Radiotherapy: Accessibility

Margaret Ferrier Excerpts

Tuesday 18th July 2023 Westminster Hall

[Selaine Saxby (North Devon) (Con)]

I beg to move,

That this House has considered the accessibility of radiotherapy.

It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.

We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.

Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.

Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.

The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?

[Selaine Saxby]

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Maria, and I congratulate the hon. Member for North Devon (Selaine Saxby) on securing this important debate. Unusually, I agree with absolutely everything that a Conservative MP said, and I hope the Minister is making copious notes.

I hope you will forgive me if there is a bit of repetition, Dame Maria, because we have been trying hard to address this issue. In effect, this is the radiotherapy lobby. Although we do not have the big guns and finances of the pharmaceutical industry, we are the Members of Parliament who argue for the very small, dedicated and highly skilled radiotherapy workforce to be given the tools and facilities to deliver what they want, which is an improvement in cancer outcomes.

I would like to declare an interest: I am a cancer survivor and have had it twice. I have undergone various treatments, including cancer drugs, chemotherapy, surgery, and radiotherapy on three occasions. I am also privileged to be a long-standing vice-chair of the all-party parliamentary groups for radiotherapy and on cancer. Given the current economic climate, characterised by fiscal conservatism and a reluctance to commit to new spending—that is not a criticism of just the governing party, because it is an issue that my own party is addressing—it is crucial that we optimise the opportunities that present themselves to improve cancer outcomes, and the hon. Member for North Devon raised the issue of IT networks and the use of AI software.

[Margaret Ferrier]

AI technology is proving to be an asset in improving cancer treatment outcomes, and Radiotherapy UK has outlined the fact that a £4 million investment in AI technologies, which equates to £15 to £40 per patient, would immediately enhance NHS workforce capacity and reduce wait times. Does the hon. Member agree that further investment in AI could be vital in increasing access to radiotherapy?

[Grahame Morris]

That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.

As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.

Food Labelling and Allergies

Margaret Ferrier Excerpts

Monday 15th May 2023 Westminster Hall

[Nick Fletcher (Don Valley) (Con)]

I beg to move,

That this House has considered e-petitions 585304 and 589716, relating to food labelling and support for people with allergies.

It is a pleasure to serve under your chairmanship, Sir Graham. I thank the petitioners for their campaign; I know that they are here today. Together, the petitions have received over 33,000 signatures. The first petition states:

“The Government should appoint an Allergy Tsar to act as a champion for people with allergies to ensure they receive appropriate support and joined up health care to prevent avoidable deaths”.

The second petition, on Owen’s law, asks for a change in the law around labelling in UK restaurants. It has three parts. First, it asks that restaurants

“put all information about allergens in their food on the face of the main menu so customers have full visibility on what they're ordering.”

Secondly, it requires servers to

“initiate a discussion with customers about allergies on all occasions”.

Finally, it states that there should be a register for all anaphylaxis deaths.

Those are the petitions, and I will discuss why the petitioners are asking for these measures. Sadly, they have suffered unbearable losses. Natasha Ednan-Laperouse died in 2016 after eating a baguette that did not have a complete list of ingredients. The baguette contained sesame seeds, to which Natasha was allergic. That caused her to suffer an allergic reaction, which resulted in her death. She was only 15—so young. Natasha’s parents Tanya and Nadim have already been successful in their campaign for Natasha’s law, which enforces a requirement for all pre-packed sandwiches to contain a list of ingredients and which became law in October 2021.

The second petition was started by Owen Carey’s sister Emma. Owen suffered from multiple allergies all his life and was used to ordering meals for his restricted diet. In April 2017, he ordered a chicken burger at a restaurant. He explained his allergies to the server; with no other information available, he was assured that he was safe. However, the chicken was marinated in buttermilk, to which Owen was very allergic. He knew instantly that something was wrong. He had a massive reaction and, after 45 minutes, collapsed and died. He died celebrating his 18th birthday—again, so young. They were both young people with their entire life ahead of them. We can all clearly see why Natasha and Owen’s families want to stop anyone else going through this.

I spoke to the families of Natasha and Owen so that they could explain to me in their own words exactly what they are trying to achieve. I am grateful to them for that. It appears that both petitions go hand in hand. The petitioners believe that if we had a tsar, they would have a champion who could work with families who have suffered bereavement and with charities that want to help, along with frontline staff, proprietors, supply chain businesses, the Food Standards Agency and all Government Departments that share an interest. It is a straightforward ask.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

The FSA has highlighted the fact that while young people are more likely to experience a food allergy, they are less likely to tell a café or restaurant about it, especially if they have eaten there before. Does the hon. Member agree that we must empower young people to speak up about their allergies and make businesses aware of the importance of proactively asking customers about their potential allergies?

[Nick Fletcher]

The hon. Member is exactly right. I was forwarded a list of many people who have fallen foul of that, and they always seem to be so young. I will definitely come on to what the hon. Member has mentioned.

The second petition seems relatively simple, too. How difficult can it be to put on a menu what allergens are in each piece of food? In fact there is already a law requiring that, but it falls short by requiring it “by any means”, which often means that allergen information is missed by those who need it most. The petitioners say that the law needs tightening up, but they are flexible in their ask: they say that allergens must be stated on the face of the menu, but that could be in paper format or electronic. For a server to make sure that a discussion is had seems another simple ask, and a list of the sad losses could be dealt with through the coroner’s office.

But as with many things in life, it is not quite as simple as all that. The industry is huge. Billions of pounds are spent each year on food from outlets of varying sizes. We have all been to a local caff or McDonald’s; some of us have been fortunate enough to go to some rather expensive restaurants in hotels with branches around the world. Then there are those in the middle, the squeezed small and medium-sized enterprises. Therein lies the problem: the variation among outlets and what and how they serve.

Fast food chains give a specification to their suppliers of the ingredients that their food is to contain, with no variations—that is what they ask for and that is what they get. But other outlets, big and small, often get swaps when they order their ingredients, pretty much like when we get an online supermarket delivery. A local caff may be able to cope with that, with a good proprietor keeping a check on what they are sent and very few menu changes throughout the year, if any. It may not be too much of a problem for them, but the large restaurants and some of the independents with fast-moving kitchens may struggle.

We have all seen a chef with 40 covers to do bellowing in someone’s ear, pots and pans everywhere, hot kitchens with hot atmospheres, young people trying to learn their trade, and impatient customers breathing down a server’s neck. These are high-pressure situations, often in open kitchens, and these people are all trying to make a living. Mistakes will happen.

Then there are menu changes. Many restaurants change their menu frequently to add to the customer experience. They have to offer a variety to keep it fresh, and hopefully in season too, but every change brings a problem—another allergy list and another place for an error to occur. It is not as easy as one first thought.

[Margaret Ferrier]

Data from 2022 published by the FSA shows that when dealing with a risk of food allergies, smaller manufacturers will focus on the physical separation and secure storage of ingredients. In comparison, medium-sized manufacturers will take further steps such as cleaning between production runs and managing the packaging, labels and transport of products. Does the hon. Member agree that businesses of all sizes should have access to personalised guidance on how they can improve their allergy awareness in risk assessment?

[Nick Fletcher]

I will be coming on to that point, but I believe that an allergy tsar, which the first petition asks for, will be able to bring those concerns together. That would help the industry immensely.

There are companies out there such as Control Catering that want to work with the Food Standards Agency and the industry to create a single source of truth. They want to work with manufacturers so that all data is seamlessly passed to the end user, the customer or diner. The petitioners believe that that is a sensible idea, as we have over 50,000 products across a huge supply chain going to many different outlets and 60 million-plus people across this land. The British Institute of Innkeeping and Hospitality Allergen Support UK feel it is sensible, too, but apparently the FSA is slow to respond when contacted about it. The industry believes that unless we have a joined-up approach, we could end up putting forward legislation that has the best intentions but turns out to be completely unworkable. I know that there is much more that the petitioners would have me say, but I must move on in the hope that other MPs will add their thoughts on the complexity of the issue.

The second part of Owen’s law would be for all servers to start a discussion with customers about allergies so that customers do not have to ask. My own experience is that that is happening anyway. However, I am fortunate enough to be able to answer no, so I am unsure how deep the conversation goes if the answer is yes. Stakeholders feel that training is required for all servers, but I understand that the industry suffers from a high turnover of staff, so that is not an easy task.

--- Later in debate ---

[Jon Cruddas]

I will come on to that point. There have been 20 years of reports that agree about a common platform for policy change, and there is a unanimity across the community. It is bewildering that over the past 20 years, Governments have not responded in a proactive way, although over the past 18 months there have been a few changes, which I will come to later.

The need for an allergy tsar is supported by the National Allergy Strategy Group. In addition, the Natasha Allergy Research Foundation and the NASG are asking the Government to better support people with allergies through, first, an expert advisory group for allergy, which would actively support the growth and delivery of high-quality, comprehensive and geographically diverse allergy provision, and secondly a national allergy action plan.

[Margaret Ferrier]

A lack of societal awareness around food allergies is dangerous. For example, 600,000 people in the UK have coeliac disease, but there is a misconception that people choose to eat gluten-free food for its health and cosmetic benefits. Does the hon. Member agree that more needs to be done to ensure that the UK public are aware of the definition and dangers of different food allergies?

[Jon Cruddas]

I agree. I would suggest that that is part of the lack of an overall strategy and of key responsibilities at national level for making people aware about the differences and the public health needs across all our communities in every constituency that we represent here in Parliament.

The second part of the proposal is a national allergy action plan, which would join up GP and hospital allergy services, increase the number of specialist allergy clinics, train more specialist allergy doctors and consultants and provide mandatory training in allergies for all GPs. Owen Carey’s family want a change in the law to compel restaurants to state the allergens in their dishes, specifically on the face of main menus. That would build on Natasha’s law, which dealt with the ingredients and allergy listings on pre-packaged takeaway foods. Natasha’s law left an uneven situation in which people who buy pre-packaged foods have more protection than those who eat in restaurants, which is what the family are keen to sort out.

The family are also campaigning for better training for waiting staff, for more thorough and certified allergy and first-aid training and, as we have heard, for the proper recording of and a national register for anaphylaxis deaths. Those are all very sensible suggestions. Businesses are also responding: in March 2023, the bosses of 11 leading UK businesses, including Tesco and Sainsbury’s, called for clearer rules on food labelling following recent tragic and preventable deaths.

As for the general context, the figures speak for themselves. One third of the UK population, or 20 million people, are living with an allergic condition, and 5 million have a condition severe enough to require specialist care. Fatal and near-fatal reactions have increased over recent years. There has been a 615% increase in hospital admissions relating to allergic disease during the past 20 years. More than 200,000 people require the prescription of emergency adrenalin because of the severity of their allergic condition. Each year, births add 43,000 new cases of child allergy to the population in need. The figures are extraordinary.

What is so frustrating—touching on what my hon. Friend the Member for Hammersmith (Andy Slaughter) raised a few minutes ago—is that over the past two decades a series of reports have consistently demonstrated the prevalence of allergic diseases, the patient needs and the lack of UK service provision. The list of reports includes two Royal College of Physicians reports, in 2003 and 2010, on allergy: the unmet need. We had the 2004 House of Commons Health Committee report on the provision of allergy services, as well as the 2007 House of Lords Science and Technology Committee report on allergy. In autumn 2021, the all-party parliamentary group on allergy and the National Allergy Strategy Group published “Meeting the challenges of the National Allergy Crisis”.

All the reports have consistently highlighted how allergy remains poorly managed across the NHS because of a lack of training and expertise. All have recommended significant improvement in specialist services as well as improved knowledge and awareness in primary care. They have all talked about a national allergy action plan and the need for a national lead person responsible for allergy services—an allergy tsar. Yet in truth, very little has happened in 20 years. Change is long overdue.

Beyond the statistics, we are talking about a growing number of people living with allergic disease. Their condition can have significant and negative impacts on their lives and those of their families. It is frightening and restrictive to live with a condition that can cause a severe or life-threatening reaction at any time.

The reports that I mentioned, spanning 20 years, have all agreed on four key recommendations for change: a national plan for allergy, which would involve making allergy a priority and investing in a national plan led by a designated Department head, a national tsar; specialist care, which would involve expanding the specialist workforce as a priority; in primary care, ensuring that all GPs and other healthcare professionals have knowledge of allergic diseases; and, in terms of commissioning, ensuring that local commissioners understand the allergy needs of their population.

As I mentioned, I want to acknowledge some progress over the last year. The previous care and mental health Minister—the right hon. Member for Chichester (Gillian Keegan), who is now Secretary of State for Education—demonstrated real commitment in this area, and since 2021 we have established a work programme and an ongoing dialogue between civil servants and representatives from the NASG to support the development of a national plan. I hope that that work continues. It should be the right of every allergy sufferer to receive a quality standard of care, and every sufferer should be able to be confident about the food that they consume in restaurants, as is the case under the arrangements that successfully operate in other countries, such as the Irish Republic.

In December 2022, the Food Standards Agency executive said that as a result of the need to respond to the deadline imposed by the Retained EU Law (Revocation and Reform) Bill, it had to delay its planned work on Owen’s law. Supporting the petition this afternoon will, we hope, put pressure on the Department for Environment, Food and Rural Affairs to force the FSA to prioritise its work on Owen’s law before another person dies unnecessarily.

I congratulate all the organisers of both petitions and urge the Government to respond favourably to them, because lives literally depend on it. Government action is important, and I hope that the Government can back both petitions this afternoon.

Brain Tumour Research Funding

Margaret Ferrier Excerpts

Thursday 9th March 2023 Commons Chamber

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

A constituent got in touch with me yesterday to tell the devastating story of her young niece, who struggled to obtain a diagnosis despite several GP trips and horrendous symptoms that left her unable to eat properly or attend school. Does the hon. Member agree that ringfenced funding, specifically for research into childhood brain tumours, must be agreed urgently?

[Derek Thomas]

I will come on to that point later. I am grateful for the contributions that we have already heard.

I pay tribute to the late Dame Tessa Jowell, who sadly received her own diagnosis of a brain tumour soon after that debate, when Government funding was being announced. At that time, about five years ago, she said in the other place:

“For what would every cancer patient want? First, to know that the best, the latest science was being used…wherever in the world it was developed, whoever began it.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Sadly, she passed away in May 2018.

Soon after, an additional £20 million of Government money was made available and the Tessa Jowell Brain Cancer Mission was established. I pay tribute to Dame Tessa Jowell’s daughter and the mission for the way that they have transformed the pathway and the care that brain tumour patients get, and for the work that they continue to do. I appreciate the way that they have engaged with me and others on the all-party parliamentary group on brain tumours in their work.

The provision of £65 million heralded a significant shift in focus towards brain tumours. Given the high-profile commitment to brain cancer research, we should not be here calling for a commitment and a focus on brain tumour research five years later. Sadly, however, despite the £40 million of Government funds that were committed to research, there has been a lack of grant deployment to researchers.

It is important to note that Cancer Research UK, since announcing its commitment to spend £25 million on strategic initiatives in brain tumour research in 2018, has committed almost £28 million to that cause. That is not the case for Government funding. To date, the figures of the National Institute for Health and Care Research—the body responsible for distributing that research funding—state that of the £40 million, between £10 million and £15 million has been deployed, and that depends on how we interpret brain tumour research.

The all-party parliamentary group on brain tumours, which I am privileged to chair—perhaps I should have declared my interest at the start—decided to conduct the “Pathway to a Cure—breaking down the barriers” inquiry, which aimed to identify barriers preventing that important funding flowing to its intended recipients. We felt the need to launch that inquiry only because a series of meetings, including with the National Institute for Health and Care Research, the Medical Research Council, the Department of Health and Social Care and a Government Minister, failed to reassure us that dedicated research funding would or could be used to ramp up the research needed if we want to discover the breakthrough that every brain tumour sufferer and their family longs for.

Those of us who serve on the all-party group were able to understand the severity of the issue and the lived experience for patients, families, clinicians and researchers only because of the sterling work of the charity Brain Tumour Research. It provides the secretariat for the all-party group and brings together thousands of people across the UK to share their experience, knowledge and understanding, and to make up what I affectionately know as the brain tumour family.

In February last year, we launched our inquiry and took evidence from clinicians, researchers and patients. We released our report last Tuesday. Today, part of the way into Brain Tumour Awareness Month, we will set out what we have unearthed during the inquiry and press the Government to review and reform their method of deploying research funds to those who can make best use of them.

From our work, we know that researchers find it challenging to access Government funding, because the system is built in silos. We know that cell line isolation and biobanking are happening, but at only a minority of sites across the research community; that the pool of talented researchers is finite; and that NIHR processes act as a disincentive to researchers who can apply their expertise and intellect more easily elsewhere in the medical research field.

We also found that there are a limited number of clinical trials available for brain tumour patients, and that the national trials database is not reliable. We found that pharmaceutical companies are choosing not to pursue the development of brain cancer drugs in the UK, and that funding is not ringfenced—specifically for research into childhood brain tumours, as has been mentioned, where survival rates for the most aggressive tumours have remained unchanged for decades.

Prescription Charges: People Aged 60 or Over

Margaret Ferrier Excerpts

Monday 6th March 2023 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

I beg to move,

That this House has considered e-petition 594390, relating to prescription charges for people aged 60 or over.

It is an honour to serve under your chairship, Sir Edward. The petition I am presenting touches on a number of incredibly important issues in healthcare from access to treatment to public health and preventative care, all within the context of how the NHS adapts to an ageing population. Although the petition focuses on prescription charges, it must be considered in the broader economic context of the cost of living crisis, with months of rising prices and inflation where even the most basic necessities are becoming luxury items for many.

The steady rise of pensioner poverty since 2015 shows no sign of stopping, continuing a trajectory that will see millions of us face a retirement dominated by debt and hardship. That context means we are duty-bound to look beyond figures on spreadsheets and examine what the proposed scrapping of free prescriptions for that age group would mean for those who would be impacted by it. It is those impacts that the petition creator Peter had in mind when he set it up.

When I spoke to Peter about why he started the petition, he shared his concern about the impact these changes would have not on him, but on his local community—the men and women who are already struggling with costs and are making difficult choices about what to prioritise. It is people like him who have spent a lifetime working in industry and those who, because of that work, now suffer from a variety of medical conditions, each needing different medications. It is those women, including his wife, who had their lives upended by the callous way the Government implemented the equalising of the state pension age. WASPI—Women Against State Pension Inequality Campaign—women, who were born in the 1950s and live in England, have further issues to deal with compared with those in devolved countries.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Uprating the age when prescriptions become free in England to be in line with the state pension age, as the Government consulted on, would be harmful given the cost of living crisis, as the hon. Lady said, and the growing economic activity in those over 50 for various reasons, including their health. Does she share my concern about what this could mean for ease of access to medical treatment for the older generation?

[Tonia Antoniazzi]

I thank the hon. Lady for her contribution. It is, indeed, a huge concern that people with multiple health problems are facing extra difficulties in accessing prescriptions and are having to make those difficult choices about how they spend their money.

For Peter, it seems that something has gone incredibly wrong to get us to this point—something broader than this planned introduction of charges, but something encapsulated by it. It is the breaking of a promise—the promise between citizen and state and the promise that a lifetime of contribution, whether financial through tax and national insurance or through the unpaid labour of care that enables our economy to function, means support in retirement. Peter kept his part of the bargain. It was great to have a conversation with him. He could not believe that his petition was being debated in this place, and it is so important that his voice and the voices of others are heard in this place. He kept his part of the bargain, first in the shipyards on the Tyne and then working on aircraft. He paid in and did what was expected, as did hundreds of thousands of others, but the Government have not held up their end of the bargain. They have changed the rules, and it looks like they will do so again. That unfairness is the reason why we are discussing the matter today.

The plan to introduce charges seems particularly unfair when Peter does not even have to look that far from home to see a better way. England is the only nation in the United Kingdom without free prescriptions and, as colleagues may have guessed from my accent, I am Welsh. I have the great pleasure of representing Gower, one of the three Swansea constituencies, which is beautiful. If anyone ever wants to visit, please do.

Swansea and Newcastle have a lot in common: both are port cities with a proud industrial heritage; both are famous for an excellent night out. It seems the height of unfairness to many in Newcastle and across England that they alone in the United Kingdom pay for prescriptions. I am sure that the Government will tell us that several conditions are exempt and that pre-payment certificates cut costs, but, as I said earlier, we must look beyond the briefings to the reality of the system actually. The exemptions list is not only woefully out of date but, apart from the addition of cancer in 2009, it has not been reviewed since 1968. It also does not cover several life-changing conditions, such as Parkinson’s, arthritis, asthma, Crohn’s disease, cystic fibrosis, lupus or motor neurone disease.

That is the tip of the iceberg. People with those conditions, and other complex, lifelong conditions, still pay for their prescriptions. For those with multiple, co-existing conditions, the cost is even higher. Evidence from the Prescription Charges Coalition, a group of 50 organisations calling on the Government to scrap prescription charges for people with long-term conditions in England, shows that people with long-term conditions struggle to pay for their medication. A third of respondents in England with long-term conditions reported that they had not collected a prescription item due to the cost. Nearly a third admitted that they are skipping or reducing medication doses, with cost concerns a key factor for more than four out of 10. As a direct result of reducing or skipping medications, nearly three in five—59%—became more ill, and 34% needed to visit their GP or hospital. In fact, the Government’s own impact assessment on the introduction of charges highlighted that issue and noted the potential effect on people’s health.

In 2018, thousands of over-the-counter medicines were taken off the list of those that GPs are able to prescribe, leaving those with long-term conditions facing additional costs for their conditions and to stay well. Those worrying health outcomes come with a cost to the NHS. Several member organisations of the PCC conducted research last year. They found that, of those surveyed, one in six of those with asthma and lung disease had cut back on using their potentially life-saving inhalers, as they were worried about the cost; 29% of respondents with cystic fibrosis reported that they had skipped their medication due to prescription charges; and one in five people with multiple sclerosis say that they do not have enough money to pay for the medication or treatment they need.

One lady who lives with kidney disease was hospitalised twice because she had to wait until payday to collect a prescription. In hospital, she had to have a lumbar puncture and an MRI scan, which cost the NHS thousands of pounds more than the prescription would have. As colleagues can see, the impact is vast and, when meeting campaigners prior to this debate, I heard far too many stories like that one. The lived reality of those impacted by this proposed change and the issues caused by the current dysfunctional exemptions system are best understood through that lens.

I work closely with Parkinson’s UK, which is one of the many organisations deeply concerned by this proposal. Medication is the only way to control the symptoms of Parkinson’s disease; most have to take a cocktail of medications to stay well. Research shows that Parkinson’s cost households over £19,000 a year in 2021, due to loss of work; and additional health and social care costs. As Parkinson’s progresses, it becomes more complex. Among people eligible to pay for prescriptions who are aged 60, in any year 5.5% will die within five years and 23.8% will need support to live independently—that is within only five years of being diagnosed. However, they would still have to pay for their essential medications for Parkinson’s.

I want to tell the Chamber a little about Denise. She is 59 and was diagnosed with Parkinson’s in April 2019. She has had to reduce her working hours from 37.5 to only 12 per week, due to her symptoms. She uses a prepayment certificate for her prescriptions, because it is cheaper than purchasing them individually. If the exemption age rises to 66, however, she will have to continue paying for them.

Denise told Parkinson’s UK about the impact that that would have on her:

“I always thought I would work until I was 67, because I would be able to. However, as my Parkinson’s advances I worry about whether I physically will be able to. My employer is really understanding, allowing flexibility to start later in the mornings until my medication has kicked in, but I have already had to reduce my hours by 60% and I’m already noticing the impact of this reduced earning capacity on our household.

I have to pay for my prescriptions, and this is eating into the diminishing amount I can contribute towards the household bills. If they were to increase the age at which I become exempt, it would be really tough because we haven’t allowed for more years of these additional charges.

It feels like the Government is once again penalising those living with a long-term condition like Parkinson’s that anyone could get and for which currently there is no cure.”

Denise’s story is not an isolated one. Parkinson’s is not the only condition whose sufferers will be further disadvantaged by the change, but this is not a problem that will be solved by changing the exemption list. An exemption list has winners and losers baked into its design, and the complexities of managing chronic conditions mean that any approach that is not universal is not fit for purpose.

Furthermore, the Government need to answer why the change is being prioritised now. What evidence is there that it will have any kind of positive impact? We cannot see one. Even if the Government make savings in the short term, the long-term impacts could be catastrophic, leading to greater illness and to more GP and hospital visits.

A poll published in Pulse found that 40% of GPs linked prescription charges to adverse patient outcomes, also indicating that those could lead to far greater costs and more adverse outcomes down the line. Initial results of the 2023 survey by the Prescription Charges Coalition showed that nearly 10% of respondents had not collected medicine due to cost. Of that group—I have more data —30.74% said that they now have other physical health problems, in addition to their original health condition; 30.33% said that they had to go to their GP; 17.32% said that they had to go into hospital for treatment; and 8.32% said that they had to go to A&E.

Research published in 2018 by York Health Economics Consortium highlighted how ending prescription charges for long-term conditions could save money and reduce pressure on the NHS. That comes from preventing avoidable health complications that occur when people do not take their medication. The research identified net savings of more than £20 million per year if the NHS scrapped prescription charges for people with Parkinson’s and inflammatory bowel disease alone. Instead, the Government are discussing introducing additional charges. That flies in the face of common sense.

We know that the NHS is under pressure, but that is the case across the United Kingdom, and the devolved nations are not even discussing removing universal free prescriptions. I urge the Government to follow that lead, to look to the future and not to engage in short-termist, quick fixes that will not be a fix for all, and not for the petition creator.

[Taiwo Owatemi (Coventry North West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing such an important debate.

As a cancer pharmacist, chair of the all-party parliamentary pharmacy group and somebody who still volunteers at a local hospital—I was there this morning—I have seen at first hand the difference that free access to medication makes to those over the age of 60. For years, I have treated patients whom the prescription proposals will make worse off. I know just how anxious they are at the prospect of having to fork out another monthly expense that they simply cannot afford. When the choice is between heating and eating, which is a day-to-day reality for thousands of people in my city, we cannot sit idly while health is incorporated into the mix. It should not have to be spelt out that, as people age, they will develop long-term healthcare needs, and those needs will need to be treated by prescription drugs.

[Margaret Ferrier]

Prescription charges have been described by pharmacies as attacks on the sick. As we have heard, pharmacies have reported a significant increase in the number of patients not collecting their prescriptions because they simply cannot afford them. Does the hon. Member agree that that is worrying for all age groups, but especially for over-60s, who are more prone to sickness and to requiring that medical aid?

[Taiwo Owatemi]

I agree. Sadly, we look at the pharmacy shelves and see that many patients are not picking up their prescriptions, or patients come to the pharmacy counter, realise how much a prescription costs and that they cannot afford it because they have not financially planned for it. I will speak about that later in my speech.

The Government’s impact assessment concluded that 52% of people between the ages of 60 and 64 will have at least one long-term health condition, so by aligning medical exemptions with the state pension age, the Government are hitting the people in my community who have the greatest need for medication but simply cannot afford it. What do the Government expect to happen when people in their 60s decide that they can no longer afford their prescriptions? If saving money is the Government’s aim, I question whether they have considered the reality—that the proposals will simply shift the costs from primary to urgent care. Health conditions will inevitably worsen, and patients will be forced into overcrowded A&E units—adding to the already overwhelmed health service.

I support some of the points highlighted by my hon. Friend the Member for Gower regarding long-term health conditions, especially unchanging health conditions such as asthma, motor neurone disease and sickle cell anaemia. As she highlighted, the York Health Economics Consortium estimated that £20 million would be saved each year if the NHS scrapped prescription charges for people with Parkinson’s and inflammatory bowel disease. That is because fewer people would be forced into A&E, which would mean fewer hospital admissions and fewer GP visits. If we want to save the NHS money and reduce the burden on the NHS, prevention is key, and medicines play an essential part in preventing patients’ healthcare conditions from worsening and preventing patients from developing other health conditions. It is concerning that the Government can consider the proposals as a way of reducing the burden on the healthcare system. That is a hugely irresponsible decision for the Government even to consider making. It is essential that the Government engage in some form of cumulative impact assessment. People over the age of 60 with long-term conditions will be disproportionately affected.

My older constituents in Coventry North West are anxious and stressed. They tell me that they simply do not know how they will make ends meet at the end of each month, especially when they have to deal with soaring energy bills and food costs. They ask why the Government continue to attack elderly residents during the most severe cost of living crisis for a generation. I hope that the Government will answer that. I especially worry that making our ageing population pay for medication will leave huge numbers of people unable to afford essentials and force them into further hardship. I add my support for the Prescription Charges Coalition, which is calling for a freeze in prescription charges for 2023 and has said that the Government must scrap the alignment plans. I recognise that the Government are planning to support the proposals.

Every year, especially on 1 April, I find myself helping patients to fill out prepayment card applications or to navigate the increase in NHS charges, because many do not even realise that those changes are coming. I therefore first ask the Government to notify patients of the increase way before 1 April so that they are able to financially plan; otherwise, the increase may mean that many do not have access to their medication when they need it. Secondly, will the Government review the long-term exemption list for patients with medical conditions that, due to their nature, we know will not change?

I want to make a final important point. Older people have contributed to our society their whole lives, and they have trusted that if they work hard and pay their taxes, they will be looked after. That is the deal we make with them, and it is what they expect from us when they get older. The Government’s proposal will break that trust. We cannot afford to abandon older people now simply because the Government have decided that this is the best way forward. Doing so will impact trust in the long term.

Lastly, will the Minister, who is responsible for primary care, come to the all-party parliamentary pharmacy group meeting from 1 pm until 3 pm on 29 March in Room S, Portcullis House, and speak to pharmacists? We would like to continue the debate and to talk about the current pressures facing pharmacy as a whole.

It has been a pleasure to contribute to the debate. I look forward to hearing from other colleagues.

Performance-enhancing Drugs and Body Image

Margaret Ferrier Excerpts

Tuesday 21st February 2023 Westminster Hall

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Until we were rudely interrupted by that vote, I was saying that we need to talk about steroids in the UK because, as the Priory Group has said:

“we are sleepwalking into a…crisis.”

As a GP, I know that the obesity epidemic has been a real problem, but part of the nation is actually getting fitter while part of it is getting fatter. I will concentrate on the part that is getting fitter, because of those who go the gym—mainly men—we know that one in 10 suffer from bigorexia. What am I talking about? Bigorexia is body dysmorphia—the idea that someone’s muscles are not big enough, no matter how much they eat or train. It is important to understand that this is a growing epidemic in our country; even more importantly, it is quite prolific in the gay community. I will break the issue down into three sections. I will talk a little bit about how I came to this topic, the drivers behind it, and, most importantly, what needs to be done.

Growing up, I was a fairly normal kid. At the age of 14 or 15, I was playing sport and was reasonably academic, but I was an outlier, because for my 15th birthday I had saved up £500 to buy a multigym. In my head, I wanted to improve my rugby, get girls, fight off bullies and improve my body image. Surprisingly, I was the under-16s first-team captain, but the other three aims fell to one side. Looking back, I think, “How many other young men feel like this?” That was 25 years ago. I think the points I mentioned are the driving forces behind why men want to go to the gym and improve their body image. Society says to them, “We need to be perfect”, but what is that perfect image?

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Social media and reality TV have played a huge part in promoting unrealistic body ideals, which we often do not think about when it comes to men’s self-esteem. Does the hon. Member agree that there should be some greater controls around edited, unrealistic imagery?

[Dr Evans]

The hon. Member is spot on. The advent of social media over the last 20 years has really brought home that idea of body image. With the likes of Instagram, if a man is interested in using a gym, they are sent hundreds of images in 30, 40 or 50 seconds. Each individual image in itself is not the issue, but the cumulative effect of repeatedly being sent such images is a problem.

I would argue that the way to solve the problem is through the social media companies’ algorithms, to ensure that there is transparency about what people are being sent. Facebook talked about diet pills aimed at young girls being a real problem. If we do not deal with male body image and body dysmorphia, this will be the next iteration of that problem.

As a doctor, over the last 10 to 15 years I have started to see more and more young men coming into my clinics and asking to be prescribed protein powders or creatine, and asking, “How do I bulk up?” I also started to see more and more men in their 20s, 30s and 40s who were using steroids and having side effects, including bad acne, scarring acne, mood problems and depression. I have even seen some men who have had strokes, heart attacks, liver problems, kidney problems and erectile dysfunction, none of which are really talked about when it comes to steroids.

The problem with steroids is that they work, so people use them and see a drastic improvement. People who want to build muscle will see that improvement, take the cycle of whatever substance it happens to be and then plateau, which is very hard for them to deal with because they no longer see the gains they were initially getting under their regime. They say, “Oh, I’ll only use it once”, but once becomes twice, twice becomes thrice, and so on.

--- Later in debate ---

[Margaret Ferrier]

The hon. Member mentions aggression. A common side effect of steroids is roid rage, which means that it is not just those who choose to use steroids who are impacted, but everyone around them, too, and that can lead to serious life-ruining consequences all around. Does the hon. Member agree that greater understanding of side effects is an imperative part of tackling the abuse of these drugs?

[Stuart C. McDonald]

The hon. Member makes a valid point. One report I read suggested that when engaging with people who are already using steroids, sometimes the most persuasive factor in getting them to reconsider and move away from this conduct comes from speaking to them about the consequences for their mental health rather than the physical consequences. That appears to have more influence when it comes to behaviour. The hon. Member makes an interesting point.

Alone, most steroids are taken in pill form. If needle sharing is involved, there are other risks in terms of HIV and hep C. Use of counterfeits also further complicates risk. Of course, another consequence if they are used in sport is that unfairness is created and sporting integrity is undermined. As has been set out, the drugs are regulated under the Medicines Act 1968 and classified as class C under the Misuse of Drugs Act 1971.

The question rightly posed to us today is: what more can we do? I speak from a position of weakness, but I agree that first and foremost, we all need to improve our knowledge of the issue. Evidence has to be at the heart of the approach, as the hon. Member for Bosworth has said, so how better can we understand the scale, incidence and causation of the problems that have been highlighted and thereby better craft a response?

As the hon. Member highlighted, last August the Health and Social Care Committee reported on the impact of body image on mental and physical health and recommended a national review of the growing use of anabolic steroids as it relates to body image. That seems to me to be an essential first step. That research will then shape our response, which will have to use a public health approach and education to tackle demand and to try to close off access as best we can. That, of course, will involve a cross-departmental approach, which was another important point made by the hon. Member.

On education and campaigning, there are two sides to the coin. First, we need to look at the material and propaganda influencing and driving people to a place where they feel it is necessary or desirable to access IPEDs. That includes media and social media, as hon. Members have said, with the all-prevalent perfect body images in the press, on TV and increasingly on social media and in online advertising. If anyone shows a remote interest in trying to keep fit or even just losing a few pounds, they suddenly find themselves bombarded on Instagram or Facebook or whatever else with relentless images of what has been referred to in the past as the “Love Island” look, which to me seems pretty much unachievable for anyone who cannot spend every waking hour in the gym or unless they use IPEDs.

The Health and Social Care Committee dealt with that point in its report, calling on the Government to work with advertisers to feature a wider variety of body aesthetics and with industry and the Advertising Standards Authority to encourage advertisers and influencers not to doctor their images. The Committee said that

“the Government should introduce legislation that ensures commercial images are labelled with a logo where any part of the body, including its proportions and skin tone, are digitally altered.”

Those seem to be valuable suggestions that are certainly worth considering. The hon. Member for Bosworth pointed out that there has been some progress, but there is further to go.

As well as tackling the images and messages that promote the use of IPEDs, Government also need to raise awareness of the risks and how to minimise harm. Again, various Committee recommendations seem sensible, advocating for a campaign co-ordinated

“through existing steroid user support groups and targeted at areas of highest risk, such as gyms with a high proportion of body builders.”

We need to tackle head on the idea that these things are some sort of equivalent to supplements. They are in a different category altogether. The Committee also heard evidence stressing the importance of education about body image for young people, in terms of both critical thinking and appraising images, as well as self-worth. Again, the Government should strengthen those areas in education settings.

A report by the Scottish Drugs Forum noted the significance of close friends as a source of IPEDs. It suggested that peer education programmes could be an important way of overcoming that, with community members cascading positive health messages. And this is not just about education; mental health strategies need to be revisited as well, and we need to think about how we can support people struggling with self-esteem amid a bombardment of images.

Finally, we also need to consider appropriately targeted harm reduction advice and drugs services. There are many examples of good work out there. Yorkshire and the Humber has a regional steroid and IPED reference group and a workers forum of more than 30 people and with every district represented. In Glasgow, an image and performance enhancing drugs clinic provides testing, needle exchange services, consultation and advice on harm reduction and alternatives. Edinburgh, too, has a steroid clinic based in the harm reduction team of NHS Lothian. It provides advice services, equipment and testing, psychological services, and support to stop with mental and physical assistance. There is good work happening in the different parts of the United Kingdom. We should learn from that, and seek to ensure that more people around the various countries can benefit from it. Those are just a few ideas.

I will close by thanking the hon. Member for Bosworth again for bringing forward this debate. None of us have all the answers; I certainly do not—far from it. He had lots of ideas. He highlighted that there are pros and cons to some of them. Some of them are quite bold or controversial, but they are definitely worth discussing. His central point was that we need to have evidence to make the discussion as fully informed as possible. We should revisit this topic, and ensure that we continue to drive forward as we seek to address what is a growing public health issue.

Cystic Fibrosis: Living Costs

Margaret Ferrier Excerpts

Thursday 2nd February 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the impact of cystic fibrosis on living costs.

It is a real pleasure to be here in Westminster Hall—a bit breathless, but we are here. This is a massive subject, and I am very pleased that many colleagues have been able to attend in support. Looking around the room, I see many Members who have personal stories to tell; they will do so, and their stories will reinforce the questions that we all wish to ask the Minister. I am very pleased to see the Minister in her place, as well as the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). He and I seem to be in many debates together; indeed, we are a bit of a tag team. It is also a pleasure to serve under your chairship, Ms Harris.

I am the DUP spokesperson for health, so I am pleased to be able to highlight the struggles of those with cystic fibrosis and other lung conditions who have been affected by the spiralling cost of living. As the Minister knows, I will make a number of asks of her in my speech. Most Members will be aware that cystic fibrosis is a progressive, life-limiting genetic condition that primarily affects the lungs and the digestive system. The condition is due to inheriting a faulty gene from both parents that causes the lungs and the digestive system to become clogged with mucus, making it hard to breathe and to digest food—that is the graphic way of explaining what it means. It is common for those with CF to also have CF-related diabetes; I did not know that until I read the research, but I was aware that other effects include osteoporosis and being malnourished. Some 80% of people with CF are pancreatic insufficient, and therefore need a higher calorie intake to maintain a healthy weight.

Roughly 11,000 people in the UK have CF: 9,000 here on the mainland in England, 1,000 in Scotland, 500 in Wales and 500 in Northern Ireland. In 2021, the median age of people with CF who died was 38. Wow—this disease really puts life into perspective. People with CF are particularly susceptible to lung infections, and therefore cannot meet each other face to face due to the risk of cross-infection. Again, the life of someone with CF is really restricted, and is much more difficult.

That brings us to the crux of the issue: living with CF demands an incredibly high burden of treatment, taking at least two to five hours and up to 70 pills each day. People with CF have higher food bills because they need a higher calorie intake to maintain a healthy weight, and higher energy bills because they need to keep their homes warm to stave off lung infections and they may need to power an additional fridge to store sterile medications or essential medical devices such as ventilators. Life as a person with CF is so different from everybody else’s life.

People with CF living in England must pay for their NHS prescriptions, unless they are exempt. Those with CF living in England and, at least until 2024, in Northern Ireland also have to pay hospital car parking charges. The Cystic Fibrosis Trust, in conjunction with Bristol University, commissioned a report entitled “The Financial Costs of Cystic Fibrosis”. I urge the Minister to take time to process that report; if she has already done so, we thank her for that. It will give her a good perspective on my speech, and perhaps on other Members’ speeches as well.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Gentleman on securing another debate in Westminster Hall—he is very successful at doing so, and I thank him very much. According to research, an adult with cystic fibrosis will, on average, incur an additional £209 per month in living costs, while a parent carer of a child with the condition will incur an additional £291. Very few people on an average income have that kind of money to spare. Does the hon. Gentleman agree that dropping prescription charges for people with cystic fibrosis, as has been done in Scotland, would be one way of easing the burden on families?

[Jim Shannon]

I thank the hon. Lady for her intervention, and I agree with her. In Northern Ireland, there are no prescription charges—there is no cost—which I believe makes a difference. That is one of my asks of the Minister; there are a lot of asks, most of which are financial, but they are very important.

To follow on from the hon. Lady’s intervention, the report also revealed that the additional cost of living due to cystic fibrosis is over £6,500 per annum. The financial burden is made up of both extra spending to keep well and the loss of income. The key findings indicate:

“Families with CF are more likely to be struggling with their finances than the public—24% of adults with CF and 35% of parents of children with CF described meeting their bills each month as a ‘constant struggle’”—

life is really hard for people with CF—

“compared to 17% of UK households overall.”

The findings continue:

“Food and rising energy bills were the biggest financial concern for people with CF and their families—both are essential to the health and quality of life of people with CF.

For the average family the combined impact of extra spending”

includes “heating, expensive dietary needs” and “attending medical appointments”—the local hospital is not always where they go to meet a consultant or specialist—and “home medical equipment”. Life for a CF patient in their home is almost like being in a hospital.

There is also the loss of income: treatment takes two to five hours every day, which means that they cannot keep down a full-time job; indeed, it would be difficult to keep down a part-time job. The extra spending and loss of income means

“they are thousands of pounds worse off than comparable families.”

The findings continue:

“Three-in-five (59%) of adults with CF had also incurred some form of income loss as a result of their condition in the last two years—for example, reducing working hours, taking unpaid leave to attend appointments or leaving work altogether”,

as many have to.

The Cystic Fibrosis Trust has seen a significant increase in the support needed, with 72%—a big figure—of helpline inquiries since October 2022 relating to financial support. Between October and December 2022, it provided cost of living fund grants to hundreds of households and increased its grants for essential household appliances and white goods. The figures are real—they are quite detrimental and very hard to comprehend.

According to the Marmot review of health inequalities,

“Those living in the poorest neighbourhoods are twice as likely to develop a lung condition, and seven times as likely to die from one than those in the richest areas.”

We have seen the pressures on those with CF, but those pressures are even greater if they live in households where money is tight, where they cannot keep a wage and where they are probably more dependent on benefits. I will talk about that in my requests to the Minister. I know that benefit payments are not the Minister’s responsibility, but they are one of the issues that come off the back of this debate.

Because poorer communities are disproportionately impacted by the cost of living crisis, many of those living with a lung condition are more likely to be struggling from the outset. Asthma and Lung UK found that almost two thirds—63%—of those surveyed with a lung condition are

“buying and eating less food.”

That is when they need food more, need the right food and need it in the right quantity. Eating less food can lower immunity and increase the risk of

“viruses that are the top trigger of asthma attacks”.

It is clear that those who suffer from cystic fibrosis, or from other lung conditions, are in grave need of help. That is my ask of the Minister today. Some of the issues will take cross-Department co-operation, but I believe the Minister is best placed to take them forward. The collective asks that I and others in this debate have are so important.

I should have said at the beginning—I apologise for not doing so—that I thank the Backbench Business Committee for agreeing to the debate. The Committee is very good when we propose debates to it, and it granted this one without any thought whatsoever. We also hoped to have the debate at this time, because it ties in nicely. There are people in the Gallery who have helped me, and probably others in this room, to prepare our contributions for today.

Ask number two, which I have raised before but will raise again, is that benefits must continue to rise in line with inflation. Some 83% of parents of children with CF are receiving one or more type of benefit, and 68% of adults with CF are claiming at least one form of benefit, according to the new report. The Office for Budget Responsibility forecasts that consumer prices index inflation for 2023 will be 7.4%. Those are the figures. If the Government—I always say these things respectfully and they are not meant critically, which is not my form, but I ask them because they need to be said—do not continue to increase benefits in line with inflation, not only those with CF but all the poorest will suffer a detrimental blow.

[Margaret Ferrier]

I thank the hon. Gentleman for giving way again; he is being very generous. Research conducted by the University of Bristol found that a surprising number of cystic fibrosis patients had applications for personal independence payment or disability living allowance rejected, and others did not apply because they did not know what support might be available. Does he have any thoughts about how the DWP could improve awareness of the condition and ensure people are getting the right support?

[Jim Shannon]

It is almost like the hon. Lady read my next point. That is one of the focuses of my request. It is my next sentence, would you believe?

We must remove unnecessary PIP reassessments for people with long-term conditions such as CF. There has to be an understanding of what CF is and how it affects people. There has to be an understanding that their lives are not like anybody else’s lives. I said earlier that the median lifespan for people with CF in the last year was 38 years. It is sad to say this, but it is a life-limiting condition.

There is a requirement for claimants to report any change in health to the Department for Work and Pensions—wow! It would be great if every person with cystic fibrosis could say, “I tell you what, I’m better today. I won’t need those 70 pills and the medication for the next wee while.” That does not happen. It would be a miracle. I believe in miracles—you know I do, Ms Harris—but they do not happen every day. The fact is that people sometimes have a sickness or a disability—this is one of them—that means they need help. I have always been a great believer that society is marked by how it helps those who need help, and that is what we need to do.

These people have a progressive lifelong condition and their health is unlikely to improve, but there is the threat of constant reassessment—my goodness, reassessment again. We know the condition is life-changing and life-limiting, and that they probably need a transplant. The hon. Member for Bristol East (Kerry McCarthy) is always here in these debates. I welcome her to her place—not that it is my job to welcome people to Westminster Hall, but I like to see her because I know she makes very helpful contributions. The reassessments provoke anxiety and are costly and unnecessary. Streamlining the assessment system would mean that those with progressive, long-term conditions such as CF do not have to undertake reassessments. That would not only remove the anxiety but provide cost savings to the DWP. We do not need to do those reassessments because it is a life-limiting disease.

I feel very frustrated—I am sure others do too—when people with life-limiting diseases have to go through reassessments for employment and support allowance, PIP or DLA. It is absolutely unbelievable that that should happen.

--- Later in debate ---

[Andrew Western]

My hon. Friend makes a really important point. We have talked about some of the associated conditions that can come with CF, such as diabetes, but the mental health implications for some sufferers are acute. I hope the Minister will take account of that in her response.

Penny is incredibly concerned—given how difficult it is for Eva to attend school and the support she needs from Penny to do that—about how difficult it will be for Eva to secure work. That is something they worry about a considerable amount; with the current cost of living, it is a huge concern, because without receiving funding to support her living costs, Eva will be left in a vulnerable position. She will be less likely to earn a decent living, as she may be able to work only part time and will not necessarily have the same qualifications as somebody who has been in school full time.

Eva’s illness is not properly recognised by the current criteria, which seem to assume that people need financial help only because they are unable to do certain physical daily tasks and lack mobility. In theory, Eva can do those things, but she does not usually feel well enough to do them and so relies heavily on help, but that does not necessarily come across in the current system. Why does current financial support not consider the impact of an illness on a person’s ability to get an education and gain decent employment, and recognise that providing support would enable them to maximise their potential and earn the best living that they can in the circumstances?

If young people such as Eva were routinely financially supported with PIP, it would take some pressure away from them so that they could focus on doing what they can manage to do, and it would help them to meet their costs of living. Penny faces the prospect that, in order for Eva to attend college, she will have to reduce her hours at work to be able to take her there. That would obviously have a significant impact on the family finances, but getting a bus early in the morning and back again after college may add to Eva’s fatigue, so Penny taking her there is the only way for the situation to be manageable and for Eva to avoid missing college too often.

[Margaret Ferrier]

The hon. Member is making a great speech. People with disabilities such as cystic fibrosis find it harder to maintain employment and, as he says, worry about keeping up with bills. It is estimated that only half of employers have occupational sick pay schemes. Does the hon. Member share my concern about the impact of the UK’s very limited statutory sick pay rate on vulnerable people who need to take time off work?

[Andrew Western]

I share the hon. Lady’s concern. She is absolutely right that this impacts significantly on people’s ability to function in the workplace. It also impacts on the mental health issues raised by my hon. Friend the Member for Bristol East (Kerry McCarthy), so it is an important issue, and the hon. Lady is right to raise it.

Let me return to Penny and Eva’s plight and the concerns that Penny has set out to me. Because Penny will no longer get DLA and Eva is unlikely to get PIP to help with costs, there appears to be little support for Eva, moving forward. I have had correspondence with Penny beyond what I have shared with colleagues here. Eva needs multiple prescriptions, which she will have to pay for as an adult. She has frequent hospital visits. These are familiar concerns, which we have heard about. Travelling to hospital incurs parking costs, but also petrol costs. Eva needs extra food to prevent her from being malnourished, as she cannot digest food properly; extra water to be clean, as she sweats excessive salt out; and, of course, extra heating—an issue that colleagues have mentioned—to keep her warm.

The cost of living is tough for us all, but it is having an especially acute impact on those with CF. Given that it is so hard for them to work full time and that the benefits system does not necessarily look after them in adulthood, this is a real crisis, so I hope action can be taken. I am pleased to associate myself with colleagues who have so far spoken in highlighting the many ways in which the Government could take action. A review of the now 55-year-old list of conditions for which there are free prescriptions is one such way. The hon. Member for Strangford highlighted an uprating of benefits. There could also be some practical support around VAT on energy bills. Other support could be offered to help people with the rising cost of food, and the hon. Member for Ashfield (Lee Anderson) mentioned the potential clash in managing diet when balancing the impacts of cystic fibrosis and diabetes, which can in itself add to food costs, although that may be offset by the free prescriptions.

There is a considerable amount going on here. As I said, I associate myself with the comments of my colleagues, and I hope the Minister will indicate in her response what action can be taken.

Oral Answers to Questions

Margaret Ferrier Excerpts

Tuesday 6th December 2022 Commons Chamber

[Neil O’Brien]

I have already talked about some of the things we are doing to crack on with improving public health and narrowing inequalities, but I will add some more. We are driving up blood donations from shortage groups and vaccine uptake in areas with the lowest uptake. I mentioned the extra £900 million for drug treatment, taking the total to £3 billion over three years. I will not repeat all the things I mentioned but, across the board, we are working at pace to improve public health and narrow health inequalities.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

10. What steps his Department is taking to improve survival rates from sudden cardiac arrest.

[The Minister of State, Department of Health and Social Care (Helen Whately)]

Immediate cardiopulmonary resuscitation doubles or quadruples the chance of surviving an out-of-hospital cardiac arrest. Defibrillation within three to five minutes dramatically improves the chance of survival, which is why NHS England is establishing a network of defibrillators and community first responders to save up to 4,000 lives a year by 2028.

[Margaret Ferrier]

On average, 150 people a day die from sudden cardiac arrest outside hospital. Access to a defibrillator is crucial for survival. Without one, the chance of surviving drops by 10% every minute. I welcome the Government’s commitment to rolling out defibrillators across state-funded schools in England and Wales, but I share the concern that, because of significant ongoing supply chain issues, it might not be achieved. Can the Minister explain how the Department is helping to reach the target of supplying 20,000 defibrillators by 2023?

[Helen Whately]

As the hon. Lady says, access to a defibrillator makes a great difference to the survival prospects of somebody having a sudden cardiac arrest, which most commonly happens either at home or in the workplace. Since May 2020, the Government have required all new school builds and refurbishments to have defibrillators installed. I am happy to look into the concern she raises and get back to her. I am also working on other initiatives to make sure we get more defibrillators into public places.

--- Later in debate ---

[Mr Speaker]

Last question, Margaret Ferrier.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

What assessment has the Secretary of State made of geographic variation in access to innovative liver cancer treatments, such as selective internal radiation therapy?

[Steve Barclay]

It is a brilliant question on which to close, because one of the things that all hon. Members should be hugely interested in is how we are adopting innovation more quickly and industrialising that innovation across the NHS as a whole, as opposed to in silos. That is something that we are focused on in the Department and it is a key priority. I am happy to speak to the Scottish Government and others about how we can work together on that.

Baby Loss and Safe Staffing in Maternity Care

Margaret Ferrier Excerpts

Tuesday 25th October 2022 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

The APPG’s report on staffing shortages found that hospital staff feel that post-natal care has suffered the most from cuts, with most aftercare being devolved to healthcare workers who do not hold the same level of qualification as a midwife. That will impact on the health of mother and baby—for example, if they do not have access to breastfeeding support because resources are stretched too thin. Does the hon. Member agree that post-natal care needs urgent attention?

[Helen Morgan]

I agree. Many of us have experience of less than brilliant post-natal care, and the staff shortages are well documented. The Health and Social Care Committee report recommendation that £200 million to £350 million a year is required to be invested immediately in maternity services speaks to that issue. On Wednesday 30 March, the then Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), confirmed that £222 million had already been committed but was not guaranteed for the future, although he would keep it under review. That was two Health Secretaries ago.

On 1 September, the next Health Secretary argued that, given how stretched the NHS was, services such as maternity might no longer be a priority. I seek reassurance from the Minister that that is not the case. Maternity services have been treated as a Cinderella service for years and we have been left with shocking scandal after shocking scandal, with thousands of families devastated by poor care at a time when they were supposed to be at their happiest. I am at a loss to understand the deprioritising of maternity services—the one service that every one of us will need at least once in our lives.

The workforce gap of 2,000 midwives and 500 new consultants has been referred to, but it is estimated that nearly 700 midwives have left the profession in the past year, and eight out of 10 report that they do not have enough staff on their shift to provide a safe service. Will the Minister commit to increasing funding to meet the £200 million to £350 million-a-year recommendation, for a specified period of time, and to developing a fully costed, multi-year workforce plan?

The safe staffing report produced by the baby loss and maternity APPGs, on which I serve, has already been referred to. I draw particular attention to the need for more bereavement midwives. The pressure and increased likelihood of failure, and the sheer exhaustion that overworked maternity staff feel, must be a cause of some of the other issues we have seen at Shrewsbury and Telford NHS Trust, and at the other trusts that face challenges.

Shropshire is not the only area of the country to have suffered a crisis in its maternity services, with Morecambe Bay, East Kent and Nottingham all facing serious issues. Far too many families have faced tragedy. I ask the Minister to ensure that their experiences are not in vain, and that the Government will act on unsafe staffing.

Liver Disease and Liver Cancer: Diagnosis

Margaret Ferrier Excerpts

Tuesday 11th October 2022 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I beg to move,

That this House has considered the diagnosis of liver disease and liver cancer.

It is a pleasure to serve under your chairmanship, Mr Betts. I am proud to sit as a vice-chair on the all-party parliamentary group on liver disease and liver cancer. I am delighted to have succeeded in securing today’s debate.

While health policy may be devolved in Scotland, I believe that work in this area across our four nations is vital. We can support each other in cutting mortality rates and improving outcomes across the UK. The liver is a remarkable organ. Like something from science fiction, it can regenerate. It is one of the more forgiving pieces of our anatomy. We can make lifestyle changes and treat it a bit better, and it has the capability to heal itself and undo some of the damage we may have caused in the past.

Considering that the liver is one of our most important organs in terms of its function, we probably do not give it the attention it deserves. Some 49% of liver cancer cases in the UK are preventable, and 20% of liver cancer cases in the UK are caused by smoking, according to Cancer Research. There are around 6,200 new liver cancer cases in the UK every year and 5,800 deaths. That is roughly 17 diagnoses a day and 16 deaths. There are five types of liver-affecting cancer, with hepatocellular carcinoma, or HCC, being the most common, accounting for more than three quarters of liver cancer cases globally.

While mortality rates for other cancers have improved over the decades, liver cancer mortality has more than doubled since the ’70s, with only 13% of patients surviving more than five years from diagnosis. Right now, the United Kingdom is facing a liver disease crisis. The number of deaths from the disease have doubled in the last two decades, while other disease outcomes, for example from diabetes or respiratory diseases, have stabilised or even improved. Around 10,000 people die from liver disease and liver cancer each year in the UK. It is the second leading cause of premature mortality in England and Wales after suicide. These statistics come in spite of the fact that 90% of liver disease is preventable.

As a Scottish MP representing a Scottish constituency, this hits even closer to home. Scotland has the highest mortality rate for liver disease in the whole United Kingdom. We also have one of the highest mortality rates for chronic liver disease across central, northern and southern Europe. This health crisis is affecting my constituents, and the statistics are sobering. In 2020, Scotland saw an 11% rise in chronic liver disease deaths on the previous year. It is one of the leading causes of premature deaths, above breast cancer and suicide. Approximately seven in 10 people who died of liver disease were of working age, so under 65. In a country with an average life expectancy at birth of 76.6 years for males and 80.8 years for females, these are premature deaths.

I want to look at why liver disease and cancer outcomes are so poor in Scotland and across the UK and at what work needs doing to address that. Let me start with the why. One of the biggest barriers to effective diagnosis and treatment is the social stigma that continues to cloud how we view patients with liver disease and cancers. It is crucial to acknowledge and understand the part that poverty has to play in the demographic of patients with these conditions. As the UK grapples with the cost of living crisis and a drastic drop in living standards, this is not a contributing factor that can be overlooked or ignored—it will be a huge risk to public health and the lives of those living in our most vulnerable communities—and it would be a catastrophic mistake to do so.

There are over 100 causes of liver disease, but the ones that contribute to the most cases are also factors much more likely to be present in poorer communities: alcohol misuse and obesity. In Scotland, 58% of liver disease deaths are alcohol related. Across the UK, alcohol-related liver disease accounts for 60% of diagnoses. Like most addictions, alcohol abuse is statistically higher in poorer communities and carries a heavy stigma: the resulting harm is seen as self-inflicted. To improve outcomes for alcohol-related liver disease, we need to look at alcohol dependency and the reasons for its prevalence. Most importantly, we need to support patients in making positive lifestyle changes. Access to the right care is paramount, and increasing the availability and quality of support available at a primary care level is essential.

On the impact of obesity, which is also higher in Scotland than the rest of the UK, non-alcohol related fatty liver disease, or NAFLD, is expected to become the leading variation of the disease in the UK within the next decade. Nearly one third of Scottish adults are obese and two thirds are overweight, but the statistics across the UK are similar. Again, obesity is more prevalent in deprived communities; it is seen as a choice. Obese people are seen as greedy or lazy, and societal conditioning teaches us that we do not need to look much closer at the reasons why.

There are many reasons why obesity is on the rise in those communities, including underlying health conditions, eating disorders and a lack of access to high-quality healthy foods. Like alcohol abuse, this challenge needs to be met with increased access to the right support, such as weight management programmes, but by far the most important tool on the road to prevention is early detection. That goes for alcohol-related liver disease, NAFLD or viral hepatitis, autoimmune or genetic-related.

Liver disease is largely asymptomatic in the early stages. Three quarters of patients with cirrhosis are diagnosed only when it has progressed too far for intervention or treatment. Without early detection pathways and investment in treatment, we will continue to see mortality rates rise. The British Liver Trust’s 2021 survey showed massive disparities in access to patient care pathways for early diagnosis in primary care settings region to region. It revealed that just 26% of local health bodies in the UK have effective pathways in place. It is calling for every integrated care system or health board to ensure that there is a named person responsible for liver disease and the identification of high-risk patients, and for all GPs to have the means to assess fibrosis.

CT and MRI scans are a critical tool for diagnosis and informing treatment plans, but this is an area that has been overlooked. The key problems are access to the right equipment and the quality of the equipment available. Some 41% of clinical radiologists state that they do not have the equipment they need to deliver a safe and effective service for patients. Industry surveys show that one in 10 CT scanners and almost a third of MRI scanners are more than a decade old—the age at which the equipment is considered obsolete. That is shocking.

This area of the NHS, like so many others, it is struggling with workforce numbers. The British Liver Trust welcomed the Government’s 15-year workforce strategy earlier this year, and I back its calls for gastroenterology and hepatology to be given due recognition through that process.

In May, I visited the Royal Free Hospital in Hampstead with the hon. Member for Caerphilly (Wayne David), as part of the APPG’s work, and we saw the Sheila Sherlock Liver Centre, a leading centre for liver disease treatment. It is well equipped with excellent, highly skilled staff. I would like every area of the UK to have something similar in place for patients. I met the chief executive, John Connolly, and Dr Thorburn, a consultant hepatologist, along with some of the patients. My conversations with Lucy and Hannah, two young women undergoing treatment at the centre, really brought home the human aspect of the disease. I am grateful to them for taking the time to speak to me about their experiences.

This morning, I received some very disappointing statistics from my local health board, NHS Lanarkshire, which is categorised as “red”, with no effective pathways in place for early detection and disease management. I have reached out to NHS Lanarkshire to request an urgent meeting so I can discuss this and seek assurances on its plans for improvement. The stats for my local board have cemented just how fundamental it is to properly fund detection and treatment of liver disease and liver cancer, and to give the NHS the tools it needs to support our communities.

While NHS Lanarkshire falls under the remit of the Scottish Government, I want to make some requests to the Minister here, too. The all-party parliamentary group on liver disease and liver cancer, along with the British Liver Trust, is calling for a full review of adult liver services by NHS England. I urge the Minister to make that a priority. I hope that I have set out enough reasons to illustrate why that is so essential, and I am sure that other Members will have more to add.

As part of the plans to improve early detection rates, the NHS health check must routinely include assessment for non-alcoholic fatty liver disease, as it looks to become the leading cause of liver disease over the next 10 years. Pathology is also vital, providing the study of disease and informing the development of treatment. I back calls for a new, nationally endorsed pathology pathway. That is another area that desperately needs support with its workforce supply and funding. I hope that the Minister will be able to address her Department’s plan for that support. Overarching all of this is the need for Government commitment and direction to address the disparities in access to care through policymaking and implementation.

Before I finish, I thank several organisations for supplying briefings to inform so much of this speech, and for their ongoing work in this area. I thank The British Liver Trust—particularly Paul, Richard and its chief executive officer, Pam—as well as Cancer Research, the Royal College of Pathologists and the Royal College of Radiologists. I look forward to the Minister’s response; I hope that, through collaboration, we can accelerate progress across the four nations to improve outcomes for patients and for our constituents.

[Mr Clive Betts (in the Chair)]

The wind-ups have to start at about quarter past, so that is six Back Benchers in about an hour. I think you can probably work out the time limits for yourselves in that respect. First of all, from the Government Benches, I call Peter Gibson.

--- Later in debate ---

[Margaret Ferrier]

Thank you, Mr Betts. I would like to speedily thank all the hon. and right hon. Members who took part in the debate. We heard from the hon. Members for Darlington (Peter Gibson), for Caerphilly (Wayne David) and for Totnes (Anthony Mangnall), who said there were no politics in this issue, which I absolutely agree with, and who spoke about transplants and the need to improve the geographical spread of adult liver services.

The hon. Member for Strangford (Jim Shannon) reminded us of the charities in this field, which are all doing such great work, and the hon. Member for Warrington South (Andy Carter) offered his area for a new transplant facility for the north-west. I thank the hon. Member for York Central (Rachael Maskell), who said we have a unique opportunity to make a difference.

This is about early detection pathways, because rates vary considerably from region to region. We must have a full review of adult liver services, and GPs must have the means to assess fibrosis. Thank you, Mr Betts, for letting me wind up.

Access to GP Services and NHS Dentistry

Margaret Ferrier Excerpts

Tuesday 21st June 2022 Commons Chamber

[Paul Blomfield]

As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.

Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.

We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

NHS services are devolved, but many concerns about them are shared across the UK. Some of my constituents have concerns about the price of NHS dentistry offered through private dental practices, and about transparency in how final costs are calculated. Does the hon. Gentleman agree that, particularly given the economic climate, practices must give cost breakdowns before treatment begins, so that patients can budget and understand what they are paying for?

[Paul Blomfield]

We need transparency, and that starts with a new structure for remunerating dentists—a structure that no longer disincentivises them from taking on NHS patients, and that does not push them towards private care. If we do not make those changes, the system will get worse. Some 50% of NHS practices have already reduced their NHS commitment, and 75% are planning to reduce further their contracts. Patients will face frustration and all the pain involved in not accessing help when they need it. As others have commented, children’s oral health will be severely damaged. It is a disgrace—it shames the country—that last year, hospitals in England carried out almost 180 operations a day on children to remove rotting teeth, and it cost the NHS more than £40 million. Those problems will impact those children throughout their life. Poor dental health is linked to endocarditis, cardiovascular disease, pneumonia, premature births and low birth weights, all of which add strain and cost to the NHS.

The good news is that there is an answer, but it is in the hands of the Government. We need to restore adequate funding to dentistry in England, and we need a commitment that the long-promised contract reform will take place. It must be real reform, and not tweaks at the edges. Otherwise, we face the slow death of NHS dentistry.