Midwife and Maternity Services

Jim Shannon Excerpts

Tuesday 17th January 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

Thank you, Mr Speaker, for the opportunity to hold this debate on midwife and maternity services. It is particularly important because, as I speak, there is a baby boom in the UK. Last year, a baby was born every 40 seconds—the highest number in 20 years—and in certain areas of the country maternity units are under considerable pressure and midwives are working harder than ever. England has seen a 22% increase in the number of births, compared to Wales at 17%, Northern Ireland at 15%, and Scotland at 12%. The number of live births in England in 2010—the latest year for which figures are available—was well over two thirds of a million, representing an increase of 22% since 2001.

The Royal College of Midwives recently published its “State of Maternity Services” report, and I was pleased to be at its launch in Westminster Hall. The report looks at a number of indicators of the pressures on maternity care and the resources available to cope, and for the first time it does so for all four nations of the Union. The report finds that a significant increase in the number of births in each of the UK’s constituent parts and a trend towards older mothers are increasing the pressures on maternity services significantly. The extra work load placed on midwives by more older women giving birth has been exacerbated by an increased complexity in their work load.

The number of births to women aged 40 or over rose by more than 70% between 2001 and 2010—a level not seen since 1948. In England that has led to a substantial deficit in the work force needed to provide a safe level of care to women and their babies. Furthermore, the existing midwifery work force in England is ageing. We can therefore anticipate an even greater strain on services over the next 15 years, if the situation is not properly addressed. One region of England actually cut midwife numbers between 2001 and 2010. Between those years, the north-west experienced a 19% increase in the number of live births, but a reduced number of full-time equivalent midwives.

The only way to get large numbers of new midwives into the profession is through training student midwives, yet the record on student midwife numbers is patchy. In the 2005-06 academic year, for example, there was even a 16% cut in student midwife numbers, and it took five years for those numbers to climb back up to their 2004-05 level. With an ageing profession, a substantial and consistent rise in student midwife numbers is the only way of rectifying the enduring problem that there are too few midwives working in the NHS in England.

I very much welcome the increased number of midwives and trainee midwives introduced by the Government. That is fundamental. I also very much welcome the increase in NHS funding over each and every year of this Parliament, including the greater investment in maternity care as part of the solution. However, the financial limits resulting from the historically high debts that the previous Administration left us mean that innovative ways to address the work force shortages need to be considered.

I know that the Royal College of Midwives, for its part, is realistic about the financial challenges facing the NHS. The “State of Maternity Services” report recommends, for example, providing more midwife-led units and appropriately integrating maternity support workers as two ways to make better use of the limited financial resources available. The report also recommends at least maintaining, and in some regions increasing, the number of student midwives to ensure that more midwives are available to meet future needs.

Maternity services in England are approaching a critical point. London, along with many parts of the south and east, is particularly overstretched, with some maternity units currently having a midwife vacancy rate of over 20%. Maternity services in Scotland, Wales and Northern Ireland are in better shape. According to the Royal College of Midwives, an average ratio of one midwife to 28 births is a safe level. At the moment the figures for the UK are as follows: in England there is one midwife for every 33 births, in Wales there is one for every 30 births, in Northern Ireland one for every 28 births, and in Scotland one for every 26 births. There are clear variations in care across the UK that need to be addressed. It is clear that with adequate midwife numbers to match the birth rate, mothers and babies receive a higher standard of care.

The situation in England is a concern, but it is certainly not hopeless. The midwifery shortage can be solved; it is simply a matter of policy will and using resources innovatively. For example, giving expectant mothers real choice when deciding where to give birth could alleviate the shortage problem in England. In essence, a mother has three main choices when choosing the location of birth: a midwife-led unit, a consultant-led unit or at home. Most women choose a local hospital, usually for convenience and because of the perception of safety and security. Encouraging more births at midwife-led units, however, would help with NHS work force planning. Births at home or in midwife-led units require fewer interventions and are less demanding on midwife time. According to calculations, for every 10,000 births moved from a consultant-led to a midwife-led unit or to the home, the required midwifery work force would be reduced by the equivalent of 71 full-time midwives.

There are significant variations in home birth take-up, which suggests that the message of choice is not getting through to all mothers. For example, in Somerset 11.4% of births are at home. At the other end of the scale, however, in Wansbeck, just 0.1% of births are at home. By encouraging real choice we could enable mothers across the country to receive higher levels of care during and after their pregnancy.

Choice of location of birth—that is, of course, a specific coalition policy set out in the NHS White Paper—is far too important to be denied to mothers, particularly when it is readily available in other parts of the country. According to the Office for National Statistics the percentage of home births decreased to 2.5% in 2010 compared with 2.7% the previous year.

Research by Oxford University’s national perinatal epidemiology unit has given further weight to the evidence that suggests women at a low risk of complications should be given full and frank options when it comes to choosing where to give birth. The general secretary of the Royal College of Midwives, Professor Cathy Warwick, welcomed the research, saying:

“This ground-breaking research makes a very important contribution to the evidence base for women and health professionals about the safety of childbirth planned in different settings for women at a low risk of complications. The RCM hopes that its findings will be widely used and will help health professionals support women to make informed choices about their options when considering where to give birth. It should also influence the planning of high-quality maternity services across the UK.”

Maternity support workers who have been adequately trained, and are appropriately supervised and suitably deployed, can also provide a significant reduction of the pressure on midwife time.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. He will be aware that some 70% of midwives oversee the birth of a child without a doctor’s support. He has not mentioned that it can cost up to £45,000 to train a midwife. Some of our midwives, certainly some from Northern Ireland, are going to Australia to gain experience. Does the hon. Gentleman see some way of retaining midwives here in England, where, as he has said, there seems to be a shortage? Might there not be some way for the regions to help each other in this respect?

[Henry Smith]

The hon. Gentleman has raised an important point, which reinforces my view that there must be proper investment—the Government are already making a good start—to ensure that student midwives learn how to help mothers give birth in a safe environment so that in most cases there are no complications. It should be emphasised that consultant-led maternity units, although obviously vital, do not represent the full picture, and that midwife-led units play an important role in increasing capacity. Midwife training in each part of the United Kingdom should be at least maintained, and in some regions increased. It is necessary to maintain the numbers who begin training to ensure that an adequate supply emerges at the other end, and I repeat my commendation of the Government in that regard.

Let me end by referring to a matter related to my constituency. Yesterday evening, during the Opposition day debate on the NHS, I mentioned that 10 years ago, in 2001, the maternity unit at Crawley hospital had regrettably been closed and moved nearly 10 miles up the road to East Surrey hospital. The move has created extra pressure at that hospital, and mothers and their families have a more difficult journey to attend the unit at for check-ups and for births.

I am personally very grateful to East Surrey hospital. It is where my children were born. My daughter Georgia was born there in 2003, my son Isaac was born there in 2006, and I feel that it is important also to mention that my son Ethan was stillborn there in 2005. The care that the hospital provided for us was second to none. Nevertheless, I think it important for mothers and families to have access to midwife-led services that are closer to their communities. It is certainly one of my hopes and desires that we may be able to establish a midwife-led unit for Crawley—and, indeed, many more such units throughout the country.

Care of the Dying

Jim Shannon Excerpts

Tuesday 17th January 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on bringing this matter to Westminster Hall; the number of Members present is an indication of its importance. Perhaps not coincidentally, we are about to recognise a memorial to the holocaust, to the 6 million Jews killed, as well as to all those people who were “socially unacceptable” or “mentally unstable”, according to the Nazis, who way back in that time took a decision to murder people whom they felt were not capable of contributing to society. I want to make some comments about that in the short time I have.

Cancer is a big killer. I can remember clearly what it meant for my own family when my father had it, on three occasions. He survived it, which I believe was because of his faith in God, as well as the medical profession and what it can do. Not everyone survives, however, and nor is cancer the only condition that can be terminal and need extensive care. Numerous other horrific illnesses include multiple sclerosis, lupus and HIV/AIDS. Some people classify those with such conditions as on the dying pathway, but, along with other speakers, I congratulate the UK on being top in the world for good palliative care, which is something to be incredibly proud of. However, sometimes palliative care is not the next step, and some steps might well be missed by those who are looking to make a diagnosis rather than to treat an illness long term. Some suffer from incurable illnesses, but others are simply elderly and infirm and need care, dignity and a programme tailored to their requirements. The word “dignity” has been mentioned by every speaker so far, and that underlines the issue clearly for me. People need dignity when they are not well.

I recently visited an occupational therapist whom I had met during my 26 years as a councillor. I got to know her well, and she was diagnosed with cancer. The hon. Member for Hampstead and Kilburn (Glenda Jackson) commented on the work of the Marie Curie centre, and I had the opportunity to visit that lady at such a centre in Belfast. She had an aggressive strain of cancer, with six weeks between her initial diagnosis and the end of her life—the disease struck quickly and hard. I and her family could not but appreciate the good work done by the Marie Curie people. At a time when she needed help most, they made her life that wee bit more comfortable—if that is the word to use—and helped her family.

No one living in the UK can be unaware of the need for efficiency savings, but in some areas we cannot afford to cut, and palliative care is one of those. Health is a devolved matter in Northern Ireland, and the health service has said in its palliative care strategy:

“The vision of this Strategy is that any person, from diagnosis to the advanced non-curative stage of disease, lives well and dies well irrespective of their condition or care setting. This requires a philosophy of palliative and end of life care that is person-centred and which takes a holistic approach to planning, co-ordinating and delivering high quality reliable care enabling patients to retain control, dignity and crucially, choice in how and where their care is delivered to the end of their life.”

It is about the people who are ill and who need care at the right time and in the right way. The hon. Member for Enfield, Southgate mentioned personal beliefs, cultures, the practices of patients and so on, and I would hold to what he said in his introduction. It is about the practices of patients and their families and carers, and recognising the contribution that good palliative and end-of-life care can make to the quality of their lives and the lives of the people around them who have to sit back and watch their loved ones die.

The NHS is supported by many charities, and one is the Northern Ireland hospice. It was established in 1981 and provides palliative care for adults—the majority of whom have had a cancer diagnosis—although there are young people there as well. The service began in Somerton house for in-patients but developed to provide specialist community nursing services, a day hospice and hospice at home—the point is that the service can be at hospital or at home, and it supports the family. Everyone knows of the tremendous work of the Macmillan nurses—personally, in many cases, and as elected representatives—and although the people of Northern Ireland continue to give generously, that is not enough to sustain the high level of care and training.

It is important for us to remain top of the world in palliative care, not because we want to show off or show our prowess, but because we want those who are dying before their time to have the best care in order to ease their way, and to ease the pain of their families. We can show what sort of a society we are by the way we treat our vulnerable people. Along with everyone else present, I support the intention behind the debate, and I hope we can assist the people who need it most: the elderly, the infirm and those who are ill and dying.

Breast Implants

Jim Shannon Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

I think I have been absolutely clear about what I expect to happen, in relation both to women treated through the NHS and what I expect of private providers. I have also made it clear that if private providers will not or are unable to meet that standard of care, the NHS is available to support women. It is absolutely wrong to say that we are somehow responding to women differently from other European countries, because across Europe countries affected by this are taking exactly the same view that we take.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and I again highlight the concerns that a great many ladies have. Just today, I have been made aware that constituents of mine, as well as those from other regions of the United Kingdom, have had PIP breast implants carried out privately in the Republic of Ireland. When they contacted the firm, they found that it had gone bust, so what help can he give ladies, both financially and physically, who were NHS patients in the United Kingdom but had operations carried out outside the United Kingdom, specifically in the Republic of Ireland?

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is absolutely right. In the summer of 2010, we learnt from Sir Mike Richards’s review that patients in this country were less likely to have access to the latest cancer medicines within five years of their introduction than those in many other European countries. I am proud that so far the coalition Government have been able, through the cancer drugs fund, to help 10,000 patients to gain access to the latest cancer medicines.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for that response. Last year, Cancer Research UK revealed that cancer deaths were down 20% since 1985 and survival rates have doubled in the last 40 years. Does the Minister agree that we must continue to research proactively and thereby continue to reduce deaths and ensure continuity of life?

[Mr Lansley]

I am grateful to the hon. Gentleman, and he is absolutely right about that, of course. He will also be aware that Cancer Research UK highlighted not only the progress that had been made, but the variation in progress on different cancers. Harking back to the earlier point about innovation, we must focus on how some of these innovations will enable us to deliver improved survival rates for specific cancers, and I announced last month that we would be funding additional scanner facilities in this country—proton beam therapy scanning interventions—in order to enable some of the most difficult cancers, such as brain cancers in children, to be treated in this country effectively.

Mental Health Unit (Burton)

Jim Shannon Excerpts

Monday 19th December 2011 Commons Chamber

[Andrew Griffiths (Burton) (Con)]

I thank you, Mr Speaker, for allowing this important debate today. Although this issue may not be big news nationally, it is incredibly important for the people of Burton and east Staffordshire. If we want to make Parliament more relevant and debate the issues that matter to people, debates such as this one, which is about a key local facility, will do a great deal to enhance the House’s reputation for being in touch with real people and their concerns.

I speak about the Margaret Stanhope centre, a very important mental health facility that is much loved and valued in Burton, east Staffordshire and south Derbyshire. South Staffordshire primary care trust is consulting on the closure of the centre, which would mean the loss of 18 acute beds and eight elderly care beds in the facility.

I have been a Member of Parliament for some 18 or 19 months now, but I have not seen an issue that has united people in the way that the campaign to keep open the Margaret Stanhope centre has. At this point, I should like to pay tribute to two gentlemen who are in the audience today, Dr Matt Long and Mr Gerald Chatfield. They have been at the forefront of the SOS—“Save our Stanhope”—campaign, and they have worked diligently and tirelessly to bring the threat of the closure of the Margaret Stanhope to the attention of people in Burton.

I should also mention the invaluable contribution of the Burton Mail, a well respected local newspaper that covers both east Staffordshire and south Derbyshire. It has led the campaign and represented the views of local people extremely well having brought the matter to their attention. I pay particular tribute to the reporter Adrian Jenkins, who has doggedly sought out the facts, and Mr Kevin Booth, who, in his time as editor of the Burton Mail, has turned it into a campaigning newspaper that is properly representative of local people.

The PCT has failed to take account of the grave impact that closing the Margaret Stanhope centre will have on mental health provision across Staffordshire and south Derbyshire. Losing those 18 acute beds and eight elderly beds will leave us with 20 acute beds and 11 elderly beds at the George Bryan centre in Tamworth, and a further 50 acute beds and 26 elderly beds at the St George’s hospital in Stafford, giving a total of 70 acute beds and 37 elderly beds for the whole area covered by the South Staffordshire PCT. I have done some research into this issue, and I have come across an important report that the Audit Commission produced in March last year. That report looked at the provision of mental health in-patient beds at 46 mental health trusts across the country, giving a snapshot of a large number of mental health providers up and down the country. That evidence showed that the median number of beds per 100,000 people was 27.5, yet in south Staffordshire, which has a population of 606,100, we currently have 88 acute beds.

I was rebuked by the Minister earlier for not having very good maths—[Interruption]—the Minister in the previous debate—but I have done the maths and I have had it checked. It shows that the figure for south Staffordshire equates to 14.5 per 100,000. Why should my constituents—people covered by the South Staffordshire PCT in east Staffordshire and across Stafford—be satisfied with the provision of less than half the median number of beds provided to other constituents and residents across the country? My residents think that that is simply not acceptable and they are saying no to that provision.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the Chamber. Has any consideration been given in his investigations to the impact on the families of those who would be in those beds, but who suddenly do not have them and will now be at home? What will happen with care in the community for them?

[Andrew Griffiths]

The hon. Gentleman makes a valid point, which I hope to come to later in my speech. He has served his community well over many years and he properly understands the needs of families, particularly the most vulnerable in our society.

Removing those beds from the Margaret Stanhope centre will bring the median down to 11.5 per 100,000 people, compared with the median of 27.5 across the country. That is putting lives at risk, and we are not prepared to put up with it in east Staffordshire.

The Audit Commission report also talked about occupancy rates, saying that the median occupancy rate across those 46 trusts was 90%. I requested the occupancy rates from South Staffordshire PCT—I think it took five weeks to winkle, or drag them, out of the PCT. I was provided with the figures for April 2010 to August 2011. I examined them and found that, with the beds at the Margaret Stanhope centre still in place, the occupancy rate across the PCT was 87%.

Organ Donation

Jim Shannon Excerpts

Wednesday 30th November 2011 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thought that I should speak, and it is a pleasure to do so, on this matter, which is one of some importance to me. Every person in this House agrees that something must happen. It is the strategy or the policy for the way forward that is the issue. I have to say that I totally support the point of view of the hon. Member for Newport West (Paul Flynn).

I have carried a donor card—it is a bit faded, but it is still a donor card—for more than 20 years. This is the second or third one. If this body that I stand in today should be in an accident, and there is an opportunity for donations, I would like my body to be used for that purpose to give life to others. That is a personal opinion. There will be others in this House who carry donor cards, and they will be of the same opinion.

My nephew Peter is a recipient of an organ donation. He received a kidney. I can well remember the day he was born—he is a year younger than my elder son—and he was a wee boy. He was born with about half a kidney, and it was touch and go the whole way through his life. The result of it all was that he received a donor kidney, and today his whole life has changed. Today he races motor bikes—a bit of a tradition in our family—and he has a job and a full-quality and normal life. That is good news.

In my constituency of Strangford, we had the opportunity to have a memorial garden. That was an initiative that came from local people, who worked with the Ards borough council and ensured that a portion of land was set aside earlier on this year—in May or June—for a memorial garden so that those who are recipients of donor organs and those families whose loved ones have passed on have somewhere where they can go to have a moment of quietness or of contemplation.

Some eight years ago, just a mile from the location of that garden, an accident took place in which one person was killed instantly and another survived for a few days. Months afterwards, the father of one of them came to see me. He was still heartbroken, but he told me that his son had managed, as a result of his death, to pass on organ donations, and the gift of life, to five families. That is another illustration of the quality of life that can arise out of such events.

I am conscious of time, but I shall make three quick points. Just four weeks ago, I put down an early-day motion for the House to consider. Through that, I became conscious that we need to do something better, because the system we have today is not working. Organ donations are not coming through and we must do something about that. We need to think outside the box, if I may use that terminology—it is used often about many things. People of the vintage of 70 to 80 years old should not be excluded from organ donation. If their bodies or organs are healthy, why not use donations from people of that age? Perhaps the Minister can give us an idea about that in her response.

The hon. Member for Ceredigion (Mr Williams) mentioned the TV programme, which I had actually seen the night before, although it was the same one. It very clearly illustrated the highs and lows of people who are waiting on organ donation—the highs when they think it is their turn and the lows when they find out that it is not suitable. It charted the life of one person through her youth, her marriage and the countdown of days after the marriage until she was on a life-support machine and had only three days to live, and then the organ donation came through. Again, that illustrates very clearly the things that we need to do.

I have been contacted by many constituents who are aware of the issue, of the need for organ donations and of the need for that to happen quickly. My last point is in relation to those who need a transplant, but—nobody has yet mentioned this—have a rare blood group. What are the chances of someone with a rare blood group receiving an organ donation from someone of that particularly group? It is one of those 100 to one or 1,000 to one chances. We therefore have to do something different. Whether that means a pilot scheme, so that people are automatically organ donors unless they say otherwise, which is what I believe we need; I would go a stage further, although I am not sure that everyone would agree.

Unless we have a system in place that gives the individual an option and ensures that organ donations can come through, we are not serving our people or our country well. I urge hon. Members to think very honestly about the issue and to move forward in a positive fashion. We need organ donation, we need it on a different system and we need it now.

Epilepsy

Jim Shannon Excerpts

Tuesday 29th November 2011 Westminster Hall

[Steve McCabe]

I certainly agree that there have been considerable strides and we should not dismiss them, but there is an overwhelming need for further research and for improvements in specialist care and treatment. That is one of the points that I hope the Minister will comment on later this morning.

SUDEP accounts for nearly half of all epilepsy-related deaths. Research suggests that the seizure activity in the brain may sometimes cause changes in the person’s heartbeat or breathing, very occasionally causing the person to stop breathing completely. The single most important risk factor appears to be uncontrolled generalised tonic-clonic seizures, which, I understand, are the type of seizure that causes a person to lose consciousness, while their body becomes stiff and then starts to jerk. Such seizures can lead to sudden unexpected death.

It is estimated that there are about 500 cases of SUDEP every year, and a further 500 deaths every year due to other epilepsy-related causes. About 39% of adult deaths from epilepsy were considered to be potentially or probably avoidable. The main problems or deficiencies that cause these deaths include inadequate drug management; lack of appropriate investigations; inadequate recording of patients’ histories; adults with learning disabilities being lost in the transfer from child services to adult services; and one or more major clinical management errors being made. The absence of evidence of a package of care for those suffering from epilepsy is also a cause of rising concern. In primary care management, the main problems identified include sparse evidence of structured management plans, missed triggers for referral and professional communication failures.

For women with epilepsy, the risk of sudden death in pregnancy remains higher for those with other long-term conditions. The risk of maternal death is an estimated 10 times higher for women with epilepsy than for women in the general population. It is probably fair to say, however, that the risk is still low overall.

I am very grateful to Young Epilepsy, formerly known as the National Centre for Young People with Epilepsy, which works on behalf of about 112,000 children with epilepsy.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to Westminster Hall for debate. I went to school with a young fellow who had epilepsy. I well recall how scary my first encounter with the condition was, because I did not know what was happening. Does the hon. Gentleman agree that there is a need for better awareness in schools? If there are pupils with epilepsy in a school, the school needs to know that, so that it can react in a positive way rather than with the fear that comes from not knowing how to deal with it.

[Steve McCabe]

Absolutely. Young Epilepsy is very effectively carrying out a pilot project, with more than 20 schools, to develop and test a model of best practice that can be replicated in any school. Although there might well be the usual problems of time and finance, I understand that the pilot is now at a stage where it could be rolled out across the country. That would go some way to addressing fellow pupils’ concerns and to preparing staff much better in what to do in particular situations. I am extremely grateful to Young Epilepsy for its work in that area.

The figures suggest that there has been a general increase in epilepsy, but that could be due to better diagnosis. There certainly seems to be a suggestion that greater attention to the recording and monitoring of people with the condition has been a factor, due to the GP outcomes framework and the introduction of the National Institute for Health and Clinical Excellence guidelines, and similar ones for Scotland. Misdiagnosis remains a significant problem: a rate of between 20% and 30% of people being misdiagnosed could equate to something like 138,000 people without the condition receiving anti-epilepsy drugs, at a cost of about £220 million a year.

There is evidence that epilepsy is more prevalent in the most socially deprived parts of the country than in the better-off ones. There is a particular problem, with which the Minister will be familiar, in the allocation of residential care for some people who suffer from epilepsy, with the local authority describing epilepsy as a health condition, but most other people saying that a combination of health and social factors are involved. A particular group to mention in that respect is prisoners. A number of studies have been done, not least by the all-party group, that show that the NICE guidelines are not followed in the vast majority of prisoner cases, and that there are problems with prisoners having access to the proper drugs and, significantly, with diagnosis. There also seems to be a problem with how some PCTs determine access to services, with some using referral and funding panels rather than relying solely on clinical judgment. I would have thought that that is not necessarily in people’s interests.

All of that leads to a picture of a treatment gap. About 70% of the population with epilepsy in this country could be seizure-free if they received optimal treatment, but only about 52% are seizure-free. Too few children are offered or referred early enough for surgery that could cure their epilepsy or at least significantly reduce seizures. I understand that there is a backlog of more than 2,000 children who could benefit from such surgery.

The Prime Minister himself has acknowledged that there is a need for improved services. More than 10 years have passed since the then chief medical officer, Sir Liam Donaldson, said in his annual report that epilepsy services suffered from a lack of interest compared with the management of other chronic conditions such as asthma. Although national initiatives such as the NICE guidelines and inclusion in the GP contract have raised awareness of epilepsy, and although there are patches of excellence across the country, overall service provision in most communities has not translated into sufficient effective interventions. One purpose of today’s debate is to ask the Minister to meet with some of the epilepsy organisations, particularly Epilepsy Bereaved, to discuss what else we can do to prevent avoidable deaths.

I do not want to take too long because I want to let other people speak, but I should mention that there are recurring stories about the deaths of young people. A young boy of nine who experienced frequent seizures had benefited from excellent care from his paediatricians, but he died following a transfer of care during an overnight stay in hospital when his history was not adequately updated. In another case, a young woman died suddenly in her sleep, leaving behind two sons. She had had infrequent seizures but had never been given adequate advice. Some five years ago, two famous cases, those of Erin Casey and Christina Ilia, led to a fatal accident inquiry in Scotland, with which the Minister might be familiar. In summarising, the sheriff was absolutely clear that the risk of sudden death might have been reduced by access to a night monitor or much better information about the particular risk at that point in the evening.

I will not dwell on the number of things we need to do. I take the view that there has been progress in our understanding of epilepsy and that there is probably less stigma attached to the condition these days. I think that the previous Government and the present one have made efforts to improve the quality of care, but we know that significant problems remain. We need to think about whether we can set up a dedicated research fund to look much more closely at epilepsy. General practice needs to be much clearer about risk management, about the potential benefits of technology—for example night monitors—and the need to flag up injuries, A and E visits and missed prescriptions. Good medicines management is needed because, as I said earlier, about 70% of people could be seizure-free if prescribed the right medicine. Much more active monitoring of epilepsy deaths is also needed, so that we know what is happening and can draw up plans to help people to manage the condition.

The depth of the subject tempts me speak for much longer, but as I said at the outset, my purpose is to flag up some of the central issues involved in avoidable deaths and the actions that could be taken to help people who suffer from epilepsy. I will allow sufficient time for other colleagues to contribute and for the Minister to reply to the debate.

Bowel Cancer Screening

Jim Shannon Excerpts

Wednesday 23rd November 2011 Commons Chamber

[Guy Opperman]

I do indeed. I welcome the fact that the guidelines from the National Institute for Health and Clinical Excellence have changed to allow screening to become considerably more frequent in such cases. I am sure that the Minister will comment on that.

Flexi-scope screening will undoubtedly save thousands of lives. FOB screening saved 700 to 1,000 lives a year, and flexi-scope screening will save about 3,000 lives a year. To confirm that, the Government implemented a pathfinder project in three areas. Unsurprisingly, two of those areas were in the north-east, this country’s leading medical region. The three areas were South of Tyne and Wear and Tees, along with Derby. The pathfinder findings are with the Department of Health and have not yet been published, but I can assure the House that, in broad terms, they accord with Professor Atkin’s findings. Last October, the Prime Minister announced a proposal to pilot the scheme nationally in 2012, but there are clinical and funding issues that need to be addressed.

First, when is the Department of Health going to invite bids for the follow-on pilot process, given that that was supposed to be done in 2011 and it is now 23 November?

Secondly, clinicians raise the specific concern that the flexi-scope system is only manageable if we have a sufficiency of trained nurse endoscopists, so where are we in respect of this crucial training? Even with the most amazing piece of equipment, if we do not have the people to operate and interpret it, it is useless. Under this scheme, several hundreds of thousands of endoscopies will have to be carried out, with colonoscopies to follow in about 10% of cases. Therefore, everything will depend on training.

Thirdly, how does the Department of Health plan to assess its age groups? My understanding is that the current group of 60 to 74-year-olds will have FOB testing, and those aged 55 will have a flexi-scope. That is relatively clear, but what will happen for gentlemen and ladies in the 56-to-60 age group is not at all clear. Will they be offered the flexi-scope as well, or is that to be based solely on GP referral? Trusts need guidance on what they are to do with such a large and unknown number of people, as they need to plan budgets, staffing and much more besides.

Fourthly, we need to assess what we are going to do with those who have a flexi-scope at 55 and receive the all-clear and then reach the age of 60. Will we rescreen? Anyone who has ever worked in the health industry will know that there is “health speak”, and in this case the following question would be asked: “What is the parallel screening modality for the future?” As always, “health speak” is gibberish, but the simple question here is: are we going to rescreen people who are fine at 55?

[Jim Shannon (Strangford) (DUP)]

I have also gone through the screening process because of a family history of cancer. My GP and consultant at that time said the screening would have to be done again in a year’s time and then again a year later, in order to be absolutely sure. Has the hon. Gentleman considered whether there should be checks not just every now and again, but on a periodic basis?

[Guy Opperman]

It is ultimately up to the clinician—which it should be, frankly. The Minister must say how this policy will be implemented, but it should always be clinically driven.

Fifthly, trusts need confirmation that the pilot projects to be implemented next year will be funded from national funding.

I want to turn briefly to the financial case. The researchers behind the Atkin study suggest that the screening programme will reduce the costs associated with treating people with bowel cancer. Ministers will be aware of the Department of Health-commissioned report, as set out in the memorably named journal, Gut, in 2006, which suggested that if a screening programme based on this test was effective, it could save an average of £28 for every person screened. I urge the Minister to follow what a lot of doctors and others have recommended. We must understand why people do not take up the state’s offer to safeguard their health. If only 54% of those eligible are taking up this offer, that is a serious issue that needs to addressed.

When should we start screening? I speak as an MP whose constituency borders Scotland, and we are often told that in Scotland the health care system is much better, much more expansive and so much more free. In Scotland, FOB screening takes place at 60, not 50 as it does in this country and my understanding is that they do not intend to take up the flexi-scope screening. Personally, I am yet to be persuaded of the clinical or financial basis for screening at the age of 50 given the immense task of screening from the age of 55 onwards, with all the numbers of people who will go through the system. Although there might be pressure—obviously, the Opposition Benches are packed—to move towards such screening at 50, there is no clinical or financial basis in the current system to justify such an approach.

I want to address the possible role of private or other public organisations, suitably supervised, in this process of change. We need to explore the issue of those whom the state must look after but do not take up the offer of screening. It affects both their health and our finite budget. The state must and will always be the provider of medical services in the future—no one disputes that—but it must also enable change and encourage private or public organisations to help in health care. All acknowledge that the take-up of screening is tragically low, as 46% resist the chance to screen themselves for bowel cancer and more than 20% of women resist the chance to have cervical or breast cancer screening. Everybody must accept that there is a problem with that. How can we address that?

Only the short-sighted or extremely socialist would suggest that the state always has the answer to all those problems. What if public sector organisations were to go the extra mile and care for their employees in a different way? We should bear it in mind that the state spends a fortune training its employees to carry out their designated tasks, whether they are consultants, surgeons, endoscopists or nurses. It surely makes sense to safeguard one’s assets—that is, one’s employees. Why not use the public sector as a lead by making it either mandatory or strongly advisable that all permanent core workers should have the screening that their health deserves and that we ask of the rest of the public? I would suggest that they should lead the way. That follows on from the point that is made about flu jabs and the prevention of winter problems in hospital.

We should also consider companies; I want to finish on a localism point. We always criticise employers in this House, but let us say that we had an enlightened employer. Why could they not be allowed or even encouraged to conduct screening of their workers, in whom they invest so much? There is clearly a benefit to the worker, the employer-employee relationship would improve as the employee was valued and cared for, and the state would not necessarily have to pay for the health care screening provided to its citizens. I am talking not just about bowel cancer screening, which is quite complex. Breast cancer screening, for example, is important but not necessarily that difficult.

The cost of such privately paid screening could then be borne in the form of a reclaimable tax break to the company, such as an equivalent cut in the cost of the company’s local business taxes. That would offer localism, increased health screening and better care for employees. Although there might be some data protection issues and concerns about who would pay for the follow-up care, it would unquestionably improve the take-up of screening. I refuse to accept that there is no mileage in my suggestion, which surely brings true localism and better screening to the workplace.

In the minute or so I have left, I want to address the fact that this is men’s health awareness month and individual members of the public must take responsibility for their own health. All around us, perfectly sane men are sporting moustaches as “Movember” kicks into gear. For too long, men have ignored their health. It is well known that they do not have regular check ups. The reality is—I am not surprised the House is not packed this evening—men do not like to talk about the prostate or their bowel. As one of the nurses I met in hospitals put it to me: “Men and their bits—they get so precious about them! If men had to go through what women have to go through with cervical cancer screening and pregnancy they would be a great deal more healthy and self aware.”

I praise the television celebrity Chris Evans for his campaign to show that there is no shame and in fact great benefit in having bowel cancer screening. The shame in such matters exists when people ignore the signs and even die through false manliness or ignorance.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Anne Milton]

I thank my hon. Friend, and I will take this opportunity to praise again the work of midwives and the Royal College of Midwives. It was a pleasure to be at its conference only last week. I would point out that there are now more than 20,000 full-time equivalent midwives. That is an increase of 2.4% on last year. We have record numbers of midwives in training, with 2,493 this year and an increase on that next year. What matters is that we get the right services for women who are pregnant, ensure that they can exercise the choices that they need, and get the right skills mix.

[Jim Shannon (Strangford) (DUP)]

Figures today reveal that older women are being discriminated against in breast cancer treatment, with some 20% of women over 65 receiving chemotherapy compared with some 70% of women under 50. Will the Minister assure the House that those who are over 65 will receive equitable treatment, and that this discrimination will stop?

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful for that question, and I assure the hon. Gentleman that the Government are determined to root out ageism wherever it might be within the NHS. That is why we have made it clear that there will be no exemptions from age discrimination legislation—and that will have to be taken into account by clinicians when they make decisions.

Obesity

Jim Shannon Excerpts

Wednesday 9th November 2011 Westminster Hall

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

It is a privilege to speak under your chairmanship, Mrs Riordan. I am delighted to have secured the debate. I have come to notice, particularly with health-related issues, that an hon. Member may think they are well informed on a topic when they succeed in securing a debate, but once they have succeeded in securing it, the administrative back-up kicks in and all the groups involved start supplying them with significant amounts of promotional material, and they are even more well informed by the time the debate arrives. I thank all the groups involved with this issue for providing me with information.

Sometimes it is wise to start a very serious debate with a slightly humorous anecdote. I am reminded of the overweight gentleman who was sent along to his local well man clinic by his wife, as men are wont to be. She instructed him to go to the well man clinic and to come back with precise instructions on what he was to do to lose weight. When he came back with a smile on his face, his wife said, “There’s something wrong here. What exactly were you told?” He said, “Well, I’m exactly the right weight—for someone who is 7 foot 8.” Unfortunately, that encapsulates part of the problem.

A sedentary lifestyle is not only costing those members of society who are overweight very dearly; it is costing all of us exceptionally dearly. From the correspondence that I have had and my own research, it appears that obesity currently costs us—depending on whom we believe—between £4 billion and £7 billion a year directly and indirectly. Whichever figure is right, the reality in 2011 is that we are talking about an exceptionally expensive but preventable series of conditions. The situation is bad at the moment, but unless we take radical steps and measures, unless we do something fundamental—I will come to that later—the rates of obesity are likely to double in the next 30 years.

Currently, almost one third of children are overweight, so obesity is not a condition that is the preserve of either the elderly or the middle-aged. All of us in society, right across the age spectrum, are being affected. Only 20 years ago, people who visited America—perhaps somewhere such as Florida—would come back here and say, “The United States has a terrible obesity problem. Thankfully we will never be like that.” But we are, and things are likely to get worse.

For example, 25 years ago, about three quarters of schoolchildren walked or cycled to school; now, less than 10% do so. When giving that figure, I take into account the fact that there have been lifestyle changes, school closures and so on, but the fact remains that there has been a significant increase in sedentary lifestyles. There has been a change in attitudes. The unfortunate reality is that more and more of us are spending more and more time at desks, in front of computers. Many people become couch potatoes—unfortunately, that analogy is all too accurate.

I will give another statistic to show how things have got considerably worse. In the early 1980s, roughly 7% of the population were classed as overweight. That ratio has trebled in the past 30 years. We can see the trend. It is likely to double again in the next 30 years. We must get to grips with a problem that, as I said, is proving exceptionally expensive for us all.

Obesity is linked to socio-economic deprivation. The figures that I have been able to establish indicate that the ratio of children in lower-income households suffering from obesity is twice that of those in higher-income households. Again, we see the repetitive nature of the problem, the cyclical response that is indicative, because many obese children are, unfortunately, the children of either one obese parent or two.

Of course, we all know of the additional and subsequent health risks associated with this condition. We are all aware that heart attacks and strokes, coronary artery disease and type 2 diabetes are much more likely among the overweight. There is an additional cost further down the line, in years to come, as people who begin to be overweight today begin to show the symptoms of those other conditions only in years to come and then of course have to be treated by the NHS.

[Jim Shannon (Strangford) (DUP)]

Type 2 diabetes is one of those hidden diseases that some people do not know they have. The indications are that there will be a 50% increase in the number of diabetics in the next couple of years. Does my hon. Friend believe that diabetes itself needs a direct Government plan in order for that issue to be addressed, because it is a hidden disease that can kill?

[Mr Campbell]

I thank my hon. Friend for that intervention. I hope that the Minister will respond to it. I want to come on to some of the things that Health Ministers throughout the United Kingdom—in the devolved regions as well as here—can do to deal with the issue, but my hon. Friend’s point is certainly well made.

Having diagnosed the problem, as it were, I want to consider what is being done. It is not all negative. A considerable series of measures is being taken, not just nationally but locally. Various councils, various health trusts in Northern Ireland and other bodies are actively engaging in trying to come to terms with the problem. Many programmes that promote healthier food choices are being actively promoted. I am aware of the healthy eating awards, and of course we are all aware of the food labelling issues that have come to the fore in recent years. There have been other programmes aimed at reducing the salt, sugar and fat in some foods. All those things are creating greater awareness among the wider community, but we are fooling ourselves if we think that the measures currently in place will arrest the problem.

I will turn at this point to what needs to be done now and for the foreseeable future. Obviously, the fast food industry is a key player in relation to the problem. Some people in that industry are quite responsible. Some have responded to the campaigns driven locally and introduced more healthy eating options—they are to be commended for doing so—but some have not. We need to see best practice not just nationally but internationally being analysed and then promoted, so that we can see significant progress.

At the moment, there is—certainly in Northern Ireland, and I assume across the UK—a better educational approach in schools. Our young children, particularly primary school children, are now getting information that simply would not have been proper protocol 25 years ago. Many people then would not have even seen the need for primary school children to receive that type of education. That is changing, but again, more needs to be done to increase awareness. We have all seen issues where, for example, healthy eating has gone wrong. Sometimes we see photographs in newspapers that show parents queuing up to give other types of food to children because healthy eating standards have gone awry. We need to ensure that the whole educational process about healthy eating for children is properly assessed and rationally implemented.

When we ally the fast food sector—I do not want to name any of the organisations—with a sedentary lifestyle, I think we can account for 80% to 90% of the obesity problem.

[Mr Campbell]

I agree with that; I was just about to come to the issue of exercising. I love walking, and when I get the time to walk, as I try to weekly, I despair at the rarity of seeing other people walking and exercising.

[Jim Shannon]

Surely, my hon. Friend does not just walk; he marches. When someone marches, they lose more calories, and I understand that he marches often.

[Mr Campbell]

I thank my hon. Friend for bringing us back to basics with a Northern Ireland and Scotland perspective on that. That is true.

I do despair when, for example, I see very few people exercising between October and March or April, and even fewer children.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am grateful for the opportunity to contribute to this debate. I will not speak for very long, but it is worth highlighting some of the issues that have been raised in a comprehensive way. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing this debate.

Obesity in the UK is a growing problem. In 1993, only 13% of men and 16% of women were obese, but in 2009, 22% of men—and 24% of women—were obese, which represents almost a doubling of the number of men with obesity. I am not talking about people with a body mass index of between 25 and 30, which means that they are overweight; I am talking about obesity. Almost a quarter of the UK population is obese and I am sure that we all find that unacceptable.

How can we deal with obesity effectively, because whatever previous Governments have done, obesity has not been addressed in a way that has worked or has been effective? First, I will briefly outline how Government policy is moving towards more community-based interventions on obesity, and I will explain how that approach, through the health and wellbeing boards that will be set up under the health care reforms, will be effective and work well. Secondly, I will talk a little about nudge theory, because I am more hopeful and optimistic about it than my medical colleague, my hon. Friend the Member for Totnes (Dr Wollaston). There is good evidence elsewhere, particularly in Iceland, that it has worked, and I hope it will also work effectively in relation to obesity.

[Jim Shannon]

While the hon. Gentleman is giving us his thoughts, and given his experience in his previous job, will he comment on gastric band operations? Just two weeks ago, I had occasion to visit the Northern Ireland Health Minister, Edwin Poots, with some of my constituents. These people had tried everything to lose weight; they had tried dieting and exercise—some of them were not able to exercise, which was the other problem—but they had clear medical and health problems. As a last resort—this really is the last chance saloon, or the last chance restaurant, perhaps—should regions and Health Ministers set aside money specifically for gastric band operations?

[Dr Poulter]

We certainly have to look at how the Government can help people to take more responsibility for their own health care. That is fundamental to obesity issues, and it is a particular challenge in more deprived areas. People often require gastric bands at the point where the medical problems associated with obesity—diabetes, the risk of heart attack or stroke, or high blood pressure—pose a potentially life-threatening risk. Such people may not have that long to live if a gastric band is not put in place, so it is the only feasible mechanism for dealing with obesity in such cases. Gastric bands have been shown to be an effective mechanism for looking after that part of the population, and there is good medical evidence to support their use. There is also good evidence in terms of the health care economics, as helping people to become slimmer will lessen the burden on the NHS.

The gastric band is good for the patient, because their health improves dramatically when it is used effectively, but the challenge with obesity is to bring about long-term lifestyle change, and the question with gastric bands is whether they necessarily deal with long-term lifestyle changes. In a medical sense, there needs to be greater emphasis on the education that goes with the bigger issues around obesity and lifestyle at the same time as the gastric band is fitted. I hope that that helps to answer the hon. Gentleman’s question.