Antimicrobial Resistance

Debate between Jim Shannon and Maria Caulfield

Wednesday 17th April 2024 Westminster Hall

[Maria Caulfield]

That goes back to my first pillar of reducing and preventing infections in the first place. We need to do that domestically, but internationally we are also doing huge amounts of work in that space to improve water sanitation. With animal health, too, we have done a huge amount of work, in particular on antibiotic use in food. Among animals used in food production, the UK has reduced by 59% the amount of antibiotics going into the food chain, which has a knock-on effect.

We are also investing in innovation and capitalising on our world-leading science, including phage therapy, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark) pointed out. I had not heard about the Leamington Spa facility, and I am interested to catch up with him after the debate to see what more can be done. The National Institute for Health and Care Research is investing almost £90 million in that type of research, so if there is potential to develop that further, we are always keen to hear it. Our plan is cross-sectional, a one health approach, recognising the links between the health of humans, animals and the environment, and the spread of resistance between them.

We have a national action plan, which is not limited to activity in the UK. We all know that infections do not respect borders. As my hon. Friend the Member for Colchester said, we are therefore working internationally and taking a lead in many elements of that across the global community, with our UK special envoy on antimicrobial resistance, Dame Sally Davies, spearheading some of the effort. On updating my hon. Friend on the action plan post 2024, we are working it up as we speak and hope to make an announcement soon. There is an ongoing piece of work to drive forward some of the changes across the three sectors.

We are doing our bit here and are leading internationally, but my hon. Friend also touched on what is happening in other countries. Low and middle-income countries have to be part of the change so that we can safeguard ourselves against antimicrobial resistance.

[Jim Shannon]

One of the groups that I speak to reminded me to mention—I quote—

“the need for Group B Strep screening in pregnant women during labour instead of using antibiotics for all routinely.”

The Minister is interested in that subject and has an opinion on it. Does she agree that this is a chance to raise awareness of that particular issue?

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Wednesday 7th February 2024 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I am always encouraged by the number of young ladies and girls who wish to be involved in science, technology and mathematics in Northern Ireland. They can do the job every bit as well men. Is it not important to ensure that companies that wish to employ people do more to encourage young ladies to take up jobs?

[Maria Caulfield]

The hon. Member is absolutely right. The Government cannot do it all; we need industry, and there are some great examples. We have a £17 million scholarship programme for artificial intelligence and data science conversion courses. We also have the UK Space Agency investing £15 million into diverse workforce streams, particularly to help young women get into the sector. He is right that we need to work hand in glove with industry.

Children’s Mental Health Week 2024

Debate between Jim Shannon and Maria Caulfield

Tuesday 30th January 2024 Westminster Hall

[Maria Caulfield]

The hon. Lady is making my argument for me. We are seeing a significant increase in demand, and that is why we are spending more on rolling out these services. She did not welcome the progress we are making on mental health support teams across our schools, or the fact that we are set to announce new mental health support hubs across England.

Last year we published our new suicide prevention strategy; my hon. Friend the Member for Penrith and The Border (Dr Hudson) talked about 3 Dads Walking, who I was pleased to meet. We are also rolling out mental health and wellbeing support in our school curriculum, teaching young people what good mental health looks like and about support mechanisms. Our strategy sets out over 100 actions to help reduce suicide and to ensure that young people in particular, who are identified as a high-risk group in the strategy, are getting the support they need. That includes making mental health and wellbeing part of the school curriculum.

[Jim Shannon]

Has the Minister had the opportunity to look at how to ensure that young people have some church activity and pastoral care, which is very important?

[Maria Caulfield]

The hon. Gentleman is absolutely right. Part of that can be done in our schools. With the increase in mental health support teams, which will now cover 4.2 million pupils, there will be different levels of support, from pastoral support right through to acute help for those with more acute mental health needs. It is really important that we ensure that those teams are rolled out as we are planning. Our hubs in local areas will also be able to provide more bespoke services for the communities they represent, which is crucial. I would like to thank Dr Alex George, the Government’s youth mental health ambassador, who has been leading much of this work, particularly on the suicide prevention strategy and making children and young people a priority group.

I reiterate my thanks to everyone who has contributed to the debate. The Government have a plan to improve mental health services for children and young people by investing in services, with capital projects to improve infrastructure in order to provide the care that is needed, from crisis centres right through to the 27,000 extra mental health workers; rolling out mental health support teams in schools and our new children and young people’s mental health hubs, which will be announced shortly; and dealing with the sheer tsunami of demand, whether it is due to the fallout of covid or the fact that people are coming forward because we are encouraging them to talk about their mental health and ask for support.

Our plan is making a difference. I am hopeful that, with the investment we are putting in to tackle the lack of investment for decades under many Governments, we are providing the building blocks to improve the mental health of our young people in this country.

Measles

Debate between Jim Shannon and Maria Caulfield

Monday 22nd January 2024 Commons Chamber

[Maria Caulfield]

The hon. Lady has a point that part of the vaccine hesitancy is due to misinformation about vaccines more generally. That is why we are trying to use the message of immunisation rather than vaccination, because it is a much more positive message. We are also providing positive messages and social media graphics for communities and Members of this House to roll out to counter some of that misinformation. It is really important that we get that message out. There is a problem with misinformation, and I want to reiterate that measles is a highly infectious disease that can be eliminated by vaccination alone.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her positive response to this urgent question. You and I are of similar vintage, Mr Speaker, and I recall getting my measles vaccination at Ballywalter Primary School in the early ’60s—so not yesterday, but a long time ago. There was a system where vaccination happened in schools, and I think that is where it should happen.

The Northern Ireland Audit Office reports that the number of pre-school vaccinations has been steadily declining and the rate of children getting the MMR vaccine at two years of age has fallen from 96% in 2012 to 90% in 2022—a significant drop in Northern Ireland, with a population of 1.95 million. There is clearly a crisis emerging not just in England, but across the whole of the United Kingdom, in particular in Northern Ireland. Does the Minister agree it would be helpful to have a joint approach across the whole United Kingdom of Great Britain and Northern Ireland, to ensure that children are vaccinated and, more importantly, protected against this awful disease? It is always better to do it together; that is my suggestion to the Minister.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 5th December 2023 Commons Chamber

[Maria Caulfield]

First, early indications show that the respiratory illnesses in China are likely to be due to increasing levels of endemic infection. These are normal infections but at a higher level.

Secondly, we are not waiting for the covid inquiry before we implement lessons learned. One of the key changes we have already made is the introduction of the UK Health Security Agency, which carries out surveillance on both national and international threats. A good example of its work is last year’s strep A outbreak, which it managed and contained very well. This year, the identification of a new covid variant—not a variant of concern—meant we brought forward our autumn vaccination roll-out.

[Jim Shannon (Strangford) (DUP)]

For all of us who lost loved ones, covid-19 is still very raw. I have been following the covid inquiry, and two recommendations have so far come forward. The first is that the lockdown should have been earlier, and the second is that those with covid should not have been sent to care homes—covid went through care homes and cast death everywhere. Has the Minister taken those two lessons on board?

[Maria Caulfield]

I know the hon. Gentleman had a personal loss to covid, and he is absolutely right to highlight those lessons learned. We are learning lessons, but each pandemic or increase in infection is different. It may have been appropriate to have lockdowns for covid-19, but lockdowns may not be appropriate for other infections, such as strep A or other respiratory illnesses. We set up the UKHSA to provide expert advice. We are learning lessons from the covid inquiry, and we are already taking action.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Wednesday 25th October 2023 Commons Chamber

[Maria Caulfield]

One key route is through apprenticeships. For many young women, being able to earn while you learn and getting that work experience is vital for them to progress through the STEM sector. We have 22,000 degree apprenticeships and seven masters degree apprenticeships. That is an increase of 14%. In STEM subjects in particular, we have 360 employer design apprenticeships, including level 3 cyber-security, level 4 software development and level 6 civil engineering. We believe apprenticeships are the way forward to drive more women into STEM areas.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for that answer. In Northern Ireland, women are under-represented in STEM industries. Only 15% of women in Northern Ireland study core STEM subjects, compared to 36% of men. That is a clear anomaly that needs to be addressed. May I encourage the Minister to use her office to engage with the Department for the Economy to encourage more uptake in university STEM subjects? Women can do the job every bit as well as a man given that opportunity.

[Maria Caulfield]

I thank the hon. Member for that question. That goes to the point raised by my hon. Friend the Member for Banff and Buchan (David Duguid). We need a UK approach. Across the Government, whether in the Department for Work and Pensions or the Department for Education, we focus on trying to improve all avenues for those, particularly women, who want to go into STEM areas.

HPV Vaccinations

Debate between Jim Shannon and Maria Caulfield

Wednesday 19th July 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for bringing this important issue to the Chamber today. I know that he has done a great deal of campaigning on this, particularly vaccination for boys, and that he has clinical experience. We have discussed this, as we have both seen at first hand the horrific effects of head, neck and oral cancers on individuals and the difficult treatments they have to undergo, including surgery and radiotherapy. People are often not aware that HPV vaccination relates to head and neck cancers as well as cervical cancer.

HPV causes about 99% of all cervical cancers, but thanks to our world-leading vaccination programme that protects girls and boys, we have seen an 87% reduction in cervical cancers in vaccinated women compared with previous generations. Our ambition is to work to eliminate cervical cancer, and the HPV vaccination programme is a key part of that, but we are also looking at the data on the impact on rates of head and neck cancers as well as other cancers. Vaccination is a game changer in preventing some cancers caused by HPV.

The UK was one of the first countries in the world to introduce an HPV vaccination programme, back in 2008. Since then, millions of vaccines have been delivered, stopping the transmission of HPV, protecting individuals and saving lives. The programme has been evolving and we have made a number of significant changes, including introducing more effective vaccines, reducing the number of injections required and making the programme universal; in 2019, it was offered to boys as well as girls. Those changes have further strengthened what was already a very successful programme, and it is a key priority for the Government to increase uptake rates of the vaccine to at least pre-pandemic levels. That is a good place to get to, but of course we want to go further if we can.

Although we are not back to pre-pandemic levels yet, we are seeing encouraging recovery among older school-age children, as those who missed their vaccination during the pandemic are being caught up with. The vaccine is mainly delivered by school-based vaccination teams, and this delivery model, in combination with alternative vaccination sites for those who are not in mainstream education, has been very successful in getting our uptake rates pretty high.

Pre-pandemic levels of vaccination were consistently high across the board. To try to get back to those levels, anyone who missed their immunisation for whatever reason will remain eligible until their 25th birthday. They can catch up via their schools, alternative sites such as community centres, and GP practices, so there is a range of routes through which a young person who missed their vaccination can still access it until they are 25.

There is a separate HPV programme for gay and bisexual men, who are also at risk from HPV. The JCVI advises that they are at an increased risk of the virus and its effects on particular cancers. That is why there is a separate programme available through specialist sexual health services and HIV clinics, and the vaccine can be accessed until a man’s 46th birthday. There are two separate programmes, with multiple ways in which people can get the vaccination, and we encourage them to do so.

We have raised the eligibility age over the course of the programme and offered the vaccine to boys as well as girls. Using recent evidence, we are able to compare pre-covid vaccination rates of girls, but we are not able to with boys, because they have only been offered the vaccine since 2019. We are looking at the data, which will take years to develop, on the effect of vaccinating boys on preventing cervical cancer in future partners and on other types of cancer caused by HPV.

We are now evolving how many doses we give. When the programme started, people were offered three doses. That has since been brought down to two doses, and from September this year, a single dose will be sufficient to vaccinate fully against HPV. The hon. Member for Strangford (Jim Shannon) asked how we can be sure that a single dose will be effective. The JCVI looked at the evidence and recommends a single dose. We know from vaccination rates that young people often come for one dose, but may not return for the second. If we are happy that a single dose is effective, that will get our vaccination rates up. My hon. Friend the Member for Mole Valley highlighted the example of Australia, where a single-dose vaccine is used, with good success rates. The JCVI, the World Health Organisation and the Scientific Advisory Group for Emergencies all recommend moving to a single dose, because the clinical evidence is that it is just as effective as two doses.

Moving to a single dose will allow our vaccination teams to focus on catching up with those who have not turned up for any vaccines. That is our key priority: reaching out to those groups that have not come forward, because of the implications of trying to prevent cancer in an individual and, as my hon. Friend the Member for Mole Valley said, trying to capture the herd immunity effect. There may be some people who cannot have the vaccine for some reason. Getting as many people vaccinated as possible means we are reducing the risk of cancer when they are older.

I can reassure the hon. Member for Strangford that these changes are based on scientific review and advice from independent experts and the JCVI. They all aim to strengthen the programme further and ensure that more people have access to effective vaccines to prevent HPV infection and future cancers.

[Jim Shannon]

First, I welcome the Minister’s response, which is very positive. I mentioned people in my constituency who are medically qualified in their particular sector. They may not have all the evidence that the Minister referred to. Would the Minister please email me to let me know when that information will be available? Thank you.

[Maria Caulfield]

Absolutely, we can send the hon. Gentleman the information provided by the JCVI on its recommendations. I think the hon. Gentleman also asked why it is a one-off and not a regular dose. The evidence and studies show that, when someone is vaccinated against HPV, the protection lasts for at least 12 years. It could well be longer but, because the programme is not that old, we have only that level of data. There is certainly at least 12 years of protection from that initial vaccination. We will send him that information; we quite rightly want people to be able to ask questions and be reassured by the evidence we are able to provide.

HPV vaccination is one of the most cost-effective ways to protect people from both the infection and related cancers. We are keen to ensure that vaccination levels are as high as possible. Pre-pandemic, the programme reached 80% coverage for two doses. Those were good levels of protection that we would like to get back to, and then go higher. Covid-19 disrupted the roll-out, because young people were not able to go to school, and the vaccination teams were not able to roll out those programmes. Despite catch-up work and teams working extremely hard, we are seeing a decrease in uptake in vaccination. That is of concern because of the future implications.

We are committed to recovering the HPV programme back to pre-pandemic levels. We have seen some recovery when we have done catch-up work. To put it in context, HPV vaccine coverage decreased by 7% in year 8 girls, and 8.7% in year 8 boys. That is quite a significant drop. We have figures only for girls pre-pandemic, but these rates are about 18% lower than pre-pandemic coverage. That shows that my hon. Friend the Member for Mole Valley is quite right to raise this issue, and that there is work to do. I am happy to commit to meeting with my counterpart in the Department for Education, the Minister for Schools, to see how much further we can go to support schools and make the vaccination roll-out more effective.

I will also meet with the screening team to see how we can drive up those rates further and whether we need better communication, for both young people and parents, about what a difference vaccination can make to a young person’s life. To a young person at school, cervical cancer or head and neck cancer seem a long way off, but vaccination is so important for the future, not just for them but for future partners. I commit to my hon. Friend the Member for Mole Valley that we will do more to get those rates back up, because it is in the interests of young people.

I thank my hon. Friend for raising the debate. I encourage him to keep holding our feet to the fire on this issue, because it is important that it does not drop off the radar. He was quite right to raise the issue of the covid vaccination. We have been extremely successful as a country, particularly in the initial roll-outs, in vaccinating the whole country at 12-weekly intervals and then with ongoing booster programmes for vulnerable people in the community. We do well with our flu vaccine roll- outs as well. We need to put this programme on a par with other vaccination programmes and I am keen to make progress.

I commit to working with my DFE counterparts and raising the profile of how important the HPV vaccination programme is. I commend my hon. Friend for all his work in this area, particularly his clinical work. He has picked up head and neck cancers at an early stage, and people will have benefited from his clinical expertise. The ideal is for them not to develop that cancer in the first place, and that is where we all want to get to. We are committed to increasing the uptake of the vaccination across all eligible groups, and I will keep the House updated on our progress.

Question put and agreed to.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Wednesday 7th June 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for that response and for the £10 million that the Department has set aside for the breast screening programme on the UK mainland. In Northern Ireland, the number of those with breast cancer is rising, which is concerning. What steps will she take to ensure that the devolved nations are not left behind on outcomes for women?

[Maria Caulfield]

I thank the hon. Gentleman for his question. He will know that health is a devolved issue, but we are working closely with all four nations, because we want to ensure that we have joined-up working, particularly in the screening programme, where we have some catching up to do post covid.

Strep A Treatments: Supply

Debate between Jim Shannon and Maria Caulfield

Monday 19th December 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I am sorry, Mr Speaker, but you caught me unawares there. I was expecting to go up and down automatically until the very end.

I thank the Minister for her answers, but this is not only about strep A. Will she confirm that discussions have taken place with Army medics, so that they can step into the breach as GPs are under pressure? One parent in my constituency simply refused to leave the GP’s office until he was seen, and quite rightly so, as his daughter had scarlet fever and needed an immediate antibiotic injection. I do not blame the GPs, because it is clear that they need more support. Can this be made available? The Army medics are perhaps the solution.

[Maria Caulfield]

I am sorry to hear about the problems that the hon. Gentleman’s constituent has had in accessing help. We do recognise that there are serious pressures. Winter is a busy time for GPs in the best of years, but this year, with strep A, UKHSA and officials are encouraging parents to come forward, and parents are doing exactly the right thing. We are working with GPs, and NHS England is reaching out to primary care colleagues to see what additional support is needed to meet that demand.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 6th December 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

5. When his Department will publish the 10-year cancer plan.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Earlier this year, we held a successful call for evidence on a new cancer plan, which received 5,000 responses. We are now considering those responses and how we can best support the diagnosis and treatment of cancer patients. I will be in a position to update the House shortly.

[Jim Shannon]

I thank the Minister for her response, but it has been five months since July, when the 10-year cancer plan was due to be published, and 10 months since February, when the war on cancer was announced. While the Government have delayed, cancer patients have faced unacceptable waiting times for diagnosis and treatment. Performance over the past five months has been the worst on record against the target of a 62-day wait between the GP referral for suspected cancer and the first treatment. I ask the Minister respectfully: does she agree that we in this House and the people of this country now need a long-term, ambitious plan to reduce waits and ensure that cancer patients in this country have the best outcomes possible? Will she set out a timeline—not just say “shortly”—for delivering such a plan?

[Maria Caulfield]

As the hon. Gentleman knows, I cannot comment on what is happening in Northern Ireland, because health is a devolved matter. I can only update him on what is happening in England. We are not waiting for a cancer plan to start on the backlogs: that is why this Government are investing £8 billion over three years to clear the elective backlog. We are seeing record numbers of patients. Cancer treatments continued throughout the pandemic, but we are seeing a higher number coming through than usual. Despite the increase of more than 129% in patients getting urgent GP referrals since September 2019, 91% of patients in England are receiving their treatment within 31 days of the decision to treat, compared with just 87% of patients in Northern Ireland in June. We are very committed to reducing cancer waiting times. I suggest that the hon. Gentleman may wish to speak to the Minister in Northern Ireland as well.

Abuse and Deaths in Secure Mental Health Units

Debate between Jim Shannon and Maria Caulfield

Thursday 3rd November 2022 Commons Chamber

[Maria Caulfield]

I thank the hon. Lady for making those points. As she knows, one of the facilities was closed in 2019 because of failing inspections and it has since reopened under another organisation, so action is taken where failings are found. My concern is that failings are often missed. That is why the director of mental health at NHS England wrote to every single trust on 13 September asking them urgently to review their services. As I said, I am taking advice and will report to the House in the coming days about what action we will be taking.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her answers. It feels like new cases of abuse of our vulnerable are coming to light weekly and it shakes our society to its very core. Every one of us is annoyed at what has happened. Humanity is judged by how we treat our most vulnerable and it appears that failures just continue to happen over and over again. How can the thousands of facilities that are doing right by their patients have trust in a system that sees them judged by the gross actions of others? Can the Minister confirm the additional support to ensure every facility has adequate staff and that controls are in place?

[Maria Caulfield]

The hon. Member is right and that is why I want to review at a national level. We are seeing a number of cases coming forward of unacceptable care in in-patient facilities. As more cases come forward, that gives confidence for others to speak out about the care that they or their loved ones received. That is why I want to take a national approach. Whether looking at staffing levels, practice, the ability to whistleblow when there are concerns, or the inspection process itself, we need to make sure that wherever someone is receiving mental health provision they are safe while they are receiving that care.

Unavoidably Small Hospitals

Debate between Jim Shannon and Maria Caulfield

Tuesday 6th September 2022 Westminster Hall

[Jim Shannon]

I thank the Minister for her answers. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) and I both asked questions about health being devolved in Northern Ireland and in Scotland, and we are keen to ensure that some of the thoughts and ideas from the debate are shared with the devolved Administrations. Can the Minister confirm that that will happen?

[Maria Caulfield]

Absolutely. We need a collaborative approach because we all face the same challenges, whether in Scotland, Wales, Northern Ireland or England. I have been in contact with Minister Swann over recent months, and I am happy to work with him and the other devolved Administrations on these matters, because we all have a shared interest in ensuring that small hospitals are successful.

I can reassure colleagues that we want to support our smaller hospitals in future so that they are able to do more for their local communities.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 19th July 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend, who campaigns hard on this issue for Airedale Hospital. I absolutely understand the urgency around aerated concrete given the effect it is having, and of course I agree that the NHS has a vital role in supporting net zero. He will understand that I cannot commit to any one application. We are reviewing all applications and we aim to make a final decision later this year.

[Jim Shannon (Strangford) (DUP)]

Can the Minister assure me, and the House, that the money used for the purpose of achieving a net zero NHS will have no impact on, for instance, those who are on waiting lists for cataract operations, who cannot even see the environment because they have been waiting for their operations for so many years? Net zero is very important, but what is more important is getting those operations done.

[Maria Caulfield]

I think we can do both. We have already reduced emissions in the NHS by 30%, and there are a number of ways in which we can reduce them further, from changes in procurement—the NHS will no longer purchase from suppliers that are not aligned with net zero ambitions—to the delivery of estate change.

NHS PPE Supply Chains: Forced Labour

Debate between Jim Shannon and Maria Caulfield

Thursday 14th July 2022 Westminster Hall

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees.

I start by congratulating the hon. Member for Strangford (Jim Shannon) on securing this debate and on all his hard work, alongside Members such as my hon. Friend the Member for Congleton (Fiona Bruce), on this significant issue. It is important to debate the supply chain for NHS PPE, to learn lessons from the past and to ensure that robust systems are in place for the future. I reassure him, and all hon. Members, that this matter is a priority for the Department and we continue to take steps to ensure that there are robust systems to safeguard against the coming into the system of supplies that may be linked to slavery or forced labour. I am pleased that this issue was debated during the passage of the Health and Care Act 2022, and further legislation will be introduced to address it.

However, I must put it on the record that our priority during the pandemic, as Members will understand, was to protect our frontline staff. This was a global crisis, in which we were competing against many countries to secure PPE for our frontline workers. Nevertheless, we had and still have a responsibility to those across the PPE supply chain to make sure that when PPE is procured, it is done responsibly and does not put people in any part of that chain at risk. It is absolutely important that we do that both globally and domestically, because although the hon. Member for Strangford rightly mentioned the Uyghurs in China, we have heard only too well this week from Mo Farah that slave labour and slavery exist in this country as well.

I take the point that the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) raised about his concerns about the Government’s approach, but I will gently say that the Herald on Sunday stated that during the pandemic, half a billion pounds-worth of procurement in Scotland did not go through the usual scrutiny process, either—and that was just one report. That reflects the fact that all countries during the pandemic had to make tough decisions to get supplies through, safeguard frontline services and ensure that those pieces of equipment were in place. Where lessons need to be learned, we absolutely will do so. Since the pandemic, almost 40 billion items of PPE have been ordered and almost 20 billion were distributed by March 2022. We are still distributing over 600 million items a month. That shows the scale of the amount of PPE that we have had to distribute. Hon. Members will be aware that covid rates are still high at the moment, so PPE is still very much needed by our frontline staff.

Global chains were used to procure many supplies, whether aprons, gloves or masks, but where possible we have tried to escalate domestic supply, because while it is not 100% failsafe against slavery, it is more likely that there are robust systems in place. To effectively distribute the supply across health and social care settings, we have built a distribution network from scratch and adopted a sophisticated sales and operations planning system to regulate supply and distribution. We have a clear understanding of where the stock has come from and the processes in place to ensure that slavery or forced labour was not used in any part of that chain. Part of the network is using technology to track and trace where that supply comes from, and if there are queries or concerns in the future, we are able to look back and see where those supplies came from. Since April 2020, over 6.9 billion PPE items have been ordered through that e-portal system.

As we move to living with covid, the decision has been made to step down some of the Department’s work on the PPE programme, and we are handing that over to the NHS supply chain more generally. Safeguards in the Act ensure that some of that work will continue to happen. Modern slavery encompasses the offences of slavery, servitude, forced and compulsory labour and human trafficking. The NHS has a significant role to play in combating modern slavery, including by taking steps to ensure that the NHS supply chains and business activities are free from labour abuses. The Government rely on their suppliers for the delivery of many important public services, and we expect high standards of business ethics from our suppliers—and their agents. They will be routinely checked for that.

The Department follows a procurement approach, as set out in the UK Government modern slavery statement, that includes a zero-tolerance approach to modern slavery and a commitment to ensure that respect for human rights is built into all our contracts, self-assessments, audits, training and capacity building. I reassure the hon. Member for Strangford that if there is a complaint or a suggestion of any supply being involved in slavery or forced labour, we can lock down that stock until an investigation is concluded. We can then unlock it if no evidence is found, but we can stop some of those contracts if there is evidence of forced labour. We look at what happens in other countries—he touched on the US—and if other countries are finding evidence of slave labour used in any part of the supply chain, investigations will start on UK stock as well.

[Jim Shannon]

I thank the Minister for her positive response. Clearly, the United States has taken a line of legislative action. Has the Minister had a chance to discuss or get ideas from what the States are doing and what drove them to do that? I posed that question and both hon. Members who spoke asked the same question. If they can do it in the States, we can do it here.

[Maria Caulfield]

Absolutely. We have secondary legislation coming forward that will enact what was agreed in the Health and Care Act 2022, which will look at some of this issue. The Procurement Bill is also passing through the House of Lords and will come to our Chamber. It will look at procurement more generally, not just NHS procurement. If he and other hon. Members with a keen interest in the subject, such as my hon. Friend the Member for Congleton, have specific questions on NHS procurement, I am happy for them to write to me and we shall see whether we can look at them as part of scrutiny of the Bill as it progresses. He is right that we want to ensure that we are learning lessons and sharing best practice across the board. I cannot speak for other Departments, but we are keen to get that right for the NHS where possible.

We are taking steps to achieve greater supply chain visibility, particularly where risks are highest, with the recognition that workers in the lower tiers of supply chains are often the most vulnerable. In line with that, we ensure that all contracts placed by the Department adhere to standard terms and conditions that include clauses requiring good industry practice to ensure that there is no slavery or human trafficking in supply chains.

Suppliers appointed to NHS supply chain frameworks must also comply with those standards or they can be removed from consideration for future opportunities. All the suppliers of PPE frameworks let in conjunction with the Department were registered and required to complete a modern slavery assessment and a labour standards assessment. Our purchase process includes safeguards to strengthen due diligence and to terminate a contract should there be substantiated allegations against a provider.

We are not content to rest on the status quo, which is why the Health and Care Act contained a regulation-making power that will come into force, designed to eradicate the use in the NHS of goods or services tainted by slavery or human trafficking. The regulations will set out the steps that the NHS should be taking to assess the level of risk associated with individual suppliers and the basis on which it should exclude them from a tendering process. Those regulations will help to ensure that the NHS, the biggest public procurer in the country, is not buying or using any goods or services produced by or involving any kind of slave labour. It represents a significant step forward in our mission to crack down on the evils of modern slavery wherever they are found. We are grateful to the work of modern slavery campaigners, who hailed the regulations as

“the most significant development in supply chain regulation since the Modern Slavery Act 2015”.

Alongside those regulations, the Health and Care Act also requires the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains and to lay before Parliament a report on its outcomes. That review will focus on NHS supply chain activity, as well as supporting the NHS to identify and mitigate risks with a view to resolving issues. The review and the regulations will send a clear signal to suppliers that the NHS will not tolerate human rights abuses in its supply chain; they will create significant incentives for suppliers to review their practices; and they will block, if necessary, any suppliers that are found to be using human trafficking or slave labour.

I was moved to hear the cases of the Uyghurs that the hon. Member for Strangford raised. He is right that that goes far beyond the NHS, which is why the Procurement Bill, currently passing through the other place, is an important piece of legislation. I am sure that he and other hon. Members, such as my hon. Friends the Members for Wealden (Ms Ghani) and for Congleton, and my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith), who are assiduous campaigners on the issue, will take a keen interest in that.

I conclude by thanking all hon. Members for their contributions. Modern day slavery is a deplorable practice that causes irreversible harm to those affected. We all have a responsibility to call it out. As a Department, we take it extremely seriously. I hope that, by sharing what is happening, I have given hon. Members confidence that we will do all we can to root it out and take out of our supply chains any affected pieces of equipment.

Ambulance Services and National Heatwave Emergency

Debate between Jim Shannon and Maria Caulfield

Wednesday 13th July 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

The Minister and the Government were able to respond to the covid-19 pandemic and showed that resources could be made available. Can I ask the Minister this question in a positive fashion? Is it possible to use some of the very successful covid-resourced helplines for people to contact to provide short-term advice on heat-related issues, rather than perhaps ringing, as they often do, the GP out of hours? What else can the Minister’s Department do to take pressure off A&E and out-of-hours GP surgeries?

[Maria Caulfield]

The hon. Gentleman makes a very constructive suggestion—one of the first of the afternoon, if I may say so. There were lessons during covid that are being rolled out across emergency services. We are looking at best practice in those parts of the country where response times are better to see if we can share it. I am very keen to look at any option that relieves the pressure. We are investing in 111, which enables people to have alternative ways of getting urgent care directed to them. We are looking at 111 being able to make direct referrals as well, so there are a number of options. I am happy to take suggestions from any hon. Member if they are keen to see those happening in practice.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 14th June 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

As IVF treatment is incredibly time sensitive, will the Secretary of State consider increasing the funding available to allow couples to make use of private facilities on the NHS, to help families have the children that they so much want?

[Maria Caulfield]

I cannot comment on health in Northern Ireland specifically as it is a devolved matter. IVF will be a significant factor in the women’s health strategy, because we recognise the disparities that exist across the country in how couples currently access IVF.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

The Father of the House is quite right that the crux of the problem is that there is a shortage throughout the country not of dentists but of dentists taking on NHS work. The contract is the nub of the problem, which is why work is under way to reform it. We will shortly announce some short-term changes and some longer-term reforms, which will hopefully help my hon. Friend’s constituents.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that dentists are now determined to turn their practices wholly private as they cannot make ends meet with NHS prices, will the Minister pledge to review NHS payments to stop the haemorrhaging of NHS dentistry provision?

[Maria Caulfield]

The hon. Gentleman is correct that the units of dental activity payments are a perverse disincentive. Sometimes, when someone needs more extensive work, their dentist is paid the same as they would be for, say, one or two simple fillings. That is the nub of the problem and we are currently in negotiations on the matter.

Vaccine Damage Payments Act 1979

Debate between Jim Shannon and Maria Caulfield

Wednesday 2nd March 2022 Commons Chamber

[Maria Caulfield]

If my hon. Friend contacts me after the debate I will be happy to find out what specific help is available for her constituent in the local area. But we do have a robust safety mechanism in place, dealing with not just covid vaccines but all medicines, and the VDPS was established in 1979 as a one-off, tax-free payment, with the aim of easing the financial burden on individuals when, on very rare occasions, vaccination has caused severe disablement.

For the specific groups of vaccines that are covid-related, the Prime Minister announced on 21 September 2021 that responsibility for the operation of the VDPS would transfer from the Department for Work and Pensions to us in the Department of Health and Social Care on 1 November 2021. We are picking up that mantle and are working at pace to address the many issues my hon. Friend the Member for Christchurch has raised.

[Jim Shannon]

Will the compensation scheme to which the Minister referred apply across the whole of the United Kingdom of Great Britain and Northern Ireland—will people in Northern Ireland, Scotland and Wales qualify if they have ailments such as those to which the hon. Member for Rutland and Melton (Alicia Kearns) referred?

[Maria Caulfield]

My understanding is that it does, but I will clarify that for the hon. Gentleman as I do not want to inadvertently mislead the House if I have got it wrong.

The NHS Business Services Authority has taken over the process and is looking to improve the claimant journey on the scheme through increasing personalised engagement and reducing response times, which was one of the points made today. A difficulty we have with the covid-19 vaccines is that they are new; we are still learning about them and the scientific evidence on potential causal links between the vaccine and instances of disablement is still developing. That is part of the reason for the delay in claims being addressed.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Tuesday 1st March 2022 Commons Chamber

[Maria Caulfield]

I absolutely agree; my hon. Friend hits the nail on the head of why we are seeing such problems in dentistry. We have started negotiations on the dental contract and are working with the British Dental Association. The UDA has to be reformed as part of that: it is a perverse disincentive that turns dentists away from providing NHS services. I will keep her updated on our progress.

[Jim Shannon (Strangford) (DUP)]

I thank all the Ministers for their responses. What steps have been taken to work with the Education Secretary to provide a higher number of places for medical students containing a golden handshake that allows for no student loan repayment or fees on condition that they stay in the NHS for a set time?

Organ Donation and Transplantation Strategy

Debate between Jim Shannon and Maria Caulfield

Wednesday 23rd February 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank my hon. Friend the Member for Totnes (Anthony Mangnall) for securing this debate and for being such a passionate champion for organ donation and transplantation. Having helped the hon. Member for Barnsley Central (Dan Jarvis) with the legislation, my hon. Friend is not just sitting on his laurels, but continuing with the campaign, because, as has been said, the legislation on its own is not enough to make a difference.

I also thank all those donors and their families who, at a very difficult time in their lives, have to make incredibly tough decisions. Even with the changes in legislation, it is an incredibly difficult time for them. Hon. Members will know that the 6,000 patients across the UK who are today waiting for lifesaving transplants are incredibly grateful for those who donate. The estimate is that every donor can save around nine lives, so it really does make a difference. More than one person a day sadly dies on the waiting list, so it is crucial that organ donation continues to be a high-profile issue.

It is nearly two years since the introduction of deemed consent for organ and tissue donation, known as Max and Keira’s law. All donors are now considered potential organ and tissue donors after death unless they make a decision that they do not want to donate. As my hon. Friend has said, among all the families approached since May 2020, the consent rate is about 66%. It could be higher. It is a good figure—much better than where we were—but there is still a lot of room for improvement. However, it has led to 296 organ donors and resulted in 714 organs being transplanted: we cannot overestimate the difference that has made to the individuals who received those organs and to their families.

If people wish to opt out, they can do so: currently, 27 million people have opted into the UK organ donor register and 2 million have opted out, so there is flexibility there. However, for many people, there is still a lack of awareness that a register exists, and very often they have not had those conversations with family members. Should the time come when, unfortunately, an incident happens and organ donation needs to be considered, families play a crucial role throughout the donation process, both helping NHS staff understand the wishes of the deceased and ensuring their organs are suitable for transplantation. As my hon. Friend the Member for Totnes has pointed out, it is really important that we continue to have national conversations about organ donation, so that if the time comes, the family of the deceased person are aware of what the issues are. Even with an opt-in and opt-out system, that conversation should take place well in advance.

At difficult moments, both families and NHS staff who may be working in A&E or in different clinical units may not feel comfortable having that conversation. When the family are struggling to come to terms with the fact that their loved one is on the register, but they are not happy about that, those are very delicate conversations to have, and it is important that staff are supported as well. The views of the family will always be taken into account: even though they cannot revoke legally valid consent, they will have an influence; as we heard from my hon. Friend, that is having an impact and meaning that some donations are not happening.

The role of the specialist nurse in discussing the matter sensitively and helping to understand some of the family’s concerns is important and that role needs to be facilitated wherever possible, because that can make the crucial difference between the family accepting the decision of their loved one and not coming to terms with it. We need to make that conversation routine and build awareness, because a 32% impact on the loss of organs into the system for donation is a very high figure.

NHS Blood and Transplant, which is responsible for organ and tissue donation across the UK, has launched the new UK-wide organ donation strategy, the main aim of which is simply to increase organ donation and transplantation. My hon. Friend the Member for Totnes asked what work is being done to raise awareness: we have organ donation week in September, and last September that led to the Leave Them Certain campaign. That campaign aimed to reinforce the role of the family and normalise people sharing their organ donation decision with family members so that, if that discussion needs to happen, it does not come as a shock. We are also introducing organ donation and transplantation into the school curriculum, because it is important to start that conversation early on, and aiming to promote awareness in young people about not just their own decision, but that of their other family members.

There was a multimedia campaign on Valentine’s day this year—my hon. Friend might have been busy on Valentine’s day; I do not know—to encourage families to have a heart-to-heart discussion about organ donation. There were 300 people waiting for a heart transplant on Valentine’s day, including more than 40 children, so it was thought crucial to raise awareness on that day, but we can all do our bit when it comes to promoting the need for organ donation. World Kidney Day is 11 March, which will provide us with another opportunity, but I am very happy if my hon. Friend wants to apply for another debate this coming September to hold our feet to the fire in making sure that we are driving up organ donation numbers.

I want to touch on health disparities, because some communities are struggling more than most when it comes to organ donation. Black and Asian communities face significant shortages and significantly longer waits—around 10 months longer than the general population—and much of that disparity is due to the lack of donation in those communities. There is a whole host of reasons why that is and, as my hon. Friend the Member for Totnes has said, this is not about judging those who do not donate: it is about increasing awareness of the difference that organ donation can make to people’s lives. Alongside other stakeholders, such as the National Black, Asian and Minority Ethnic Transplant Alliance and all the main faith organisations in England, we are actively trying to tackle some of the concerns of particular groups and communities around organ donation. We are raising awareness and promoting the work that can be done.

I am particularly concerned about the point that my hon. Friend mentioned about provision for living donations in the south-west, and the logistics that sometimes lead to donations and transplantations failing. If someone is willing to donate an organ, we should make every effort to ensure that it becomes a successful transplant. I will take away his point and look at some of the factors that might be influencing that situation.

Covid has had an impact on the service. As we heard from the hon. Member for Barnsley Central, the waiting list is higher than it has been in past, but I am pleased to say that organ donation and transplantation has now mostly returned to pre-pandemic levels, although there is a backlog of people to get through.

[Jim Shannon]

In my intervention, I referred to the need for co-ordination between the four regions, so that no organ could or would be lost. There was some discussion in the newspapers, although I am not sure of the evidential basis for it, that said that some organs had been lost during the covid pandemic. Let us make sure that does not happen.

[Maria Caulfield]

The hon. Gentleman is absolutely right. We need to ensure that we tackle any practical or logistical issues; I am happy to look at that. If there are particular regions where the centres are difficult to access because of the distances involved, then we absolutely need to consider that.

I take on board the points made by my hon. Friend the Member for Totnes about improving the ability of people to sign up for the register, whether through the electoral roll or through other mechanisms; we want to make that as easy as possible. I am convinced that there are groups of people who would be very happy to donate, but we need to make it as easy as possible for them to do so.

I will look at international comparisons. If there are lessons to be learned from other countries, let us not reinvent the wheel but gain some knowledge from them.

I thank all hon. Members for taking part today, particularly my hon. Friend the Member for Totnes, and I thank the Meredith family, who are driving this campaign forward and are the reason for the debate today. We are making huge progress. The legislation has made a big difference, but there is lots more we can do to ensure that people are not waiting on the transplant list any longer than they need to.

Question put and agreed to.

Eye Health and Macular Disease

Debate between Jim Shannon and Maria Caulfield

Tuesday 11th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking the hon. Member for Strangford (Jim Shannon) for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend the Member for Darlington (Peter Gibson), who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend the Member for Great Grimsby (Lia Nici). We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from the hon. Member for East Londonderry (Mr Campbell), we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

[Jim Shannon]

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

[Maria Caulfield]

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend the Member for Sedgefield (Paul Howell) about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend the Member for Hendon (Dr Offord) asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by the hon. Member for West Ham (Ms Brown) about her constituent, Darren, and those raised by the right hon. Member for Hayes and Harlington (John McDonnell). I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

Surgical Fires in the NHS

Debate between Jim Shannon and Maria Caulfield

Thursday 16th December 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing this hugely important debate. While he is right that we may be small in number this afternoon, it is the quality not the quantity of the Members that counts.

Health is a devolved matter, so I can really only respond on behalf of the NHS in England to the issues the hon. Gentleman raised, but, as the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), said, surgical fires are a priority area of concern in all the devolved nations. Patient safety is our absolute focus. We want to provide the public with the safest care possible. As the hon. Member for Strangford said, a fire affects not only patients but the NHS staff working in those units. We traditionally think of surgical fires as taking place in hospital-based settings such as theatres, but more and more minor surgery is taking place in community facilities such as primary care facilities. This issue is expanding to other areas of the NHS, so it is important that lessons learned in hospital trusts are learned in the community as well.

Supporting a culture of safety in the NHS is critical, and we have put in place a number of measures aimed at supporting the NHS. The key is learning from incidents. Where there have been surgical fires in the past, it is important to identify their causes and how they could be prevented in the future. It is also important to hear from staff, who will sometimes not be surprised when an incident occurs or who may have flagged issues a number of times before attention is taken.

We are taking a number of initiatives to improve patient safety across the board. The first is establishing the health safety investigation branch, which conducts independent reviews and investigations into any patient safety concerns, including surgical fires. We are also introducing a statutory duty of candour to ensure that NHS organisations are open and honest towards patients. If a surgical fire happens, as in the hon. Gentleman’s tragic example, a patient who may have been asleep at the time should be made aware of that and receive an apology and support afterwards. Sometimes the fires are quite minor and the patient is not affected, but it is important that they know that an incident happened. We are also setting out in legislation the first ever patient safety commissioner, which will be for England only. They will be a champion for patients in relation to medicines and medical devices and will certainly look at the issue of surgical fires.

Regrettably, despite some of the progress and some of the measures we are putting in place, and despite the high quality of care provided by NHS staff, incidents happen that cause harm to patients and put staff at risk. If a surgical fire is extensive enough to take a theatre out of service for a time, that has a knock-on effect for other patients on surgical waiting lists, who may be delayed as a result. Minimising the risk of surgical fires is an area we take very seriously, and although rare, when they do occur in or around the operating table, they can cause extensive damage and put patients and staff at risk.

The issue is how to best minimise the risk of fires in the first place. As has been pointed out, work is going on into this area. NHS England’s national patient safety team has been involved with the expert working group on the prevention of surgical fires, which the hon. Gentleman referred to and which is chaired by the chief executive of the Association for Perioperative Practice. We will continue to support the development of its guidance. I am happy to meet the hon. Gentleman to follow this up, because as highlighted by the shadow Minister the working group published a report in September last year on the prevention and management of fires and made a number of recommendations. It is the view of the national patient safety team that further work on surgical fire prevention following the report is best developed alongside the wider national safety standards for invasive procedures. Those standards were created to support all aspects of patient safety in the surgical environment and are currently being led by the Centre for Perioperative Care, which is responsible for ensuring that national safety standards for invasive procedures continue to be fit for purpose.

[Jim Shannon]

I am very encouraged by the Minister’s response. I referred to four key recommendations, which she referred to. She also referred to the fact that there are ongoing negotiations and discussions with the expert group. Has there been an opportunity to push for those four key recommendations as part of the change that is needed?

[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

Oral Answers to Questions

Debate between Jim Shannon and Maria Caulfield

Thursday 28th June 2018 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

3. What steps his Department is taking to support businesses to invest overseas.

[Jim Shannon (Strangford) (DUP)]

9. What steps his Department is taking to support businesses to invest overseas.

Autism: Educational Outcomes

Debate between Jim Shannon and Maria Caulfield

Tuesday 6th February 2018 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

As a female MP, I am honoured to have secured this Adjournment debate on the 100th anniversary of women gaining the vote.

Last week saw the launch in Parliament of the “Autism and education in England 2017” report of an inquiry, which was co-chaired by myself and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), that formed part of the work of the all-party parliamentary group on autism. The report came about due to our first-hand experience as new MPs of listening to many parents who visited our surgeries to tell us their stories of the difficulty of getting support for a child with autism.

The often invisible nature of autism means that it can be difficult for a child to get a diagnosis. The process can be long and difficult for parents, often taking years rather than months. Parents feel that the extreme pushing that they have to undertake to get a diagnosis for their child often means that they are labelled as bad or difficult parents who just cannot cope with a naughty child. As a result, a diagnosis can be missed or delayed by many years. Many parents tell me—I know that colleagues have had the same experience—that they often have to resort to paying for a private assessment so that their child can get a diagnosis and start receiving the support that they need.

The problems for parents and autistic children do not end even once a diagnosis has been made. The lack of support that they receive in our schools and education system is shocking, and teachers, who desperately want to help these children, can feel inadequate and unable to offer support because they have had little or no training. I am pleased to say that that will change this year, because initial teacher training will include dealing with children on the autistic spectrum. However, that will not tackle the lack of training for existing teachers and headteachers.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. We are all in the Chamber for the same reason: we know constituents who have faced such problems. A Northern Ireland Department of Health report confirmed that there has been a 67% increase in the number of school-age children across all trust areas in Northern Ireland who are diagnosed with autism. I am sure that the figure for the hon. Lady’s area is similar, so does she agree that that massive increase must lead to an increase in the support for such children in schools? If each class has a classroom assistant, it is a vital step towards improving educational outcomes for children with autism.

[Maria Caulfield]

I agree. Our report found that as many as one in 100 children attending our schools is on the autistic spectrum, which means that a significant number of children need our support.

Our inquiry heard from teachers who told us not only how they struggle to support students in mainstream schools because of a lack of special educational needs provision, but about the difficulties they experience because they have not received training. That comes on top of a lack of specialist provision for children for whom mainstream education is not sufficient. However, such children are often placed in mainstream education, which just cannot cope with their needs.

Palliative Care

Debate between Jim Shannon and Maria Caulfield

Wednesday 4th November 2015 Commons Chamber

[Maria Caulfield]

I agree, and I will highlight that point later in my speech.

For me, palliative care is about support and services that help to achieve a good death and underpin the care in someone’s final weeks and months of life. What happens now is that all too often the provision of palliative care is distributed on the basis not of need but of availability, and depends on the diagnosis, where the person is treated, and sometimes even their age, leading to a patchy and ineffective service. We heard during the Adjournment debate on Monday night about the impact of not having good bereavement services, which stays with relatives not just at the time someone dies but for years afterwards, and may never go away if they have had a bad experience.

This patchy service continues despite all the hard work in recent years reviewing palliative care provision across the country. As far back as 2008, an end-of-life care strategy was produced, and in 2011 the National Institute for Health and Care Excellence produced quality standards, yet palliative care services remain patchy. To highlight that further, let us look at a few more statistics.

Unfortunately, we know that 100% of us will die eventually, and that three quarters of those deaths will be expected. That means that three quarters of the population could benefit from palliative care, but currently only 48% of people who have palliative care needs receive palliative care support. Of the 500,000 deaths that occur in this country every year, 82.5% are among the over-65s, yet fewer than 15% of that group have access to palliative care. That tells us that those who need it most often have the hardest job accessing it. For older people, death is often seen as inevitable and not something that palliative care should be helping with.

More shockingly, between 50% and 70% of people who are dying say they would like to die at home, but only 30% actually do. Most people end up dying in hospital—just over 50%. Hospitals are amazing places, but they are acute settings helping to deal with urgent and emergency cases. While they do need to do more to provide better palliative care, we need to invest in our excellent hospice movement and facilities so that if people want to die in a hospice, they can. We also need to support our community outreach programmes so that if people want to die at home, they can have that choice too.

[Jim Shannon (Strangford) (DUP)]

The need for palliative care always comes at a time when people and their families are feeling vulnerable. The importance of charities and Churches at that time is something that we all know very well. The hon. Lady referred to hospice care groups and organisations. Does she agree that their role should be recognised more by Government and by the authorities so that they can take better advantage of hospice care and do better for those people through it?

[Maria Caulfield]

I thank the hon. Gentleman. I absolutely agree. That point is picked up in the Bill.

The most shocking statistic concerns the diseases that people are suffering from. The London School of Economics says that 92,000 people a year miss out on palliative care help. At the moment, 88% of our palliative care provision goes to people with cancer. As a cancer nurse, I am certainly not saying that that needs to be reduced, but the majority of deaths are due to other diseases. Only 29% of people die of cancer, with 28% of deaths due to heart disease, 15% due to respiratory illnesses, 10% due to stroke, not to mention Alzheimer’s disease, motor neurone disease and multiple sclerosis. Until we ensure that palliative care provision is mainstream, and not just for patients with cancer, the majority of people will be denied access to a good death.

The Bill introduced in the other place comes up with solutions to resolve this situation and place the responsibility firmly in the hands of local clinical commissioning groups to ensure that all patients, no matter where they want to die or what disease they have, will get access to palliative care services. That will take the pressure off existing acute facilities that are currently having to provide them. The Bill makes some key practical proposals. The first is about the ability to admit people directly to palliative care facilities. This happens really well in a lot of places, but it does not happen everywhere. That goes back to the point made by the hon. Member for Strangford (Jim Shannon) about investing in our hospices to ensure that it can happen more widely. The Bill talks about support for healthcare professionals in all settings, so that whether they are an intensive care unit nurse or someone who works with motor neurone disease, they have a signposted facility to access specialist palliative care that helps them to help patients manage their symptoms.

The Bill fits very firmly into the Government’s seven-days-a-week NHS in calling for the availability of seven-days-a-week palliative care services. As I know only too well, it is at 4.30 pm on a Friday that a patient will phone up in pain and say they cannot cope, when pharmacies are closed and it is possible to get a prescription but not a drug. Someone who is breathless and needs a chest drain often has to wait until the Monday morning, in the meantime being admitted to A&E or a medical assessment unit and then finding it very difficult to be discharged to go home. This is why we need a seven-days-a-week palliative care service.

The Bill calls for some really basic things that should exist now but do not, such as sufficient equipment for our community services. It is unbelievable that a ward nurse who wants to discharge someone with a morphine pump cannot do so because the pump belongs to the hospital. Unless the community has a spare pump, that patient will not go home. That is why only 30% of people are dying at home—they are stuck in hospital because communities do not have the necessary equipment to look after patients. There are shortages of mattresses and feeding pumps, which would make a crucial difference if they were available.