchase them from charitable donations. I have since learned that in Birmingham, as well as in Newcastle, in my region, the Bear appeal is seeking to raise the money for a CyberKnife system from charitable sources.

What an indictment of the NHS under this coalition government! The NHS should not have to go begging for charitable funds to buy the latest life-saving equipment, especially when we know that the Department of Health is currently holding back £300 million in capital allocations, in Whitehall coffers. This resource is for capital equipment, but is not given to the hospitals in regions like the north-east where it is most needed. If the Minister is serious about reducing health inequalities in the north-east, and, indeed, in the south-west, we should have this equipment and not be left to linger at the bottom of the radiotherapy dataset, which the Minister himself said is the benchmark for future provision. I ask the Minister to make a commitment to investing some of this £300 million in the capital equipment needed to reduce these disparities in the provision of radiotherapy in general and SBRT in particular.

Haemophilia

Jim Shannon Excerpts

Wednesday 8th February 2012 Westminster Hall

[Diana Johnson (Kingston upon Hull North) (Lab)]

I am delighted to serve under you today, Mr Weir, and I am pleased to have secured this debate on an issue that I know is of interest to a number of Members from all parties. I pay tribute to the Minister present, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), who has taken a keen interest in this area, and with whom I have had a number of meetings. I am a little disappointed that the debate is a short one and that I can give only the headline figures. There are many issues to raise, but I will try to concentrate on just a few.

I pay tribute to my constituent, Glenn Wilkinson, and to his family, who first came to see me in 2010 to tell me their story, and to raise the scandal of how he and thousands of others had received contaminated blood products as part of their treatment as haemophiliacs. There are two main parts to what I want to say today: the first is on the ongoing treatment for haemophiliacs, and the second is on the care, support and treatment offered to people who have contracted viruses such as HIV and hepatitis C through NHS treatment for haemophilia. I also want to pay tribute to the work, over many years, of the Haemophilia Society, and of campaign groups such as TaintedBlood and the Manor House Group, and also to the work of the Newcastle initiative, which was born out of a multidisciplinary workshop on haemophilia care held in the city in autumn 2010.

Turning first to treatment, I want to concentrate on the need to ensure that the care and treatment of people affected by bleeding disorders is addressed in the NHS reforms that are currently before Parliament. The haemophilia community has been the subject of what Lord Winston described in his evidence to the Archer inquiry as the

“worst treatment disaster in the history of the NHS”.

There has been much progress in haemophilia treatment over the past decade, but it is now under threat, as is much else, from the Health and Social Care Bill, and I will go on to explain why. Standards of care vary considerably around the country, and there is the risk that the new commissioning arrangements for specialist services will result in a levelling down, rather than up, in haemophilia care.

Haemophilia services are currently commissioned by 10 regional specialist commissioning groups, with funds pooled from their constituent primary care trusts. The Department of Health has also injected extra funding for haemophilia care, which rose to £88 million per annum between 2003 and 2006, to finance the provision to all patients of recombinant rather than plasma-derived clotting factors. That money remains important to the quality of care, but has more recently been absorbed into PCTs’ baseline budgets, and I seek reassurance from the Minister that the money will still be available for haemophilia care post the NHS reforms. I understand that from April 2013 specialist services will become the responsibility of the NHS Commissioning Board rather than of the 10 specialist commissioning groups. That could mean that best practice is spread across England, but equally, there is the danger that under financial pressure standards will be levelled down.

I also want to raise with the Minister the question of where responsibility for haemophilia policy will sit. Because of the contaminated blood scandal, the Department of Health has taken a leading role in the development of that policy, and it is unclear whether after the passage of the Health and Social Care Bill that role will be maintained, or all responsibility will pass to the NHS Commissioning Board. It would help if the Minister could set out her understanding of where that responsibility will sit. Also, will the twice-yearly liaison meetings between the Department and the Haemophilia Society continue? Those meetings were established in direct response to the Archer inquiry’s recommendation that a statutory committee be established to advise the Government on clinical, financial and other provisions for people with haemophilia. There is also a call for a new national policy statement on haemophilia care to replace health service guidance (93) 30, which is now nearly 20 years old and no longer reflects best practice. Can the Minister confirm that that will happen at this stage?

Does the Minister agree with the need to support the development of robust haemophilia networks to combine the best of local care with access to tertiary expertise 24 hours a day? For example, in a recent survey by the Haemophilia Society, only 15% of respondents were aware of having been offered a care plan. In both the report of that survey, entitled “Fit for the Future: Haemophilia Services in the New NHS”, and in the Newcastle initiative’s paper, “Learning from the past to inform the future”, it was found that standards of treatment and care were generally high, which is very encouraging, but that access to the provision of associated services, including dentistry, physiotherapy and psychological support, required significant improvement. The reports also concluded that patients must be given a comprehensive care plan, that they must be able to access home treatment, and that they must be involved in all decisions about all their treatment. Those goals are partially but not consistently met under the current system, and we would, of course, like to see consistency across the whole country.

All Governments have said that lessons about treatment have been learnt from the contaminated blood scandal and that there is a need to maintain the highest standards of care so to avoid any repetition of it.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall. Is she concerned about the level of support given to haemophiliacs who have received blood contaminated with HIV or hepatitis C? Should an additional level of care and assistance be given to those who suffer through no fault of their own but because of the blood?

[Diana Johnson]

I will come on to deal with the financial support that is available to individuals who have had contaminated blood products and now have HIV or hepatitis C, because that is an important issue.

To finish this first section on the treatment of haemophilia, may I ask the Minister to confirm that there should be continued research, for example into sterilisation in areas with a high risk of variant Creutzfeldt-Jakob disease contamination, in order to support the need to ensure that a contaminated blood scandal never happens again?

The second part of my speech relates to contaminated blood. In recent months, along with many other Members of Parliament, I have been raising the issue of care and support offered to victims of the NHS contaminated blood scandal, as it has come to be known over the past 30 years. My constituent Glenn Wilkinson has campaigned tirelessly for proper support for those who have received contaminated blood products as part of treatment for haemophilia or via other medical treatments, such as blood transfusion in childbirth.

This week, Glenn and other campaigners established the contaminated blood campaign. The treatment of people who contracted hepatitis C from NHS-administered blood products has been particularly unfair, and many of those people have, unfortunately, died already. The campaign set up by Glenn is also fighting for an independent public inquiry on the same lines as the report in Ireland and the Scottish Penrose inquiry, which I believe is due to conclude shortly.

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[Diana Johnson]

My right hon. Friend makes a powerful point about trust and the need for us all to work together to ensure that those people do not suffer further, and that they get the compensation and support they are clearly due.

I want to concentrate on hepatitis C sufferers for a minute. I believe that they will be unfairly penalised by the Government’s plans in the Welfare Reform Bill. In a debate in October 2010, I asked the Minister whether it would be possible for people with hepatitis C and HIV to be passported on to the new system. The Haemophilia Society has also asked about people with fluctuating medical conditions, such as bleeding disorders, particularly those with viral infections from contaminated blood products. People suffering from fluctuating medical conditions such as haemophilia, HIV and hepatitis C tend to have good days and bad days.

The Haemophilia Society recommends that the work capability assessment be suspended for people with fluctuating conditions until Professor Harrington has considered the representations of the Disability Benefits Consortium. Many people living with hepatitis C in particular have been placed in the work-related activity group of the new employment and support allowance, rather than in the support group, where benefits will continue indefinitely. That has two consequences: it means that sufferers will have to have annual assessments, and that, after 12 months, their benefits will become means-tested. That is effectively penalising people for prudent behaviour and hard work while they were well enough to be employed.

People diagnosed with hepatitis C know that they are unlikely to be able to continue working until normal retirement age. Furthermore, people must currently wait up to 11 months for a tribunal appeal. It is to be noted that appeals for hepatitis C sufferers have a particularly high success rate. Automatically moving contaminated blood product victims into the support group would save patients stress and the Government money.

[Jim Shannon]

I thank the hon. Lady for her graciousness in giving way. Many haemophiliacs have suffered from poverty and discrimination because of contaminated blood. Does she not feel for that reason that the Government must urgently address those still suffering from such maladies?

Alcohol Strategy

Jim Shannon Excerpts

Tuesday 7th February 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing the debate. For me and my constituents—as I suspect it is for many in the Chamber—this issue is probably the biggest problem in our area. I deal with related issues concerning community safety every day. I rise to give the perspective from Northern Ireland and to outline the critical and crucial programme that we have to ensure that issues caused by alcohol are addressed.

In Northern Ireland, on 1 March 2010, there were 5,846 individuals in treatment for drug and/or alcohol abuse—a very high number. More than 50% were in treatment for alcohol misuse, some 22% for drug misuse and a fifth of those for both. Approximately 75% were male, 27% female. Although it is predominantly a male problem, clearly a large proportion of females are involved. The hon. Member for Walsall South (Valerie Vaz) said that it is terrible to see young people drunk. It is always particularly upsetting to see young ladies and girls drunk and we certainly have to consider that. The last figures available show that the number of people receiving treatment increased by 5% in just one year, from 5,583 to 5,846—some 500 extra on that list, which again, unfortunately, is an upward-moving figure which we are concerned about.

There are some 1.5 million victims of alcohol-fuelled violence in the UK as a whole. Community safety is threatened by the misuse of alcohol. We have to deal with that. The police superintendents have outlined and advised that alcohol is present in half of all crimes. That worries me and I suspect that it worries all hon. Members here. It also shows that a high proportion of victims of violent crime are under the influence of alcohol at the time of the assault. So alcohol runs, almost like blood itself, through all the violence and the problems.

Some 37% of offenders had a current problem with alcohol use; 37% had a problem with binge drinking; 47% had misused alcohol in the past; and in 32% violent behaviour was related to their alcohol use. As other hon. Members have mentioned, drinking starts slowly with small indulgence and increases, with peer pressure involved, then there is binge drinking and then misuse of alcohol, with the violence that comes off the back of that.

I want to focus on young people, who need to learn at an early age to drink responsibly when they are of an age to do so at 18. In Northern Ireland, the average age for young people to have their first drink is 11. When I read that I said, “My goodness me, that’s shocking.” I am aware, as an elected representative, of people who started with one drink, perhaps when their marital relationship broke down, and drank whenever there was alcohol in the house and whenever there was peer pressure. I fought a case for a liver transplant for a young boy who started drinking at the age that I mentioned and at 17 or 18 he found himself a candidate for a liver transplant. If such facts do not shock people to their core, they should. It certainly shocks me.

[John Glen (Salisbury) (Con)]

Throughout society there are different instances of alcohol misuse. In the armed forces, in the under-35 age group, alcohol misuse among men is more than double that in the normal population. Does the hon. Gentleman not think that that underscores the fact that a Government approach must recognise pressures in all different elements of society and the different phases at which interventions need to take place?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I agree wholeheartedly and I think that all other hon. Members do. There are different levels. I was developing a point about young people, but there is a drink culture in the armed forces as well. Perhaps that is to do with the job that they do or the time that they spend together. Government has to address those issues.

Around a quarter of 11 to 16-year-olds in Northern Ireland drink regularly and around one in eight have been drunk more than 10 times. One third of 11 to 16-year-olds who have tried alcohol have bought it from a pub, off-licence or shop. There is an issue there for the police in enforcement and for local councils, where the power lies, to monitor and control what happens. There is also a strong link between starting to drink at a young age and problematic alcohol use in later life. A shocking statistic is that one in four young people claim to have been drunk 20 times in the span of a month. The number of 15 to 16-year-olds who binge-drink in Northern Ireland is one of the highest in Europe.

Alcohol use among young people is of particular concern, as they are more vulnerable than adults to suffering physical, emotional and social harm from their own and other people’s drinking. The hon. Member for Totnes mentioned what emerges as a result of that. Drinking leads to a high risk of unsafe sexual behaviour, traffic and other accidents, unintended pregnancies, failure at school and mental health problems, antisocial behaviour, vandalism and violence. This is a serious issue and is not a matter of kids being kids: it goes a lot deeper and the problems caused are a lot longer-lasting and have a great impact on our community as a whole. We have to take on the big issues.

I work in my constituency with many community and residents’ associations that are determined to stamp out abuse in their areas. There are many ways of doing that, including through education programmes for children. A group called the forum for action on substance abuse works hard with young people; it takes on the hard issues, gets the community and young people involved and ensures that a safer option is available for kids, other than standing at street corners being pressured into trying drink or drugs.

Community groups in my area are working hard to do what they can to end the vicious circle of alcoholism and drug use. Yet they cannot do it themselves; they need Government help and educational, health and police strategies as well. There needs to be a system in place that lends support and advice and co-ordinates events and information to ensure that people are informed.

A recent survey carried out by a church group in Newtownards in my constituency found that under-age drinking was a major issue that led to people feeling unsafe in their neighbourhood. The abuse of alcohol leads to side effects being felt by other people who are not involved, including not feeling safe. The fact is that problems arise when people are mixed with a large amount of alcohol. When young people, who have not yet had the time to develop their moral standards and ideals, are mixed with alcohol we get a generation fuelled by a desire to live in the moment without the thought of consequences.

Alcohol changes personalities. When young people are learning who they are, adding alcohol to the mix means that they will never have a good understanding of who they are. That is why it is essential that we put in place a way of combating under-age drinking by ensuring that drink is not available for people under 18.

When wearing my other hat as an Assembly Member, prior to coming to this House, we raised the age on buying cigarettes—that has been implemented—as it was recognised that upping the age limit would make it easier for retailers to demand identification. It is time that we enforced the same rigour and control with regard to alcohol. It is time for the Government strategy to take on board the involvement of councils and all the other bodies, which is important. We need to take on the issue of sales venues, including off-licences and pubs. We must increase police activity and police the councils in their monitoring pubs and off-licences.

We also have to say something about parental control that perhaps has not been said yet: it is neglected many times. Parents do not exercise the control that they should, but they need to do so.

I support increasing the price of alcohol. It is important that we do that. I do not see anything wrong with that. We must ensure that drink promotions do not encourage binge drinking.

[Eric Joyce (Falkirk) (Lab)]

The hon. Gentleman has made a great deal of sense up till now, particularly when mentioning education, but does he not think that minimum pricing is simply aimed at the least well-off? It is all very well for those who are not affected by it, but essentially that policy is aimed at the least well-off, who may continue to spend the same amount on alcohol, or more, because it will be more expensive for them, and spend less elsewhere.

[Jim Shannon]

I thank the hon. Gentleman for his intervention, but we will have to agree to differ. It is important that we increase the price of alcohol, because doing so takes away the ability to binge-drink from those who are clearly involved in it.

[Eric Joyce]

indicated dissent.

[Ms Abbott]

Will the hon. Member for Strangford (Jim Shannon) give way?

[Jim Shannon]

Let me just get this important point on the record. We have to address all the issues. There are different ways of doing so and one is to increase the price of alcohol.

[Ms Abbott]

Does not the hon. Gentleman agree that all the medical and research evidence shows that price is a key factor for two categories of drinker: young drinkers and problem drinkers?

[Jim Shannon]

I thank the hon. Lady for her wise words. That is exactly what we feel is important. We have to take on hard issues and address them early. We need a strategy that reflects an in-built protection for children and adults alike.

I urge that the points of view advanced by the hon. Member for Totnes and other hon. Members be considered and that we adopt a strategy that addresses the issues that plague society today.

Stoma Care

Jim Shannon Excerpts

Wednesday 25th January 2012 Westminster Hall

[Jonathan Evans]

I respect my hon. Friend’s views on many matters and also have only praise for stoma nurses, but that does not take away many of the concerns in relation to sponsorship. Sponsors have a direct interest in the clinical decisions made by nurses, because they are the manufacturers of the products that are being prescribed under the NHS.

If the Secretary of State for Health had proposed the introduction of such an arrangement—the sponsorship of nurses by commercial organisations—as part of his current reforms, we can imagine the outrage it would have produced. “Newsnight” and the “Today” programme would have relentlessly questioned the Minister. We might even have seen a “Panorama” special on the BBC. The reality is that this extraordinary situation started more than 30 years ago and expanded to its current pre-eminence during the years of the previous Government.

The concept was thought up not by the commercial firms themselves, but by the health care trusts, which first approached the manufacturers to explore the commercial opportunities. The Department of Health does not appear to have played any part in the dialogue, not even in terms of establishing a protocol that could reassure the public that commercial sponsorship does not impact upon clinical judgment, just as my hon. Friend the Member for Montgomeryshire (Glyn Davies) has said that he is satisfied that that was not the case in his experience.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman think that it would be acceptable if sponsorship were offered to help the patient or the health board itself?

[Jonathan Evans]

I am not going to propose the end of sponsorship, but we need more robust mechanisms of managing the potential conflicts of interest. I will develop that argument in the limited time available.

The Department of Health appears to take comfort in the professional code of nurses, which states:

“You must ensure that your professional judgement is not influenced by any commercial considerations.”

Surely, we can be sure that that code is being properly observed only if the Department undertakes, at least from time to time, some assessment of the commissioning decisions being made, but it has never done so.

In January 2001, The Guardian drew the practice to wider public attention, reporting that the NHS planned to crack down on these commercial sponsorship deals. The paper claimed that more than half of stoma nurses were funded by commercial deals that were worth— remember that this was a decade ago—up to £100,000 a year to each health trust. The RCN claimed that the manufacturers specified that a minimum percentage of patients had to be fitted with the commercial sponsor’s products.

The previous Government’s response to The Guardian’s revelations was to issue new guidance requiring NHS trusts to review all such arrangements in which suppliers met all or part of the cost of members of staff, discounts on drugs and equipment, or subsidised research and training as a condition of the contract. Nevertheless, Health Ministers maintained that they did not want to prevent collaborative partnerships between the NHS and private contractors—nor do I—but they also said that clinical decisions should always be based on evidence of what was best for the patient. I agree, but how do we know? Again, the Department did not undertake any assessment of its own to reassure itself that that was being done.

By 2003, sufficient concern was being expressed over these commercial deals that the then Government launched the first of what was to be a series of consultations on the arrangements for paying appliance contractors. By 23 January 2006, the Government issued a report on the consultation, noting:

“Specific and frequent mention was made of the issue of sponsored nursing posts in secondary care, with most parties”

—I stress, “most parties”—

“feeling that this practice was inappropriate, and that it should cease.”

The Department of Health’s response to that concern was to ignore it. It maintained its policy of resisting any assessment of impact of commercial sponsorship on commissioning decisions, and that strand of concern was, interestingly, subsequently eliminated from further consultation on these matters by Health Ministers.

In Scotland, the Scottish Executive took a completely different line. The Scottish Government decided that commercial sponsors could no longer directly subsidise specialist nurses in stoma care. The nurses were taken on and paid directly by the NHS. In fact, the British Healthcare Trades Association funded transitional support to the Scottish health boards for two years because of that dramatic financial change. The outcome was also dramatic. Free samples of stoma products were withdrawn from Scottish hospitals by the manufacturers that had always previously provided them, and it is estimated that, over the following five years, the number of specialist stoma nurses in Scotland fell by up to half.

In Scotland, therefore, the policy has been to ban commercial sponsorship—this addresses the concerns expressed by my hon. Friend the Member for Montgomeryshire and the hon. Member for Strangford (Jim Shannon)—with a consequential fall in both the quality and the availability of specialist stoma care to patients. By contrast, the policy of Health Ministers here has been to refuse to undertake any assessment whatsoever of the impact of commercial sponsorship on these arrangements within the rest of the UK.

As I hope I have made clear, I am not arguing for the Government to follow the Scottish policy. Patient groups have made it clear to me—this is endorsed by the words of my hon. Friend the Member for Montgomeryshire—that they recognise that the quality and the availability of stoma care in Scotland has fallen markedly. I want to make it clear that I am not questioning in any way the commitment or the concern of stoma nurses. Again, I can say that patient groups who have briefed me for this debate have made it clear that they deeply value the services that are provided by stoma nurses.

Nevertheless, as I indicated to the hon. Member for Strangford, there are real questions about conflict of interest, which successive Governments, sadly, have ignored. Let me draw an analogy with another sector that we debate a lot in the House: the financial services sector. Today, all financial services companies are required to satisfy the regulator that they have robust processes in place that are fully understood by all staff for managing conflicts of interest. Can we imagine a Minister standing at the Dispatch Box talking about concerns with financial services and saying that he is entirely satisfied there is no need for robust conflict of interest processes because he is satisfied that the professional code of those who work in financial services will always require them to act properly? That is a ludicrous proposition. There is a need for the management of conflicts to be subject to a similarly robust process in terms of stoma care.

In March 2011, Health Ministers were asked by parliamentary colleagues some basic questions to glean information on the number of stoma care nursing posts sponsored in the UK. No helpful response was provided, and the Department had no statistics to share with colleagues. So, for this debate, I have had to turn to the British Healthcare Trades Association for the figures. According to the association, stoma care manufacturers sponsor more than 200 of the 337 departments in England at a cost of £10 million a year. However, some of those manufacturers share the same concerns about commercial sponsorship that I am outlining. They only maintain their sponsorship for fear that other suppliers will otherwise corner the market. Those manufacturers have even expressed their concern to me that the current commercial arrangements might fall foul of the new Bribery Act 2010. Have Ministers undertaken any assessment of that?

On 15 October, I wrote to the Minister and received a response from him on 9 November confirming again that the Department had not made any assessment of the commissioning decisions of PCT employees sponsored by private enterprises. Again, he highlighted the fact that Ministers relied on the code of professional conduct, but he said in his letter that he was satisfied that that was a concern and that he had asked his officials to make further studies into the activity. I hope that the Minister can tell us the outcome of those studies.

The issues that I have raised relate to the maintenance of patient choice in the appliances that are prescribed for stoma care, and the concerns are shared by patients, charities and several manufacturers. Such concerns have been shown to be very well-founded by reports of recent discussions between major manufacturers of stoma care products and PCTs about what has come to be called off-script tendering, which you mentioned in the second part of your comment, Mr Hollobone. What is being proposed is that preferred or single supplier agreements are made between commissioners and manufacturers, in which the commissioning body would get a bulk discount for requiring all patients to take one manufacturer’s products. The arrangements would then bypass the operation of the drug tariff for the provision of such products, which is regularly reviewed on an annual basis by the Department.

Currently, a GP or suitably qualified nurse issues a patient with a prescription—an FP10—and the patient is free to take that to the manufacturer of their choice to have the product dispensed by a pharmacy contractor or an appliance contractor. The drug tariff industry forum considers the advantages of that system to be patient choice, cost and value for money, quality of products and a centralised system working on a local basis. The British Healthcare Trades Association has obtained legal advice that suggests the off-script arrangements being discussed by big manufacturers might be beyond the powers of health trusts. However, the question arises whether such arrangements could be taken forward as part of the Government’s health reform.

Those questions were raised by the Urology Trade Association, which is a body representing 95% of manufacturers, and by the Urology User Group Coalition on behalf of patients in evidence given last year to the Select Committee on Health. Unfortunately, follow-up questions by parliamentary colleagues confirmed the long-standing Department of Health response that no assessment of those issues had been undertaken either.

The thousands of patients who suffer bowel or bladder cancer and require ongoing stoma care deserve better. They should be assured that the Government will defend patient choice and maintain robust processes for managing real or perceived conflicts of interest in the commissioning of services. The Government should ensure the continued provision of specialist nursing advice and support and reassure us that it is in no way influenced by financial or commercial considerations.

Health Inequalities (North-East)

Jim Shannon Excerpts

Tuesday 24th January 2012 Westminster Hall

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. As I said, the causes of health inequalities are complex. Alcohol dependency certainly varies significantly throughout the country. We need, and we are seeing, targeted campaigns to address that. I hope that the Government will introduce concrete measures to address alcohol dependency, such as legislation and a minimum price if that is appropriate.

Labour prioritised addressing health inequalities. We could not overcome the legacy of inequality in 13 years, but we made real progress, as the figures for infant mortality show. However, that is set to change. There are three main ways in which the Government are undermining work to reduce health inequalities.

First, the Government have changed the funding formula, and reduced the component designed to address health inequalities. I have been in Parliament for 19 months, and I have raised this matter directly with Ministers four times, not counting written questions. I am hoping it will be fourth time lucky for receiving a direct answer. Will the Minister confirm that in 2010 the Secretary of State decided, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of the primary care trust target funding allocation from 15% to 10%? Two weeks ago, during an exchange on the Floor of the House, the Secretary of State cited a 2.8% rise in funding when I asked him about changes to the funding formula. Will the Minister address the change to the formula, rather than the overall increases that the Government claim?

During a speech on the Floor of the House in December 2010, I asked the Secretary of State to confirm that more will be invested in health services for every man, woman and child in Newcastle for every year of the comprehensive spending review as the Government claim that they are increasing NHS spending. He declined to do so, so will the Minister step into the breach?

Clearly, if funding is changed to reduce the amount associated with health inequalities, the north-east will lose out. The Minister will say that the Government have ring-fenced public health spending and handed it over to local authorities. She may refer to the public health outcomes framework, which was published yesterday, just in time for today’s debate, and is very interesting reading. It includes 66 measures, which will be monitored, but they cannot distract from the assault on public health that the Government’s wide-ranging cuts represent for local authorities. For example, cuts to fuel poverty reduction programmes such as Warm Front will leave pensioners in Newcastle colder and more vulnerable to illness. Cuts to area-based grants such as the Supporting People programme mean there will be less investment in support services for those with mental health issues.

The second way in which the Government are undermining work to address health inequalities is the top-down, unnecessary and destructive health care reforms. It is estimated that they will cost £3 billion, and we now know that in the north-east the NHS has been asked to put aside £143 million for those organisational changes. The Government claim that efficiencies will make up for that, but the service is already being asked to meet the 1.5% efficiency cuts challenge at a time of wholesale reorganisation. As the Select Committee on Health said today, it is incredibly difficult, if not impossible, to make such efficiency savings when everything is changing.

In the north-east, our strategic health authority and primary care trusts are being abolished. Funding will be in the hands of GP consortia. Newcastle already has a pathfinder consortium in place. Newcastle Bridges GP commissioning consortia covers most of the city, and has shown that it is keen to work with other stakeholders across the city to promote public health, but it is having to make it up as it goes along in the face of huge uncertainty and change in the public sector and in the third sector, with unprecedented local authority cuts, watched over by an eager private sector that is keen to take advantage of the profit-making opportunities that the Prime Minister and the Health Secretary have promised.

A recent letter to the Health Service Journal, signed by more than 40 directors of public health and more than 100 public health academics, argued that the Bill will increase health inequalities, not reduce them. If the Government will not pay attention to what the Opposition say, perhaps they will pay attention to what the profession says. Michael Marmot told the Health Committee that there is little evidence that the health premium will reduce inequalities. Indeed, he said that it is most likely to increase them. Seven former presidents of the Faculty of Public Health have said that the Bill will “exacerbate inequalities”.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to the Chamber. I am a Member not for the north-east, but for Northern Ireland, where health is a devolved matter, but she is expressing concerns felt by many people throughout the United Kingdom, even where such matters are devolved. There are two reasons for that. The problems for her constituents, to which she referred, are as real in my area as they are in other areas of the United Kingdom. The Government’s reduction in the block grant for Northern Ireland means that our health will also be affected. The changes in health care here will be the marker for future changes for us. Does she believe that the service that the NHS is offering is not the standard that we in the United Kingdom expect and are accustomed to, and is not of the standard that is needed to address core health issues?

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. I believe strongly that the national health service is one of the best, most efficient and most effective health services in the world. The evidence shows that, as I will explain. It is absolutely right to say that the concerns I am expressing on behalf of my constituents and the north-east are felt throughout the country, and with good reason. The proposed measures will have an impact on the health of all constituencies in the country. The profession believes that the changes will have a negative impact on health inequalities. The Health Committee’s recent report on public health warned that the Bill poses a “significant risk” of widening health inequalities, yet the Government are pressing ahead.

The third way in which the Health Secretary will widen regional health inequalities is through the wholesale marketisation of the national health service. Before the Minister pretends otherwise, let me quote her colleague, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who admitted last year that the Bill will turn the NHS into a “genuine market”.

We should recognise that despite having serious health inequalities, we suffer relatively little from inequalities of access. I am no expert on health services, but I am told by those who are that the stent insertion that Prince Philip recently underwent at Papworth hospital did not differ materially from the treatment that any of my constituents would have received at the Freeman hospital if they had suffered a similar condition. That is fantastic, but it is not the case in the United States of America where there are terrible health access issues due to its private health care system. In the short term, the Government’s reforms are diverting funds away from patient care, which will have an impact on waiting times. Those who can afford it will tend to seek private health care, but those on low incomes will be unable to do that. In the longer term, the Bill is about the privatisation of the NHS. Strong independent evidence indicates that the NHS is one of the most efficient and equitable health systems in the world. Why would we want to make it into a market? The Bill misses an important opportunity to focus on the real issues and the wider determinants of health in this country.

I shall therefore finish by asking the Minister these questions. The Government have signed the recent World Health Organisation declaration to deal with the social determinants of health inequalities, so what concrete actions will Ministers take? The previous Government accepted the Marmot review’s recommendations in full. When will the current Government do the same? What are the coalition’s proposals for introducing a national minimum unit price for alcohol? Will the Government confirm a commitment to undertake a consultation on plain and standardised packaging for tobacco products, and on what date that will take place?

Does the Minister share my concern about the Royal College of Midwives and Netmums survey showing that women from lower incomes were denied antenatal classes and the choice of a home birth? Will that not entrench health inequalities from before birth? The Minister looks somewhat surprised at that question, but differences in health access do exist in our country.

As Blane said, no law of nature decrees that the children of poor families should die at twice the rate of children born into rich families. In the north-east, there are more poor families. Will the Government commit to reversing their changes to the funding formula component designed to deal with health inequalities?

The national health service’s first Minister of Health, Nye Bevan, famously said that when a bedpan falls to the floor in Tredegar, it should echo in the Palace of Westminster. The Minister of State, Department of Health, the right hon. Member for Chelmsford, quoted that with some amusement and disdain and proclaimed that those days were long gone, so what does this Minister think should echo in Westminster? Does she accept responsibility for reducing health inequalities? Can she assure me that health inequalities between the north-east and the rest of the country will reduce over the term of the present Government?

084 Telephone Numbers (NHS)

Jim Shannon Excerpts

Tuesday 24th January 2012 Westminster Hall

[Mr Ainsworth]

That is a good idea. If the Minister communicates with GPs again, he should do so in the strongest of terms, because it is clear that well over 10%—the estimated figure is 13%—of GPs have totally ignored the Department of Health to date. They are determined to continue not to pick up the costs of the systems that they have put in place and to pass them on.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the right hon. Gentleman for bringing this critical issue to the House’s attention. Many of my constituents do not have landlines, but they have mobiles, the costs of which are extreme. A call to a doctor can cost £4, and some of my constituents’ tariffs have run out while they were on the phone. Does the right hon. Gentleman agree that it is time to return to a landline number rather than an 084 number?

[Mr Ainsworth]

The 03 number would give people an opportunity to use the system for no enhanced charge, and the GP should, if they are not prepared to migrate to an 03 number, provide a landline alternative. Since I first raised this issue, most of the people who have contacted me have been pensioners. They have told me that they have contracts with their telephone provider and have found that, at the end of the quarter, the charges under discussion are additional to the contract and therefore to their bill. People who use mobile phones are probably not as ready to contact a Member of Parliament, or do not listen as closely as pensioners to such debates. People who use mobile phones—overwhelmingly poorer people—are being charged extortionately for access.