Preventable Sight Loss

Debate between Jim Shannon and Margaret Greenwood

Tuesday 30th April 2024 Westminster Hall

[Margaret Greenwood]

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector”

and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

Musculoskeletal Conditions and Employment

Debate between Jim Shannon and Margaret Greenwood

Wednesday 10th January 2024 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered musculoskeletal conditions and employment.

It is a pleasure to serve under you chairmanship, Dame Caroline. Musculoskeletal conditions can be devastating for those affected. They can cause pain, reduce mobility, diminish self-confidence and lead to isolation. They can also lead to extended periods of absence from work and, in some cases, people giving up work altogether. Instead of enjoying a productive working life, people can find themselves unemployed and impoverished. In addition to the terrible human cost, MSK conditions bring substantial costs to the state in the form of social security and NHS spending.

Conditions include osteoporosis, rheumatoid arthritis, traumatic fractures, osteoarthritis, rheumatic rheumatoid arthritis, traumatic fractures and a range of conditions that cause pain in the lower back, the neck and parts of the arms and legs. The workplace can be a source of such conditions through injuries sustained from one-off accidents or through poorly managed working practices that lead to conditions developing over time.

The Health and Safety Executive has noted that MSK conditions can be caused by a number of things, including, but not limited to: lifting heavy loads, working with handheld power tools, long-distance driving or driving over rough ground, working with display screen equipment, and repetitive work that sees an individual using the same hand or arm action over a period of time. HSE statistics show that the industries with the most reported incidents of musculoskeletal disorders are agriculture, construction, health and social care, and transport and logistics.

It is clearly important to ensure that healthy working practices are the norm and that mitigations are put in place where such movements are required. That might include ensuring that there are sufficient breaks from routine activities. The Health and Safety Executive has reported that 35.2 million days were lost due to work-related ill health in Great Britain in 2022-23. MSK disorders accounted for 6.6 million of those lost days and was the second highest cause after stress, depression or anxiety. Research from the charity Versus Arthritis suggests that over 20 million people—around a third of the UK population—live with an MSK condition. For current UK employees, the figure is one in 10.

Of course, we have to remember that a lot of people have to give up work precisely because they have an MSK condition. According to the Government's statistics, the employment rate for people who have an MSK condition and are classified as disabled was 57.5% in 2022-23. In contrast, the employment rate for the whole population was much higher at 75.7%. Versus Arthritis estimates that the cost of working days lost due to osteoarthritis and rheumatoid arthritis, which are just two of the many types of MSK conditions, was £2.5 billion in 2017, and that that figure will rise to £3.43 billion by 2030. In 2022, the Government’s Office for Health Improvement and Disparities stated that musculoskeletal conditions represent the third largest area of NHS spend, costing around £5 billion a year. The report cited a 2016 study based on 2012-13 costs, and so is not recent. It would be helpful if the Government could revisit this and provide a more up-to-date figure.

The scale of the problem demands a clear and focused response from the Government. In short, the Government should come forward with a cross-departmental MSK strategy. That strategy must set out how the Government will seek to promote good MSK health, reduce the risk of accidents and practices in the workplace that lead to or exacerbate MSK conditions and ensure that support is there for people who need it through positive workplace practices and, where appropriate, the use of equipment, devices and assistive technologies. They should also invest far more in the provision of leisure centres and swimming pools, particularly in deprived areas, so that people can manage and improve their health, and should increase investment in research into MSK conditions. Ministers should consult with stakeholders including clinicians, health and safety experts, trade union health and safety representatives, employers and employees when coming up with this strategy.

Those who are in work need the right support so that they can remain in work, and those who are looking for work need to know of the support that is available to help them get back into employment. Modern design and technology can improve working conditions for people with some MSK conditions, yet people can often feel awkward asking for such adjustments.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Wirral West (Margaret Greenwood) for bringing this important issue forward for us to consider. I apologise to you, Dame Caroline, and to the hon. Lady because, unfortunately, I cannot be here for the debate because I have to attend a Northern Ireland Affairs Committee session. I will just make this point: in Northern Ireland, we have almost half a million sufferers of MSK. That equates to a quarter of the population. Does the hon. Lady agree that we need to enable working people to continue working by providing support and help? I think she does, and I believe that the Minister will as well. The Government must offer support to small businesses to ensure that they know how to make a reasonable adjustment to allow someone who wants to work to do so, rather than having to take sick leave, which they do not want to do.

[Margaret Greenwood]

The hon. Gentleman is absolutely right. Support is needed particularly for small businesses who may struggle to understand and source what is required to support people, and to have the confidence to do so and the understanding that it is a positive investment in their workforce. He makes a really important point. I am also very glad that he cited the scale of the issue in Northern Ireland. One in four is incredibly high, so we need a focused response as a matter of urgency, and I thank him for that point.

There should be absolutely no stigma around having an MSK condition, nor for asking for help in relation to it. For example, in an office environment, it should be common practice that employees are made to feel comfortable in speaking up if they face issues, and that adjustments and equipment such as sit-stand desks, voice recognition software, a vertical mouse, split keyboards and other ergonomic computer equipment are made available to people if that would support their MSK health.

The strategy to which I have referred should be launched alongside a large public awareness campaign so that everyone can be involved and benefit. The Access to Work scheme provides important support for people who are disabled or have a health condition that impacts on their ability to get work or stay in work, but it seems that not nearly enough people know about it.

There has been much evidence to suggest that many people who could benefit from the scheme do not know that it exists. Indeed, I have heard it referred to as the Government’s best-kept secret. In 2021-22, only around one in eight—just over 4500 people—who received support from Access to Work had an MSK condition. The Work and Pensions Committee has highlighted that the application process can be complex and difficult for people to navigate. We therefore need a much greater effort from the Government to raise awareness of the scheme and the benefits that it can bring.

For example, the Government could make it a legal requirement for all employers to inform new and existing employees about Access to Work and to provide a point of contact for any employee who thinks they might benefit from it. This would highlight and promote the scheme, and it would give the opportunity for expertise to be developed within workplaces to support MSK health.

The Government must also give thought to the fact that over 7 million adults in England have very poor literacy skills. It is vital that information about the scheme is presented in a way that is easy for them to understand. Last year, the Government published their “Transforming Support” White Paper, which, among other things, pledged to pilot a new Access to Work enhanced package for people who need more support than the existing scheme can provide. How does the Minister envisage that that will benefit those with MSK conditions specifically? The White Paper also spoke of Access to Work developing an innovative digital service. Will the Minister guarantee that changes will be mindful of the fact that so many adults struggle with literacy and digital skills?

It is disappointing that the Government are failing to administer the Access to Work scheme promptly. In a response to a written question from my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who will respond on behalf of the Opposition this morning, the responding Minister said that 21,780 applications were outstanding on 5 September last year. That is 21,780 people waiting to receive support for their health condition. It is completely unacceptable. I ask the Minister to update the House on the current state of affairs.

The last Labour party manifesto committed to help disabled people who want to work by bringing back specialist employment advisers and introducing a Government-backed reasonable adjustments passport scheme to help people move between jobs more easily. In their White Paper, the Government said:

“Access to Work is supporting a series of Adjustment Passport trials. The Adjustment Passport will provide a living document of the disabled person’s workplace adjustments, general working requirements and signposts adjustment support at every stage of the journey into work.”

Will the Minister give more information on these trials and how they are going? Can she say what actions her Department has taken to ensure that the passports are user-friendly for people who have problems with literacy?

The Government can promote MSK health and prevent issues from arising through specific campaigns developed with the expertise of health professionals and occupational therapists. They can also legislate for good working practices. It is important that the Government lead on creating positive workplace cultures around promoting MSK health, but for this to be most effective, they need to look at the issue from the employee’s perspective. Under the Equality Act 2010, employers must make “reasonable adjustments” to workplaces, working practices and policies or procedures, to remove or reduce any disadvantages faced by workers that are related to their disabilities. However, it can be difficult for people to raise concerns in the workplace, especially if their job is insecure. People on zero-hours contracts are a particular risk in this regard.

One of the key sectors in which MSK has an impact is transport and logistics, and we know that many delivery drivers are on zero-hour contracts. Health and care is another key sector affected; again, many in the care sector are on zero-hour contracts. Clearly, then, banning zero-hour contracts, as Labour would do, is important not just to ensure that people know that they have stable work and a reliable income, but to prevent a race to the bottom in health and safety at work. The Health and Safety Executive is responsible for inspecting organisations and enforcing statutory duties in relation to health and safety law. The HSE can investigate businesses and has the power to bring enforcement proceedings, including prosecutions, in cases of serious failures. Its work is incredibly important, yet the HSE’s funding has been savagely cut since 2010.

Analysis last year from the Prospect trade union found that Government funding for the HSE decreased by 45% in cash terms between 2010 and 2019, from £228 million to £126 million. Funding increased to £185 million in 2022, but this still represents a huge decrease from 2010 levels. Prospect’s research also highlighted staff cuts of 35% across the HSE since 2010, while the number of inspectors has fallen by 18%. These cuts are an attack on the health and safety of all of us, and I call on the Government to review the needs of the HSE and restore funding to at least 2010 levels. We cannot allow the Government’s obsession with austerity to damage our health and safety.

The Government could also promote MSK health and prevent issues from arising by supporting the “Better Bones” campaign, which is led by the Royal Osteoporosis Society and the Sunday Express and backed by many organisations, including the Federation of Small Businesses, Parkinson’s UK, Coeliac UK and a number of unions and royal colleges. Some 50% of women and 20% of men over the age of 50 will have a fracture caused by osteoporosis—staggering rates. A third of those who have a fracture and have osteoporosis will have to leave their jobs.

Fracture liaison services can do invaluable work in identifying whether people have osteoporosis. However, only 51% of NHS trusts in England have them. As a result, many people will break bones and go to A&E, and will be seen without their underlying osteoporosis being diagnosed and treated. That leaves a massive risk that they will suffer further, more serious fractures in the future. As a result of this postcode lottery, around 90,000 people a year are missing out on important diagnosis for a condition for which they could otherwise receive medication that would reduce their risk of further fractures.

The “Better Bones” campaign is calling for access for all over-50s to fracture liaison services with dedicated bone specialists, £30 million a year of extra investment to make fracture liaison services universal in England, Wales and Scotland, and the appointment of a fractures tsar for each British nation. It was therefore extremely disappointing that there was no extra funding in the autumn statement for fracture liaison clinics, despite the Minister in the Lords saying in September:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality. NHS England is also setting up a fracture liaison service expert steering group”.—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

That is especially disappointing from a Government who claim that they want to try to help people over 50 to get back into work. It is disappointing too that, in July, the then Secretary of State for Health and Social Care said that the Government planned to spend more than £8 billion from 2022-23 to 2024-25 to support elective recovery, with NHS England prioritising fracture liaison services in its elective recovery plan. However, in the end, fracture liaison services were not even mentioned in the elective recovery plan.

The Government must address the shortcomings in fracture liaison services, which would contribute to helping over-50s back into work, and I ask the Minister to press this point with ministerial colleagues. As the Federation of Small Businesses said of the “Better Bones” campaign, it

“is more than a health initiative—it’s a matter of economic vitality. We need to address the increased numbers of those who have left the workplace as employees, self-employed or small business owners themselves due to sickness. This campaign is one of those steps.”

The Government can support workers with MSK conditions, too, by ensuring flexible working from day one, as a Labour Government would do. We also need to see action from Government on people’s general health and MSK conditions through investment in the health and wellbeing of all communities.

Versus Arthritis argues that being overweight or obese increases the risk of developing arthritis conditions such as osteoarthritis and gout. It also points out that swimming is a good exercise for people with musculoskeletal conditions, such as arthritis or back pain. The water helps to support the weight of the body, which reduces strain on painful joints. The Government should also promote MSK health by ensuring people can access facilities such as swimming pools and leisure centres.

Sadly, central Government cuts to local government since 2010 have resulted in many pools and leisure centres closing across the country, including in my own constituency of Wirral West. During the campaign to save the Woodchurch Leisure Centre and swimming pool, I remember people telling me how they used the pool to cope with arthritis. The loss of this facility has been devastating for many people trying to manage MSK conditions in my constituency and it is doubtless the same for people across the country.

Government strategy must look at the impact of austerity policies on sport and leisure facilities and at the impact that this has on the health of the population. Musculoskeletal issues cause serious problems for millions of people and can have a devastating impact on an individual’s working life. The high prevalence of such conditions warrants a high-profile, cross-departmental policy intervention. I to pay tribute to all those who work so hard to promote safe and healthy working environments, including the HSE professionals, occupational therapists and of course hard-working trade union health and safety reps who do such invaluable work in identifying workplace issues and campaigning for greater safety for working people.

The Government must bring forward a cross-departmental MSK strategy with clear goals to improve prevention and to support those with MSK conditions. Failure to do so will only lead to continuing costs to people’s health and happiness and continuing costs to the Exchequer for NHS and social security spending. The benefits of taking action on MSK are clear to all, and I call on the Government to do just that.

Heart and Circulatory Diseases (Covid-19)

Debate between Jim Shannon and Margaret Greenwood

Thursday 23rd June 2022 Commons Chamber

[Jim Shannon]

I thank the hon. Gentleman for his kindness. The Backbench Business Committee is kind to everyone who applies for a debate, so I am always very pleased to do so, and on a regular basis. It will not be too long before I am back looking for more debates.

On this debate, I put on the record my thanks to the Committee. I am pleased to see that Members from across the House are involved, although I am mindful that today right hon. and hon. Members have many other engagements that mean they are unable to be here, even though the debate is in the main Chamber.

It is just over two years since the start of the lockdowns, and a little more since the pandemic first arrived. Life changed for everyone—I do not think there is anyone in the United Kingdom of Great Britain and Northern Ireland who did not have a life-changing moment—and for some of us it may never be the same as it was. It will never be the same for those who have lost loved ones; that is very real for every one of us. Some of the changes that took place due to the pandemic and covid-19 were cosmetic, but others have been life changing, and it is those changes that we need to address.

I want to say a massive thank you to all the doctors, nurses, auxiliary staff and cleaning staff—there are so many to name—who have been outstanding. There is nobody in this House who does not know some of them, has not spoken to them and does not also want to put that on the record as well. I thank them at the beginning of this debate.

During lockdown, barriers and obstacles to providing care for heart patients and all patients rocketed. I know that happened across all health departments, but in particular I thank the British Heart Foundation and the Stroke Association for all the information, detail and evidence they sent to me and others for the debate. We are very pleased to have that.

Some of those efforts by doctors were heroic; I do not use that word often, but on this occasion it is a word that aptly describes their efforts. Despite those heroic efforts of doctors, nurses and other key workers in our health systems, however, we have seen cardiovascular services disrupted so greatly that people are still feeling the effects today.

I am beyond thankful for every NHS staff member who went ahead with emergency surgeries. The reality of life for elected representatives is that we do not get many people coming and saying, “Thank you very much for that.” We get the complaints, but that is what we do. We are a conduit for their complaints and concerns. Some of the people were waiting for emergency surgery were not sure whether they would pay a price for that, so again for that I sincerely say a big thank you.

We are all aware of the waiting lists, reduced access to primary care and the pressures on urgent and emergency care. They all have real consequences for people’s health. That is why hon. Members pushed for this debate and why we are so pleased to have the opportunity to hold it today in the main Chamber. I feel incredibly privileged, honoured and humbled to be able to present this case—not for me, because I am not important, but on behalf of our constituents who have experienced hardship because of those things.

Those problems have also had real consequences for families’ lives, their relationships and the happiness of their families. Very often, the issues for those who were ill reflected back on the families, who were under incredible pressure to deal with circumstances that would be difficult to deal with normally but that, with covid-19 and the pandemic, escalated even more. There are 11,000 people living with heart or circulatory diseases in my constituency. I know the Minister does not have responsibility for Northern Ireland, but I will provide examples from Northern Ireland that are relevant across the whole of the United Kingdom of Great Britain and Northern Ireland. There are 2,000 stroke survivors and 13,000 people who have been diagnosed with high blood pressure.

Long waits, difficulty accessing routine medical services and long ambulance response times make life more difficult for the 7.6 million people living with heart and circulatory diseases in the UK. I mention those issues not as a criticism, but to highlight them and raise awareness. Ambulance response times in many parts of the United Kingdom, including in my own constituency, have been difficult, as have been the waiting times outside accident and emergency departments, with ambulances in place. That is happening not just in Northern Ireland but elsewhere, as I am sure other hon. Members will confirm.

Someone in the UK dies from a heart or circulatory disease every three minutes. This debate has been going for six minutes, so that means two people will have died from heart disease since it began. By the time the debate is over—it is a stark headline, unfortunately—as many as 20 people will have passed away. That statistic reminds us of the fickleness of life. It also reminds us of what this debate is about and why we are here. Someone is admitted to hospital due to a stroke every five minutes. Indeed, someone will have been admitted to hospital since this debate began. Two thirds of patients leave hospital with a disability. Stroke as a standalone condition costs the UK economy £26 billion annually, yet it is largely preventable and recoverable.

I look forward very much to hearing the response to the debate from the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup). I know she is very committed to her job and has a deep interest in it, so I look forward to what she has to say in response to the questions we will ask her today. I also look forward to hearing from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who is a good friend and with whom I seem to be in debates all the time. If we were not in the Chamber today, we would be in Westminster Hall.

Northern Ireland Chest, Heart and Stroke highlights that there were 15,758 recorded deaths in 2019. That is some figure and it is worrying. The top three causes were cancer, circulatory diseases and respiratory diseases; together, those accounted for 64.3% of all deaths in Northern Ireland. That figure reminds us of just how fickle life is and that we are just a breath away from passing from this world to the next. They have been the three leading causes of deaths since 2012. Deaths due to chest, heart and stroke conditions, when combined, are the No. 1 cause of death, at 36%. As I said earlier, that reminds us why this debate is so vital and why we look to the Minister for a response that can help us, encourage us and give us some hope for the future.

These are some of the most prevalent, serious and life-altering conditions that anyone could have the misfortune to suffer from. They touch everyone’s lives, be they in Northern Ireland, where my Strangford constituency is, Scotland or Wales—or England, with whose health matters this House is primarily concerned. I also very much look forward to hearing from—I apologise; I should have said it earlier—the hon. Member for Motherwell and Wishaw (Marion Fellows) on behalf of the SNP. She has a deep interest in health, too, and I look forward very much to her contribution.

Every one of us has a neighbour, a friend or a loved one who has problems with their heart. Those problems do not halt at any border. They do not even, dare I say it—rather mischievously, perhaps—stop at the Irish sea border, which is able to prevent most things from crossing over. What prevents them from getting the care they need? The most obvious issue is undoubtedly waiting lists, which are at record levels. One of the questions I would like to ask the Minister—I always ask such questions constructively; that is my way of doing things—is: what is being done to reduce waiting lists and to provide some hope? According to NHS England, only this month the queue for NHS care stood at 6.5 million, the highest number on record ever. The number of patients waiting more than a year to be seen has increased to 323,000, which is a massive number. These are record levels as the health sector recovers from the impact of the pandemic.

Although the pandemic has hugely affected waiting lists, the issue predates the pandemic. At the start of 2020, around 30,000 people were waiting more than 18 weeks for cardiac care. This problem was not caused by covid, but it was exacerbated and worsened by covid. If it was bad before, it is much worse now.

The pandemic has had a seismic effect. In April 2022, two months ago, 170 times more people in England were waiting more than a year for heart procedures than in February 2020. I look for an indication of how we can reduce that number, and I know there is a strategy. I am putting this constructively, because I believe there are ways to do it, and the hon. Members for Denton and Reddish and for Motherwell and Wishaw, other Members and I are keen to hear what they are. Waiting lists for cardiac care have also hit record levels, rising to 319,000 people. In Northern Ireland there are 31 times as many people waiting more than six months for cardiac surgery compared with the end of 2019.

And it is not only life-saving surgery, as some of this surgery is about people’s quality of life. Waiting times for echocardiograms, a kind of heart ultrasound used to diagnose a range of conditions, have risen, too. More than 170,000 patients were waiting for an echocardiogram at the end of April 2022, with 44.6% of them—almost half—waiting more than six weeks. That is a 32% increase on the year before. The covid-19 pandemic has increased those numbers, and I am not blaming anyone for that, but we need to address these issues, both as a Government and collectively, in a way that gives succour and support to our constituents.

In Northern Ireland, the number of people waiting more than six months for a cardiac investigation or treatment reached a new record in March 2022. That is the responsibility of Robin Swann, the Health Minister in the Northern Ireland Assembly, and I know he has taken steps to try to address it, but this is a general debate about how we address heart and circulatory diseases across the whole United Kingdom of Great Britain and Northern Ireland following covid-19.

Nearly three quarters of people in Northern Ireland waiting for an echocardiogram have waited longer than the recommended clinical maximum. A number of worried, heartbroken family members have come to my office to say that covid is killing their loved ones, even though they did not have covid themselves. The delays were and continue to be a threat to life. Covid-19 does not seem to result in the number of hospital cases that it once did, which is good news.

Although an echocardiogram is not open-heart surgery, delays still cause increased anxiety for patients and delay the treatment they need. Taken as a whole, cancelled operations risk a rise in avoidable deaths and disability, and they cause anxiety and put physical pressure on people with heart problems.

What can we do about this? The British Heart Foundation is watching this debate, and I thank it for giving me most of my information. I also have a staff member who is qualified in this, and she has given me some information, too. I am proud to work with the British Heart Foundation, which has welcomed the additional funding for the NHS and the announcement that 95% of patients who need diagnostic tests will receive them within six weeks by 2025. It is good news that we have a target but, with respect, that target is a few years away. We need to consider how we address the situation over the intervening three years. The foundation has also pushed for an accompanying Government strategy for cardiovascular disease to take us beyond recovery and address the problems that existed before the pandemic.

With all that in mind, we need to think about how we can do better and support those who need help today. The NHS long-term plan identifies cardiovascular disease as

“the single biggest area where the NHS can save lives over the next 10 years.”

If there is one issue I would love us to tackle, it is how we can save lives. I am ever mindful of the statistic I cited earlier that every three minutes someone dies as a result of heart problems. If we can save lives, that is what we want to be doing. We know that the NHS is doing all it can to deliver cardiovascular services, but without a properly funded cardiovascular disease strategy, it cannot meet its targets and deliver adequate care. When will a strategy be put in place to address the issues in the short term?

What else would such a strategy address? Cardiovascular diseases have many and varied impacts on patients, who need different forms of care as a result. Access to primary care is integral to the identification and management of heart conditions. When people cannot access primary care, opportunities to prevent heart attacks and strokes are lost, and more problems are caused for those who are already under pressure. How do we address that issue?

A 2021 survey of 3,000 heart patients found that 12% had a routine medication or condition review cancelled or rescheduled in the first year of the pandemic. I understand that the pandemic was not the Government’s fault; the Government are to be complimented and thanked for how they responded to it, because we are all beneficiaries of the vaccination programme and it is probably why some of us are alive today. However, the cancellation or rescheduling of routine medication or condition reviews explains the longer waiting lists. Four patients in 10 have had appointments cancelled or rescheduled more than once. I know people back home who have actually fasted for an operation and then been told that it would not go ahead, which has caused anxiety and worry.

Health Foundation analysis shows that 31 million fewer primary care appointments were booked between April 2020 and March 2021 than in the previous 12 months. The pandemic has also had an impact on how patients with heart and circulatory disease interact with primary care. Some people say that there are lies, damned lies and statistics, but statistics prove a point: there were 5 million fewer face-to-face GP appointments in 2020 and in 2021 than in 2019. We understand the reasons why, but we have had a lot of debates in this Chamber and in Westminster Hall about GP appointments, and there is not one of us who would not wish for the number of appointments that we once had. My constituents tell me that, and I am anxious and keen for appointments to return.

Many people welcome the flexibility and safety that remote appointments bring, but they can mean that healthcare professionals lose the opportunity to collect information that they usually gain through physical examination. Constituents have told me that their ailments and problems would be better assessed physically. The quicker we move back to physical assessments, the better. Someone cannot really be diagnosed at the other end of a Zoom call; they can say what their issues are, and by and large the doctor may get a fair idea, but in many cases it takes a physical examination. The situation is no one’s fault, but it may lead to a delayed or even missed diagnosis of a condition such as high blood pressure. I take a Losartan tablet for my blood pressure every day; I was told by my doctor not to worry about it, but after he told me I would have to take it every day, he said, “By the way, you can’t stop it.” At that stage, I realised that it is necessary to keep me on the straight and narrow and keep me breathing, so perhaps in a small way I understand the need to control blood pressure.

We do not know for sure how many missed diagnoses there have been but we do know that the NHS issued 470,000 fewer prescriptions for preventive cardiovascular drugs between March and October 2020 than in the same period of the previous year. The Institute for Public Policy Research forecasts that if those missing people with high-risk cardiovascular conditions do not commence treatment there will be an additional 12,000 heart attacks and strokes in the next five years. I ask the Minister what is being done to find those who have not been prescribed these preventive drugs over the last period of time, mindful that the unfortunate end result of that is more heart attacks.

This is a ticking time bomb, and we need to defuse it if we are to meet NHS long-term plan aspirations to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29 and, more importantly, if we are to be able to look those families in the face. Behind every person who dies of a heart attack there is a grieving family; we know that probably personally and certainly from constituent cases. As the Good Book says, we have threescore years and 10; we might get less than that or we might get more, but one thing we do know is that our time will pass. We must address the issue of preventing heart attacks, strokes and dementia.

At least half of the 15 million adults in the UK who have high blood pressure are undiagnosed. We all need a bit of stress; it is part of life, and I thrive on a bit of stress, but we can only take so much and it is important to find the right balance. Many of those with high blood pressure are not receiving effective treatment. It is vital to find people early and support them to manage cardiovascular risk factors such as atrial fibrillation. The Automated External Defibrillators (Public Access) Bill was introduced in the House not long ago, with support from all parties; I hope the Government will support its progress so its measures can be introduced in health and education settings. Finding the people with conditions early is vital; we must try to help people manage conditions such as raised cholesterol and hypertension so they can longer and healthier lives.

However, we cannot do that if we do not know who they are, which shows that data is important; it comes up in almost every health debate I participate in. To be fair, the Government and the Minister understand this, as data helps to focus on the right strategy and develop it in a constructive way based on evidence. I ask the Minister to put on the record where we currently are in relation to the collection of data, as it will point the way forward.

Some patients do not need to be found, however, as they or a loved one call 999 because of a medical emergency. For cardiovascular conditions, that normally means they have had a heart attack or stroke. A fast response that gets the right person to the right hospital department at the right time in an ambulance can be the difference between life and death. The newspapers often present examples of ambulances not arriving in time for whatever reason and people passing away. Unfortunately, in England the average response time in May for a category 2 emergency such as a heart attack or stroke was almost 40 minutes; we must do better. The target is 18 minutes; it is not being met.

I did not manage to source the corresponding data for Northern Ireland, but I know personally of one 70-year-old lady who had called believing her husband was having a stroke. She was told to give him an aspirin to chew and that the ambulance was delayed. She was then told in another phone call, which was fairly frantic, that if possible she should bring him herself to hospital, so she dragged him to the car—he is a fairly big man—and arrived at the hospital crying and begging passers-by to help. This man was diagnosed with some form of hernia which presented like a heart attack, and I thank God for that because he could have died waiting on the ambulance and then waiting on his elderly wife to trail him to a car and on to a hospital; that is simply not good enough.

Owing to the scale of current ambulance and A&E delays, we will see more disability and deaths from heart and circulatory disease that could otherwise have been avoided, but if we can avoid them—if we can do things better—the debate will have achieved its goal. This is happening despite NHS workers and paramedics going above and beyond the call of duty to help those in need. I used the word “heroic” earlier, and I use it again now. It is not a word that is taken out of context when I apply it to those workers. Ambulance delays are the symptom of a system that is under immense pressure at every level. Problems in one part of the NHS affect other parts. Problems with accessing primary care lead to more emergencies, which means that, again, there is a greater demand for ambulances.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Gentleman is making an excellent speech, and I commend him for securing the debate. He mentioned the waiting times for category 2 emergencies. A constituent of mine lost her mother because the ambulance took more than an hour to arrive. This is a heartbreaking situation, and no family should have to go through it. Does the hon. Gentleman agree that we need urgent action to improve ambulance attendance times?

[Jim Shannon]

I certainly do, and I am sorry to hear of the passing of the mother of the hon. Lady’s constituent. If the ambulance had arrived earlier, perhaps she would be alive today. That example is probably replicated throughout the United Kingdom of Great Britain and Northern Ireland; I know that it is in my constituency, and indeed elsewhere. Perhaps when the Minister responds to the debate, we will hear some indication of how this could change.

A holistic response is needed. The NHS cannot begin to address this crisis, the very crisis to which the hon. Lady has just referred, without significant help from the Government—again, I look to the Minister—in the form of a cardiovascular strategy covering the whole patient pathway, as has been called for by the British Heart Foundation, which is also calling for a similar strategy in Northern Ireland. While the BHF wants the strategy in England, of which the Minister will be aware, to be replicated in Northern Ireland, I suspect that the same applies to Scotland and Wales.

The UK strategy, at its core, needs to address the issue of the workforce. Just as workforce shortages are key to issues involving waiting lists, access to primary care and ambulance delays; solving those shortages must be key to the response. I know from statements that Ministers have made, both in the Chamber and in Westminster Hall, that they are committed to increasing the number of nurses, doctors and other staff in the NHS, and the figures are certainly very encouraging. We have not yet reached the targets of 50,000 nurses and 20,000 GPs, but the Minister may be able to give us some timescales and some idea of when the Government hope to achieve those targets.

People who are at risk of cardiovascular diseases, and those already living with them, are supported by a diverse range of health professionals—paramedics, cardiographers, and specialist cardiac nurses—but the 2021 “Getting It Right First Time” cardiology report estimates that the NHS is short of nearly 100 consultant cardiologists; there are currently about 1,700. Perhaps the Minister will be able to tell us when those 100 vacancies will be filled. I ask these questions with the aim of being constructive and ensuring that our constituents throughout this great nation have a better idea of what is going to happen. It is said that we also need 760 new cardiac physiologists to meet the demand over the next decade. Is there a strategy and a recruitment plan? If there is, we will be greatly encouraged. I look forward to the Minister’s response.

[Margaret Greenwood]

I thank the hon. Gentleman for being so generous with his time. He has talked about shortages, and how we should plan for the future. A number of my constituents have written to me about the financial difficulties experienced by medical students, particularly during the final two years of their training. Does the hon. Gentleman agree that the Government really need to come up with a plan to protect and support student doctors, so that we can have the workforce that we need for the future, and ensure that people from all backgrounds can have a career in medicine?

[Jim Shannon]

I thank the hon. Lady for that helpful intervention. I am glad that she mentioned that: it should have been in my notes and she has reminded me. We do need to have a plan to help those students who wish to pursue a future vocation as consultant cardiologists. If we can recruit them now, it will take three, four or even five years before they are ready. I am not sure whether it is the Minister’s responsibility, but perhaps she could give us some idea of whether there is a plan to give students some financial assistance. I have asked the question before, and the answer would be very interesting. If people make a commitment to staying in the NHS for that period of time, perhaps the Government can make a financial commitment to them.

National Health Service Funding

Debate between Jim Shannon and Margaret Greenwood

Tuesday 22nd November 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is not often that the people who come last get more time to speak, so thank you very much for that, Madam Deputy Speaker.

The speeches by right hon. and hon. Members from all parts of the Chamber have been exceptional. We should focus on the good things in the NHS, which everyone in this Chamber acknowledges. The passion that we hear in debates like this often comes out of what our constituents tell us.

[Margaret Greenwood]

Does the hon. Gentleman share my concern about the introduction of ACOs through the STPs, which come from America and are often used in insurance-based models of healthcare? Because people here do not pay for healthcare, except through direct taxation, but do pay for social care, there is a lot of concern about the blurring of the boundaries and a worry that we will wind up with people being asked to take out health insurance.

[Jim Shannon]

I agree wholeheartedly with the hon. Lady. Madam Deputy Speaker mentioned how fast she speaks; perhaps she is trying to take away my record. The hon. Member for Vauxhall (Kate Hoey) says that I do more words to the minute than anybody else in the House. Perhaps the hon. Member for Wirral West (Margaret Greenwood) is trying to take that mantle, but we will see.

I am the health spokesperson in the House for the Democratic Unionist party. It is a portfolio that needs to be balanced, and we should look for the greater good at every stage. In my opinion, it is the most difficult portfolio for anybody to hold. I am glad that I am not in the position of the Secretary of State for Health, because I would find it difficult to say to a person, “We cannot supply the drugs that you need to prolong your life, but we are hoping to save the life of the person beside you. We need the money to save, rather than prolong, life.” The hon. Member for Monmouth (David T. C. Davies) referred to sofa-surfing and the lottery for those who need access to drugs. Although I do not envy the Government in having to make such decisions, I cannot sit back and not highlight the difficulties that exist within Government funding and the fact that the NHS must have more designated funding to keep it running.

I read with interest the briefing provided by Macmillan. It sent chills down my spine. By the end of this Parliament, about one in every two people will be diagnosed with cancer in their lifetime. I look around the Chamber today and remember that those statistics include us and our loved ones. Indeed, there are some Members in the Chamber who have experienced cancer and are survivors. My own father battled and won against cancer three times. I am aware of what that battle entails, and how much of it is based on the right diagnosis and treatment, the availability of that treatment, the skill of the surgeon’s knife and the prayers of God’s people—those are all very important. It is clear that improvements in diagnosing and curing the disease mean that more people surviving it are living for longer with it; some 2.5 million people are living with or beyond cancer in the UK today.

In my opinion, more must be done to help those with rare diseases and rare forms of cancer. Will the Minister give us an indication of what funding and resources will be set aside for them? Those rare diseases and cancers are increasing. Put together, those conditions affect a large number of people. I know that funds are not infinite, but we must focus on those with rare diseases and with rare forms of cancer.

I will mention a tremendously courageous lady—I hope she will not mind me mentioning her name in this Chamber—who works in my constituency, called Aundrea Bannatyne. She watched her son battle cancer and triumph, only to be told that she had pancreatic cancer and that there was no treatment for it in Northern Ireland. The help she needs will cost up to £100,000 and the people of the area where she lives, Dundonald, have dug deep to help fund that.

That lady’s story could be replicated in the constituency of every Member in this Chamber, across the whole of the United Kingdom of Great Britain and Northern Ireland, but the postcode lottery says that she cannot have treatment because she lives in Northern Ireland. However, she would be able to access it in other counties on the mainland, which is something that the hon. Member for Monmouth referred to. That lottery is not what is needed. We need treatment in all areas. That must be addressed by additional funding. Aundrea needs more than us wringing our hands and being sympathetic. She needs practical, physical help. That is the only thing that can change her hopes for her future and her son.

Macmillan has said that one in four people living with or beyond cancer face disability or poor health following their treatment. That can remain the case for many years after the treatment ends. It is vital that they can access the best care—the care that is right for them—when they need it. The NHS must be able to meet the changing needs of cancer patients. That would not only increase the quality and experience of survival, but ensure that resources are invested in the most effective way. That is key, given that the five year forward view projections indicate that expenditure on cancer services will need to grow by some 9% a year, to £13 billion, not to get ahead but simply to stand still. That level of spending is likely to yield outcomes that continue to be below average when compared with similar international healthcare systems. We must therefore act now to ensure that the money is spent as effectively as possible, to give England and the United Kingdom of Great Britain and Northern Ireland a better chance to achieve world-class cancer outcomes and deliver the Government’s manifesto commitment.

The health service currently spends more than £500 million a year on emergency care for people with the four most common cancers alone. If we are spending £500 million on emergency treatment for cancer, there is something wrong with the system that we have to address effectively. Emergency care should be a last resort for people living with cancer. Such a vast amount of emergency care spending is symptomatic of a system that is not geared towards helping people take control of their health.

I am conscious that the hon. Member for Bury St Edmunds (Jo Churchill) is waiting to contribute, so I will conclude with this comment. Let us make the right decisions to sustain the NHS as it is—never mind give more, which is what people actually need. If that means taking simple things such as paracetamol off the prescription list, to save £80 million, let us do it.

Let us look at real issues that can make a change. Let us do the simple things for the greater good, and let us determine to be more efficient where possible and cut unnecessary red tape rather than services. Let us ensure that our NHS can withstand not only the surge of cancer diagnoses but the surge of diabetes—other Members have referred to that—heart disease, and all other major illnesses, which are only worsening. I do not envy the Minister’s task, but we have to make hard choices. We have to get the funding in the right place, and make decisions that take away bureaucracy and restore funds where they are needed—to cancer, rare diseases and rare cancers.

Cockling: Dee Estuary

Debate between Jim Shannon and Margaret Greenwood

Tuesday 19th July 2016 Commons Chamber

[Margaret Greenwood]

That is an interesting point. I certainly know that a number of families in my constituency have been involved in cockling for a great many years.

My constituents feel that the Environment Agency is not representing them adequately, and that, as Natural Resources Wales is an agency of the Welsh Administration, its responsibility is obviously to people in Wales rather than those in England. They have spent months making requests for access to the accounts showing the fishery costs, which have been released in a piecemeal fashion. They have made repeated requests to see the full accounts, but have been provided with only a summary, which has led them to conclude that the fishery is not being managed properly.

My constituents believe that they are being overcharged for their licences because Natural Resources Wales is not acting in a cost-conscious or effective way. They are concerned about the lack of scrutiny of NRW by the Environment Agency and the lack of attendance by EA representatives at meetings, and that is clearly an issue. After submitting numerous freedom of information requests, they were given sight of a document: references from the minutes and papers of the partnership board meetings to Dee Services and transfer of functions. The Partnership Board executive summary of 6 October 2015 states:

“NRW are under pressure from fishermen (who fish the Dee River Cockle Beds), for a meeting. NRW would like EA representation at this meeting but local EA staff are unwilling.”

The Environment Agency apparently pays £18,000 a year to Natural Resources Wales to manage the cockle fishery, but, according to my constituents, that figure never appeared in the accounts before 2015. I should like the Minister to tell me exactly how much the Environment Agency has paid Natural Resources Wales in each year since 2012, and how much scrutiny the Environment Agency is giving to how the money is being spent. The lack of oversight of the way in which money is spent is of real concern.

Last year I asked the Minister what enforcement measures the Department had undertaken in relation to illegal cockling on the River Dee, how many prosecutions for illegal cockling had been brought in each year since 2010, and how many prosecutions had been successful. The Minister replied:

“All cockle fisheries within the Dee Estuary are controlled via the Dee Estuary Cockle Fishery Order 2008. Enforcement of the Order is a matter for Natural Resources Wales (NRW) as grantee of the Order.

Defra does not have information pertaining to the specific enforcement measures taken by NRW on illegal fishing occurring within this fishery.”

My follow-up question is this: why does Defra not have that information? It is paying NRW to manage the fishery, so it should have some interest in how the money is being spent.

More importantly, not only are my constituents paying for bailiff activities via their licence fee, they have also been told that it will pay towards unsuccessful prosecutions. I have asked the Minister how much the Department has spent on the management and enforcement of cockling rights in each year since 2010 and what information the Department holds on equivalent spending by the Welsh Government. The Minister’s response was to state:

“DEFRA does not hold this information.”

Why does it not hold this information? Last year the cockle beds were closed for quite some time, so I ask the Minister what discussions have taken place with the Welsh Government on, first, the management of fish, mussels, cockles and other seafood stocks in the river estuary; secondly the reasons for the closure of the cockle beds in the estuary; and, thirdly, the projected date for the reopening of the cockle beds?

[Jim Shannon (Strangford) (DUP)]

The cockle industry is also important in my constituency. With advances in technology and environmental science there is great potential, but does the hon. Lady agree that ensuring that the jobs of local fishermen continue must be the priority for future legislation?

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention and he makes a good point: it absolutely is important that we protect the jobs of those currently engaged in the industry, as they have been for generations.

To return to the Minister’s response, he stated:

“Fisheries is a devolved matter, and the Dee Estuary is a cross border fishery which is managed by the Welsh Government and Natural Resources for Wales for the Welsh part of the estuary. For the English part of the estuary, fisheries management is covered by my Department, the Environment Agency, the Marine Management Organisation, and the North West Inshore Fisheries and Conservation Authority.

However, Natural Resources for Wales (NRW) has responsibility for managing the cockle fishery in the Dee Estuary (on both the Welsh and English sides) as grantee of the Dee Estuary Cockle Fishery Order 2008. NRW has taken the decision to not open the fishery this year due to insufficient stocks. It has suggested that it may be opened in July 2016 should sufficient stock be available. I have not had any direct dealings with counterparts in Wales within the Dee Estuary fisheries management context or specifically in relation to the closure of the cockle beds.”

Does the Minister believe it is fair for NRW to charge cocklers the full licence fee for a season when that season amounts to only a few days? Cocklers are not doing this as a hobby; this is their livelihood, and if they are unable to access the beds they have no income. The cocklers are concerned that under the bird food modelling system used by NRW, a closed season will become the norm but they will still be expected to pay for a full licence and eventually be driven out of business by this cost.