Pharmacies and Integrated Healthcare: England

Martyn Day Excerpts

Wednesday 11th January 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing the debate. I found much that I agreed with in her contribution, and I echo her call for a pharmacy-first culture.

It is a pleasure to take part in the debate, although I must admit to feeling a bit of an observer, as the debate is about pharmacies and integrated healthcare in England. We have heard from a number of speakers about the different practices that affect their parts of England; I hope that my observations from Scotland may also be of interest to Members. I have commented in a few debates that there are often lessons that we can learn from one another and good practices that can be shared. This issue provides an excellent case in point.

Community pharmacies were developed in Scotland 10 years ago and are there for minor ailments, chronic medication and public health services. The Scottish Pharmacy Board has stated that more than one in 10 GP consultations and more than 1 in 20 accident and emergency attendances could be managed by community pharmacists using the minor ailments service; that represents huge potential for the future. Although we await the full evaluation of the minor ailment service later in the year, estimates suggest that as much as £110 million could be saved. Further expansion of the MAS is planned.

[Mrs Main]

I do not often agree with what is said by Scottish National party Members, but I looked at the Scottish service, and one of the key things, which I think other hon. Members have raised, is the software functionality that in Scottish pharmacies are obliged to have. That is something we do not have in England—I do not know about Wales—and I wonder if the hon. Gentleman could let the Minister know about that. The ability to input into scripts and the remuneration that comes through that software functionality in Scotland is something that I found very interesting.

[Martyn Day]

The hon. Lady has emphasised the point very well. There is a considerable degree of integration in the Scottish service. It has been around for 10 years and is a fairly mature service.

The Scottish Government work side by side with the medical professions in Scotland and recognise just how important community pharmacies are. They are interested in exploring new ways for pharmacies to offer primary care services to help deliver care across our communities. There are some 1,200 pharmacies throughout Scotland, providing a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four NHS pharmaceutical care services, which have been gradually introduced since 2006. These are the minor ailment service, which I have mentioned, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists more in the community in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailment service by March 2015.

Patients register with a pharmacist in the same way as they register with a GP. The aim is for all people to be registered with their local pharmacist, wherever they consider that to be, by 2020, and for all our pharmacists to be independent prescribers by 2023. Approximately 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under the service, which is some 2.2% of all items dispensed by community pharmacies in Scotland. Almost 500,000 patients are registered under the chronic medication service.

It is important that retail and dispensing pharmacies in England be encouraged to go in a similar direction to Scotland, because that would bring great benefit for the NHS. In Scotland, we recognise just how important community pharmacies are. We are committed to supporting and developing local GP and primary care services and have recently announced a three-year, £85 million primary care fund to help develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

Looking at pharmaceutical services across the two nations, one of the significant differences appears to be how the services have developed, partly as a result of the funding structures. In Scotland, pharmacists do not get a large payment merely for existing, such as the £25,000 in England. Instead, they receive a modest establishment payment of £1,730. However, payments are based on needs that reflect a population’s age, vulnerability and deprivation. That model will see funding in Scotland rise by approximately 1.2%, while it looks likely to decrease by around 4% in England.

Another difference is the almost random way in which pharmacies in England appear to have opened, as a result of anyone being allowed to do so if they open 100 hours a week. A concern must be that there could equally be unplanned random closures, if they are allowed to shut down simply because they can no longer afford to survive. In Scotland we have a system of controlled entry for those who want to open a community pharmacy. Need must be demonstrated and applications approved by health boards. Consequently, we find community pharmacies in areas of deprivation, serving those most in need. Often health boards refuse applications because demand is already met.

Pharmacists are located throughout communities in Scotland, from rural areas to deprived inner-city areas, providing pharmaceutical care on behalf of NHS Scotland. The Scottish Government policy remains that, wherever possible, people across Scotland should have local access to NHS pharmaceutical care. There is much in the Scottish model that is working well and may provide a useful example for study on this side of the border. It is imperative that this successful model of community pharmacies across Scotland should not be put under threat by UK Government health budget cuts, which would impact on the Scottish Barnett formula.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

The benefit of Brexit will be that we can take precisely such decisions in this Parliament, because we will get back control of our borders. I am grateful to my hon. Friend for mentioning the very important work done by people from outside the EU in the NHS. Because I happened to meet the Philippines ambassador last week, I want to pay credit particularly to the Filipino workers in the NHS and the social care system, who do a fantastic job.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

May I start by extending my party’s sympathies to the victims of the Berlin attack?

Much of what we have heard today is about keeping those who are already here, but BMA Scotland has said that insecurity is stopping EU nationals from taking up posts that really need to be filled. This is an urgent problem, so does the Secretary of State agree that it is time to create some certainty for EU nationals and to avoid a self-made workforce crisis?

[Mr Hunt]

I absolutely agree with the hon. Gentleman, which is why it is extremely frustrating that the current signals from the EU are that it is unwilling to bring forward negotiations about the status of EU nationals here, and indeed that of British nationals in the EU. No one from either side of the Brexit debate has ever said that there will be no immigration post-Brexit; they have simply said that we will control that immigration ourselves through this House and through decisions made by the British people at general elections.

--- Later in debate ---

[David Mowat]

My hon. Friend raises an important point, and he is right to say that we must move the community pharmacy network away from just dispensing and into services, which will include minor ailments and repeat prescriptions. I will be encouraging CCGs to do that.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Community pharmacies, which were developed in Scotland 10 years ago, are there for minor ailment, chronic medication and public health services. Although the Minister has expressed admiration for the Scottish system, does he not recognise the need to work with the pharmacy profession to develop the full potential within community services?

[David Mowat]

I have mentioned on previous occasions that Scotland has, in some respects, gone further and faster than we have in England so far on community pharmacies. The £300 million that we have set aside in the integration fund for the rest of this Parliament is going to be used to do just the things that the hon. Gentleman has mentioned, in terms of minor ailments and repeat prescriptions. We are determined to make that happen.

Child Cancer

Martyn Day Excerpts

Monday 28th November 2016 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Bath (Ben Howlett) for opening this interesting and emotive debate, which was scheduled by the Petitions Committee. I am grateful to him for clearly explaining the issue and highlighting that unfortunately, the rarer the cancer, the greater the resource challenges it faces, and that development of paediatric drugs lags behind the development of drugs for adults.

It is a pleasure to follow such informative and powerful contributions by the hon. Gentleman and other participants from both sides of the House. I am particularly grateful for a couple of the points that have been made. I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for putting this into the European context. Although we deal with small numbers in our country, childhood cancer is a much larger problem across that wider area. I am grateful to the hon. Member for Bristol West (Thangam Debbonaire) for illustrating the scale and challenge of the financial difficulties that people face. Unfortunately, the burden of relieving those all too often falls to charitable organisations rather than the state.

I offer my condolences to Mr Barnard and his wife on the sad loss of their daughter Poppy-Mai. I thank them for raising awareness of this important issue with the petition that brings us here. It must be very traumatic for them to relive each moment of that tragedy as they hear this debate. Unfortunately, theirs is not a unique case—such cases occur all too often across our countries. We must therefore recognise our shared responsibility to tackle child cancer.

The Scottish National party Government are working hard to improve cancer outcomes for children as well as the entire population of Scotland. As my hon. Friend the Member for Inverclyde (Ronnie Cowan) illustrated, cancer is relatively rare in children. Childhood cancer accounts for less than 1% of all cancers in Scotland, with approximately 150 new cases every year. There are approximately another 180 new cases in young adults aged between 16 and 25. An updated cancer plan for children in Scotland was launched earlier this year, which will complement the ongoing “Getting it right for every child” programme to ensure that Scotland’s children have access to the best possible services.

In recent years, the system in Scotland for supporting children suffering from cancer and their families has been reorganised. All cancer treatment centres now work together as one single managed service network for children and young people with cancer—the MSNCYPC, which may be the longest acronym I have ever used. As a result, young patients have access to appropriate specialist services that are as local as possible and both safe and sustainable. The network ensures that the care pathway is as equitable as possible, regardless of where in Scotland people live.

The SNP Government are focused on improving health outcomes for children, which is at the forefront of the SNP’s health priorities. We are serious about improving cancer care and treatment, which is a key reason why the Scottish Government will invest £100 million over the next five years through their new cancer strategy. As well as providing funding to health boards, we invest in a range of areas to support healthier lives for children and families, such as children’s palliative care, the cost of which is rising—delivering lifeline care and support to seriously ill children cost nearly 10% more in 2015-16 than the previous year.

That support for children’s palliative care charity funding is in stark contrast with what is happening in England. Barbara Gelb OBE, the chief executive of Together for Short Lives, says:

“We believe that ministers should follow the example of the Scottish Government, which has recently committed £30 million funding to Children’s Hospice Association Scotland (CHAS) over the next five years. We’re calling on the UK government to re-examine funding arrangements as a matter of urgency and carry out a national inquiry into the state of children’s palliative care funding in England.”

I hope the Minister will address that comment.

I commend the work of the many charitable organisations that are active in this field. For example, as others have highlighted, CLIC Sargent does tremendous work to support young people and their families as they come to terms with cancer diagnoses and journey through their treatment. In Scotland, leukaemia is the most common cancer in children—leukaemia, brain tumours and lymphomas account for more than two thirds of child cancers. The Brain Tumour Charity conducts various research projects and focuses on understanding the causes of childhood brain tumours. I take this opportunity to commend its investment of more than £18 million in its many research projects. Its commitment and work means that a brain tumour diagnosis no longer means a death sentence. Although that is welcome, it is sadly not the case for everyone, as has been evidenced.

Whole communities in my constituency were devastated by the tragic loss of five-year-old Tilly from Linlithgow, whose case echoes the points made by the hon. Member for North Thanet (Sir Roger Gale). Tilly lost her brave fight against her brain tumour just a few weeks ago, leaving her family heartbroken and touching the hearts of entire communities. A family member spoke to the Journal and Gazette, the local newspaper, about the support the family had received from the local community, which included fundraising to send Tilly to the United States, which is all too often the case. They said:

“We really could not begin to thank people enough for the support they have shown Tilly and the family during all of this. It has been overwhelming and we will be forever grateful. To raise such a massive amount of money shows how much people care and how communities come together when people need them. The money that is left over will be given to raise awareness of the type of brain tumour Tilly had and to help families who find themselves in a similar situation so they can get treatment for their loved ones.”

That action shows the strength of community feeling, which is echoed by the sheer number of people who signed the e-petition. It also shows how a child cancer diagnosis, with all its consequent personal and emotional devastation, affects more than just the child and their immediate family; it affects entire communities.

I thank all right hon. and hon. Members who have taken part in today’s consensual and informed debate, which I hope and trust has helped to raise awareness among the wider public.

Contaminated Blood and Blood Products

Martyn Day Excerpts

Thursday 24th November 2016 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful for the opportunity to participate in this important debate. Let me start by thanking the Backbench Business Committee for scheduling today’s debate and the hon. Members responsible for tabling the motion. I especially thank the hon. Member for Kingston upon Hull North (Diana Johnson) for leading the debate and for her work on the all-party group. She summarised the situation clearly and forcefully, and I am particularly grateful to her for outlining the risk of private operators administering the scheme. That concern has been raised by several hon. Members on both sides of the House.

Another recurring theme in the debate has been justice and the question of how much was known about the contamination at the time—that question has been asked, so it deserves an answer. Without any doubt, this subject is one of the most terrible chapters in the history of our NHS. It is truly horrific and has had an impact upon tens of thousands of people and their families. In some cases, their experience has been ongoing for more than 40 years. Many people have already died or been left suffering long-term disability and hardship as a result of infections. Relatives have had to sacrifice their careers to provide care and support. In some cases, partners and loved ones have become infected. Indeed, I received an email from a surviving victim of contaminated blood whose partner subsequently became infected and died. Patients, families and carers have had to deal with such difficulties with immense and enduring courage, and I wonder how many have found the strength—physically, emotionally and, indeed, financially.

That brings me on to the proposed changes to the current ex-gratia payments. As my hon. Friend the Member for Glasgow South West (Chris Stephens) illustrated, the proposed new scheme in Scotland will lead to an increase in annual payments for those with HIV and advanced hepatitis C from the current £15,000 to £27,000 per year. That amount is set at a level that reflects average earnings. That point is important as this is not about poverty; it is about a decent standard of living. The payments for those co-infected with HIV and hepatitis C will increase from £30,000 to £37,000 per year, and that amount reflects their additional health needs. When a recipient dies, their partner will continue to receive 75% of the previous annual entitlement. That, too, is important, given how many have had to give up their own careers to look after loved ones. Those infected with chronic hepatitis C will receive a £50,000 lump sum payment, which gives an additional £30,000 to those who have already received the lower payment.

The Scottish discretionary support scheme is set to see its funding more than treble. It will have an independent appeals mechanism, and there is a general guarantee that no individual will be worse off than at present. To simplify the situation so that those affected will no longer have to apply to more than one body for funding, the Scottish Government aim to deliver this scheme through a single body. Full governance arrangements are still to be detailed for this new organisation, but it is likely to be administered by National Services Scotland. It is also worth remembering that the Scottish Government are committed to reviewing the distinction between stage 1 and stage 2 hepatitis C.

There are clear differences between what is proposed for Scotland and the system elsewhere, with many viewing the Scottish scheme as comparatively more generous. That said, it is not without its detractors, particularly those with lesser health impacts who will not receive the more generous payments proposed. It is therefore important that we continue to listen to the views of beneficiaries as we design and implement the new Scottish scheme, so evidence-based reviews of the payment criteria will be carried out. In Scotland, we want to improve the scheme for everyone, but we must give greater priority to those in most severe need.

We have already heard of many tragic individual cases from throughout the UK, but I will spare hon. Members further heart-wrenching examples of cases of which I have received details. Instead I shall focus on some of the questions that have been raised with me by victims and their support groups; I hope that the Minister can assist with some answers. The first relates to the compensation schemes and the fact that there are currently five different organisations funded by UK Health Departments, including the three devolved health authorities. That means that using the existing schemes to make the new Scottish payments requires the agreement of all four nations of the UK. There must also be agreement from the boards of the UK-wide schemes. Currently, only Scotland is signed up. There will be a Scotland-wide payment system, but the timing will depend on the UK Government, Her Majesty’s Revenue and Customs and the Department of Health. I therefore ask that the UK Government do not stand in the way of the Scottish payments.

That brings me to my second ask, which echoes one made by my hon. Friend the Member for Glasgow South West: Westminster must pass tax orders so that none of the payments are liable for tax—that must happen whichever mechanism is used to make the new payments. Thirdly, what more can be done about cross-border infections? The current schemes are based on where the individual was infected, rather than their residency, which means that the English schemes apply to some Scottish residents and the new Scottish scheme will apply to others resident in England. That issue compounds the next point I wish to make: hepatitis C sufferers are acutely aware of the cold, and during the winter their heating bills go through the roof. If they cannot afford to heat their home, they are at greater risk of death through complications due to illness such as flu or colds. There is therefore a clear need for the winter fuel allowance, so perhaps Ministers can advise us on their rationale for wanting to remove it.

It has been suggested to me by the Scottish Infected Blood Forum that the liver damage test is outdated and we should look at the impact the condition has on the whole body. The problem may be amplified among those who have made positive lifestyle choices such as abstaining from alcohol, as their liver may appear to be less affected. Finally, people want some certainty about future funding, so what support will continue after the current spending review period?

I always try to be positive and to look forward to the future, but given the age of many victims and their medical complications, people are dying every week—there are fewer of them every year. Thousands have already died and for them this is all too little, too late. It is difficult to be positive in the circumstances, but I am grateful to have had the opportunity to take part in today’s excellent and generally consensual debate.

Diabetes Technologies

Martyn Day Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship today, Mrs Gillan. I thank the hon. Member for St Ives (Derek Thomas) for bringing forward this interesting debate on diabetes technologies. I thank him for his explanation of the position, and would like to publicly agree with him that we need to accelerate access and that we could do better. I am also grateful to him for informing us of flash glucose monitoring—FGM. It is a new technology that I must admit I am not familiar with, and I would have guessed completely wrong, based on its initials, as to what we were discussing.

There can be little doubt that diabetes is the fastest growing health threat of our time and a critical public health matter. It is estimated that more than one in 16 people across the UK has diabetes—be that diagnosed or undiagnosed—and it is worth remembering that around 80% of diabetes complications are preventable, or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part. With that challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes yet ever more important. We can learn much from the different approaches to this issue throughout these isles, and we have heard examples today that are both good and bad. The right hon. Member for Knowsley (Mr Howarth) informed us of the problems faced by many young people and their experiences at schools. That is a very good example of how we could do better.

Much of the debate centres around the two main technologies: insulin pumps and continuous glucose monitors. It is, unfortunately, fair to say that at present the challenges facing sufferers in Scotland in obtaining them are greater than for those in England and Wales. However, much progress is being made and the Scottish Government are committed to ensuring that people living with diabetes have access to the best possible care.

Since 2010, the Scottish Government have set and met targets to increase insulin pump therapy. In Scotland, we have already made good progress in its provision, and by the end of the current Parliament some 6,000 adults—more than 20% of the type 1 diabetes population across Scotland—will have access to insulin pump therapy; currently, the figure is around 9.5%. In 2010, the diabetes action plan called for NHS boards in Scotland to introduce plans to make insulin pump therapy available for patients who would most benefit from it. That was followed, in 2011, by the target that 25% of under-18s with type 1 diabetes should be on insulin pump therapy; that was met by December 2014, and the figure had reached 31.2% by the end of 2015. Good though this progress is, we must still do better.

This form of insulin delivery has made a big difference to those who have received it; however, it is worth remembering that is not always appropriate for everyone. To be successful, insulin pump therapy requires intensive work by the patient in association with the local diabetes team, and requires self-management and monitoring.

Continuous glucose monitoring devices can be extremely useful in helping sufferers to manage and monitor their glucose levels. The Scottish Intercollegiate Guidelines Network—SIGN—guidance recommends that CGM should not be used routinely for people with diabetes; however, it may be considered for women with type 1 and type 2 diabetes, as it may be beneficial during pregnancy. As a result of that, provision through the NHS in Scotland is limited. Earlier this month, Shona Robison, the Cabinet Secretary responsible for health, wellbeing and sport in Scotland, confirmed that a national approach is being developed, stating:

“Work is currently on-going to develop a national approach for the use of Continuous Glucose Monitoring (CGM) devices in Scotland, as we recognise the speed of development of this technology.”

Best practice on provision of CGMs and insulin pumps will continue to evolve with developments in technology. Innovative new approaches to healthcare may prove key to improving the treatment of conditions such as diabetes. The Scottish Government, in partnership with Scottish Enterprise, has funded a £500,000 competition to develop a new technology to help with the management of type l diabetes. To supplement existing education programmes, competition entrants have been asked to develop a mobile health product, which could be an app, a new interface or a new device, to assist people in dealing with their condition. The competition is a good example of working with partners across private, public and third sector organisations to develop a new and innovative solution. At its launch, Dr Lena Wilson, chief executive of Scottish Enterprise, said:

“The economy grows faster when companies embed innovation in all they do. Scotland operates in an increasingly competitive global market so developing and maintaining competitive advantage is imperative. The work underway with NHS Scotland on solutions to the challenges Type 1 diabetic patients face offers an opportunity for more of our SMEs to embrace innovation.”

Of course, the potential benefits of that are not just with the businesses that take part. Managing diabetes accounts for about 10% of the annual NHS Scotland budget —almost £1 billion a year. When 80% of NHS spending on diabetes goes on treating avoidable complications, potentially significant savings can be made through better self-management and use of technologies—and that is before we consider quality of life for the actual sufferers who benefit.

In conclusion, we can do much to improve diabetes education and care for both type l and type 2 diabetics, and diabetes technologies have a key role to play in that process. The challenge is to find effective ways to overcome barriers to implementation, and to facilitate greater access for those who would benefit. I am thankful for the opportunity to take part in today’s consensual and informative debate.

Self Care Week

Martyn Day Excerpts

Tuesday 22nd November 2016 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Walker. May I start by thanking the right hon. Member for Rother Valley (Sir Kevin Barron) for bringing this timely debate, and also for his clear and detailed explanation of his position?

For my part, I supported Self Care Week last week by treating the latest winter cold I have picked up with a couple of lozenges and a few hot toddies. My hon. Friend the Member for Rutherglen and Hamilton West (Margaret Ferrier) has set me a challenge to get through the debate without coughing; I have to confess I have failed already. However, I will repeat the dosage later on tonight.

We have heard that self-care is the act of looking after one’s own physical or mental health, and that that extends to treating common illnesses with over-the-counter drugs and managing long-term conditions. We know that 80% of all care in the UK is actually self-care, and most people feel comfortable managing everyday minor ailments themselves, particularly when they feel confident that they have been successfully treated before using over-the-counter medicines.

Self-care is a fundamental part of healthcare—and Self Care Week provides an opportunity for us to encourage people to engage in self-care in a wide variety of areas—but it is important for us to get the balance right between managing conditions that are self-treatable and knowing when to get professional medical help. The right hon. Member for Rother Valley stated some examples in which it was clearly inappropriate to go to accident and emergency, and it is getting that balance right that we have to promote.

Self-care need not be as lonely as the term suggests. Often, conditions that can be self-managed are done so with support, be that from health professionals, organised support groups or advice from community pharmacies; people are not out there on their own with self-care. There are many good examples of such support across my constituency, covering a range of conditions and ailments. Eczema Outreach Scotland, which is based in Linlithgow, is a support charity for families affected by eczema. While it does not provide medical advice, it helps affected families in many ways, from practical advice to emotional support. As we know, one of the most common conditions experienced is joint pain, and the central arthritis self-help group, which meets in Grangemouth, organises outings, hydrotherapy and exercise sessions to assist sufferers.

Obviously, self-care for mental health is just as important as for physical conditions. In Bathgate, there is the West Lothian bipolar self-help group, which helps people affected by that common condition to share advice and insights on getting back into work and staying fit. Another example is the West Lothian health and social care partnership, which brings together NHS Lothian and West Lothian Council. It runs the superb “Eatright West Lothian” scheme, which aims to promote good nutrition and healthy eating, which can assist with many different conditions.

It is worth noting that the Self Care Forum recommended the following top tip:

“Involve the local pharmacists and community nurses in giving the same advice and support for self care; and work with the local pharmacists to ensure that their triage of common problems is similar to that in the practice.”

That is not quite the way I would have worded it, but I agree wholeheartedly; it is very good advice. Community pharmacists can only give out certain medicines and products, although the benefits of that can be massive, as it can cut the workload of GPs and other NHS staff across the country. The Scottish Pharmacy Board stated that, in 2015-16, more than one in 10 GP consultations and one in 20 A&E attendances could have been managed by community pharmacists utilising the minor ailment service.

Some 1,200 pharmacies throughout Scotland provide a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four new NHS pharmaceutical care services which have been gradually introduced since 2006—the minor ailment service, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists in the community more in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailments service by 31 March 2015.

The minor ailment service allows people to get advice and free treatment on issues such as, but not exclusive to, acne, headaches, athlete’s foot, head lice, backache, indigestion, cold sores, mouth ulcers, constipation, nasal congestion, cough pain, diarrhoea, period pain, earache, thrush, allergies, sore throat, threadworms, hay fever, warts and verrucae; in fact, pretty much everything that is covered with self-care. Nearly 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under it, accounting for some 2.2% of all items dispensed by community pharmacies in Scotland.

In Scotland, we recognise just how important community pharmacies are. The Scottish National party Scottish Government are helping to explore new ways for community pharmacies and other primary care services to aid self-care within our communities. The SNP Scottish Government are committed to supporting and developing local GP and primary care services, and have just announced a three-year, £85 million primary care fund to help to develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

In conclusion, I welcome the recent words that we have heard from the UK Government that they want to copy the Scottish Government’s approach to community pharmacies and the minor ailment service. I thoroughly recommend that model to everyone, because we have found it to be very good and effective to date. I also welcome the opportunity to take part in today’s interesting and good-natured debate, which I hope will help to promote self-care further to the wider public audience.

Health Service Medical Supplies (Costs) Bill (Third sitting)

Martyn Day Excerpts

Committee Debate: 3rd sitting: House of Commons
Tuesday 15th November 2016 Public Bill Committees

[Dr Whitford]

My colleague will speak to that amendment.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship today, Mr Pritchard. I am somewhat reassured by many of the Minister’s comments, and I thank him for his explanations. Much of this stuff is technical, and I hope he sees amendment 48 in a similar light. I think it would improve and strengthen the measure.

The clause does not currently set out a mechanism for the disclosure of information to devolved Administrations or bodies. For example, how will the information be disclosed, and by what means? Will it be only the Secretary of State who can disclose? In short, will the devolved Administrations be able to get the information when they want and need it, so that it ties in with the figures and statistics they are seeing and they can see patterns? It is about flexibility.

The amendment is fairly straightforward and we think it would help to strengthen and improve the Bill. I hope that the Minister agrees. We would like him to clarify whether the Government intend to leave disclosure to the discretion of the Secretary of State, on an ad hoc basis. Otherwise, what would the terms of disclosure be?

[Rob Marris (Wolverhampton South West) (Lab)]

To tease out the amendment a little more, proposed new section 264B(1)(h) relates to the provision of information to

“any person who provides services to any person falling within any of paragraphs (a) to (g)”.

Is the hon. Gentleman concerned that under his amendment there might be disclosure to other private providers; or is that covered because only paragraphs (a) to (g) are specified?

[Martyn Day]

I thank the hon. Gentleman for his intervention, and I hope that I can clarify my clarification. It is about timing—when the information is disclosed, not to whom it is disclosed. The Bill covers that and we are quite comfortable with that.

I was saying that we think our amendment would strengthen the clause. I am reminded that on Second Reading the Secretary of State referred to fact that there would be amendments—we are grateful to see many of them today—

“to reflect the agreement between the Government and the devolved Administrations, so that information from wholesalers and manufacturers can be collected by the Government for the whole of the UK and shared with the devolved Administrations.”——[Official Report, 24 October 2016; Vol. 626, c. 80.]

We think our amendment would enable him to get his wish and provide a mechanism in the Bill.

We feel strongly about the matter and want to push it to a vote if we do not receive the necessary assurances from the Minister. I hope that he can provide them.

--- Later in debate ---

[The Chair]

If the SNP Front-Bench spokespersons want to press the amendment to a vote, that will happen later, but it would be helpful to the flow of the proceedings if they confirmed now whether they intended to do so.

[Martyn Day]

We are satisfied with the Minister’s answer.

[The Chair]

I am grateful to the hon. Gentleman.

Amendment 1 agreed to.

Amendments made: 2, in clause 6, page 4, line 5, leave out from “any” to “to” in line 6 and insert “UK producer”.

This amendment is linked to amendments 1, 3 to 16 and 19 to 35. It allows regulations to require the provision of information by a person who manufactures, distributes or supplies Welsh health service products, Scottish health service products or Northern Ireland health service products.

Amendment 3, in clause 6, page 4, line 19, at end insert—

“(d) the determination of the payments to be made to any persons who provide primary medical services under Part 4 of the National Health Service (Wales) Act 2006;

(e) the determination of the remuneration to be paid to any persons who provide pharmaceutical services under Part 7 of that Act;

(f) the consideration by the Welsh Ministers of whether—

(i) adequate supplies of Welsh health service products are available, and

(ii) the terms on which those products are available represent value for money;

(g) the determination of the payments to be made to any persons who provide primary medical services under section 2C(1) of the National Health Service (Scotland) Act 1978 (“the 1978 Act”);

(h) the determination of the remuneration to be paid to any persons who provide pharmaceutical care services under section 2CA(1) of the 1978 Act;

(i) the consideration by the Scottish Ministers of whether—

(i) adequate supplies of Scottish health service products are available, and

(ii) the terms on which those products are available represent value for money;

(j) the determination of the remuneration to be paid to any persons who provide primary medical services or pharmaceutical services under Part 2 or 6 of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I. 14));

(k) the consideration by a Northern Ireland department of whether—

(i) adequate supplies of Northern Ireland health service products are available, and

(ii) the terms on which those products are available represent value for money;

(l) the exercise by the Secretary of State of any powers under sections 260 to 264 and 265;

(m) the operation of a voluntary scheme.”.

This amendment is linked to amendments 1, 2, 4 to 16 and 19 to 35. It sets out the purposes for which a person may be required to record and provide information to the Secretary of State by virtue of regulations under section 264A(1) of the National Health Service Act 2006.

Amendment 4, in clause 6, page 4, leave out lines 20 to 29.

This amendment is linked to amendments 1 to 3, 5 to 16 and 19 to 35. It removes subsections (3) and (4) of section 264A of the National Health Service Act 2006 because the provision made by those subsections now appears in amendment 3.

Amendment 5, in clause 6, page 4, line 30, leave out

“an English producer or other”

and insert “a”.

This amendment is linked to amendments 1 to 4, 6 to 16 and 19 to 35. It is a consequential amendment. A reference to an English producer is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Amendment 6, in clause 6, page 4, line 33, leave out from “for” to end of line 35 and insert “UK health service products”.

This amendment is linked to amendments 1 to 5, 7 to 16 and 19 to 35. It is a consequential amendment. A reference to English health service products is no longer needed as those products will fall within the definition of “UK health service products” inserted by amendment 14.

Amendment 7, in clause 6, page 4, line 38, leave out “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 6, 8 to 16 and 19 to 35. It is a consequential amendment.

Amendment 8, in clause 6, page 4, line 41, leave out “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 7, 9 to 16 and 19 to 35. It is a consequential amendment.

Amendment 9, in clause 6, page 4, line 43, leave out second “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 8, 10 to 16 and 19 to 35. It is a consequential amendment.

Amendment 10, in clause 6, page 5, line 1, leave out from “whether” to “health” in line 2 and insert

“they are UK health service products and, if so, which of the following they are—

(i) English health service products;

(ii) Welsh health service products;

(iii) Scottish health service products;

(iv) Northern Ireland”.

This amendment is linked to amendments 1 to 9, 11 to 16 and 19 to 35. It is a consequential amendment. It enables regulations to require a UK producer to provide information about products for verifying whether they are Welsh, Scottish or Northern Ireland health service products.

Amendment 11, in clause 6, page 5, line 14, at end insert—

“(8A) “Excepted person” means any of the following—

(a) a person who provides primary medical services under Part 4 of the National Health Service (Wales) Act 2006;

(b) a person who provides pharmaceutical services under Part 7 of that Act;

(c) a person who provides primary medical services under section 2C(1) of the 1978 Act;

(d) a person who provides pharmaceutical care services under section 2CA(1) of the 1978 Act;

(e) a person who provides primary medical services or pharmaceutical services under Part 2 or 6 of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I. 14)).”.

This amendment is linked to amendments 1 to 10, 12 to 16 and 19 to 35. It lists the persons who are excepted from being a “UK producer” for the purposes of the definition inserted by amendment 1.

Amendment 12, in clause 6, page 5, line 15, at end insert—

“( ) “Northern Ireland health service products” means any medicinal products used to any extent for the purposes of health care provided by virtue of the Health and Social Care (Reform) Act (Northern Ireland) 2009 and any other medical supplies, or other related products, required for the purposes of health care provided by virtue of that Act.”.

This amendment is linked to amendments 1 to 11, 13 to 16 and 19 to 35. It provides a definition of “Northern Ireland health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 13, in clause 6, page 5, line 15, at end insert—

“( ) “Scottish health service products” means any medicinal products used to any extent for the purposes of the health service within the meaning of the 1978 Act and any other medical supplies, or other related products, required for the purposes of that health service.”.

This amendment is linked to amendments 1 to 12, 14 to 16 and 19 to 35. It provides a definition of “Scottish health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 14, in clause 6, page 5, leave out lines 16 to 26 and insert—

“( ) “UK health service products” means any English health service products, Welsh health service products, Scottish health service products or Northern Ireland health service products.”.

This amendment is linked to amendments 1 to 13, 15, 16 and 19 to 35. It provides a definition of “UK health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 15, in clause 6, page 5, line 26, at end insert—

“( ) “Welsh health service products” means any medicinal products used to any extent for the purposes of the health service continued under section 1(1) of the National Health Service (Wales) Act 2006 and any other medical supplies, or other related products, required for the purposes of that health service.”

This amendment is linked to amendments 1 to 14, 16 and 19 to 35. It provides a definition of “Welsh health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 16, in clause 6, page 5, line 26, at end insert—

“( ) Until the coming into force of the repeal of section 27 of the 1978 Act by schedule 3 to the Smoking, Health and Social Care (Scotland) Act 2005 the references in subsections (2)(h) and (8A)(d) to pharmaceutical care services under section 2CA(1) of the 1978 Act are to be read as references to pharmaceutical services under section 27(1) of that Act.”.

This amendment is linked to amendments 1 to 15 and 19 to 35. It makes transitional provision in relation to references to pharmaceutical care services under section 2CA(1) of the National Health Service (Scotland) Act 1978.

Amendment 17, in clause 6, page 5, line 35, at end insert—

“(fa) the Common Services Agency for the Scottish Health Service constituted under section 10 of the 1978 Act;”.

This amendment adds the Common Services Agency for the Scottish Health Service to the persons listed in section 264B(1) of the National Health Service Act 2006. This means that information provided by virtue of section 264A of that Act may be disclosed to that Agency.

Amendment 18, in clause 6, page 5, line 36, at end insert—

“(ga) the Regional Business Services Organisation established under section 14 of the Health and Social Care (Reform) Act (Northern Ireland) 2009;”.

This amendment adds the Regional Business Services Organisation to the persons listed in section 264B(1) of the National Health Service Act 2006. This means that information provided by virtue of section 264A of that Act may be disclosed to that Organisation.

Amendment 19, in clause 6, page 5, line 40, leave out “English producers or other”.

This amendment is linked to amendments 1 to 16 and 20 to 35. It is a consequential amendment. A reference to English producers is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Amendment 20, in clause 6, page 5, line 46, at end insert “(subject to subsection (4))”.

This amendment is linked to amendments 1 to 16, 19 and 21 to 35. It flags the provision made by amendment 29.

Amendment 21, in clause 6, page 6, line 4, leave out “or (4)” and insert

“(a) to (c), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19, 20 and 22 to 35. It is consequential on amendments 3 and 4.

Amendment 22, in clause 6, page 6, line 8, leave out “or (4)” and insert

“(a) to (c), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19 to 21 and 23 to 35. It is consequential on amendments 3 and 4.

Amendment 23, in clause 6, page 6, line 11, leave out “to (g)”.

This amendment is linked to amendments 1 to 16, 19 to 22 and 24 to 35. It is consequential on amendments 25 and 26.

Amendment 24, in clause 6, page 6, line 12, leave out

“either of the matters specified in section 264A(4)”

and insert

“any of the matters specified in section 264A(2)(d) to (f), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19 to 23 and 25 to 35. It is consequential on amendments 3 and 4.

Amendment 25, in clause 6, page 6, line 13, at end insert—

“(ca) in relation to a person falling within subsection (1)(f) or (fa), the purpose is that of exercising functions connected with any of the matters specified in section 264A(2)(g) to (i), (l) or (m);”.

This amendment is linked to amendments 1 to 17, 19 to 24 and 26 to 35. It is consequential on amendments 3, 4 and 17.

Amendment 26, in clause 6, page 6, line 13, at end insert—

“(cb) in relation to a person falling within subsection (1)(g) or (ga), the purpose is that of exercising functions connected with any of the matters specified in section 264A(2)(j) to (m);”.

This amendment is linked to amendments 1 to 16, 18 to 25 and 27 to 35. It is consequential on amendments 3, 4 and 18.

Amendment 27, in clause 6, page 6, line 17, leave out “(c)” and insert “(cb)”.

This amendment is linked to amendments 1 to 16, 19 to 26 and 28 to 35. It is mainly consequential on amendments 25 and 26.

Amendment 28, in clause 6, page 6, line 20, leave out “or (4)”.

This amendment is linked to amendments 1 to 16, 19 to 27 and 29 to 35. It is consequential on amendments 3 and 4.

Amendment 29, in clause 6, page 6, line 20, at end insert—

“(4) The Welsh Ministers may disclose any confidential or commercially sensitive information disclosed to them under subsection (1) to any of the following persons—

(a) a Local Health Board or other person appointed under section 88(3)(b) of the National Health Service (Wales) Act 2006 to exercise the functions of a determining authority under Part 7 of that Act;

(b) a National Health Service trust established under section 18 of the National Health Service (Wales) Act 2006;

(c) any person who provides services to the Welsh Ministers or to any person falling within paragraph (a) or (b).

(5) A person to whom any confidential or commercially sensitive information is disclosed under subsection (4) may not—

(a) use the information for any purpose other than the purpose of exercising functions connected with any of the matters specified in section 264A(2)(d) to (f), (l) or (m), or

(b) disclose the information to another person.”.

This amendment is linked to amendments 1 to 16, 19 to 28 and 30 to 35. It allows the Welsh Ministers to disclose information to other persons including Local Health Boards, National Health Service trusts and persons providing services to those persons.

Amendment 30, in clause 6, page 6, line 24, leave out “English producers or other”.—(Mr Dunne.)

This amendment is linked to amendments 1 to 16, 19 to 29 and 31 to 35. It is a consequential amendment. A reference to English producers is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Question proposed, That the clause, as amended, stand part of the Bill.

NHS Funding

Martyn Day Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.

The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.

I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.

I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.

On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.

On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

With some 80% of trusts in deficit and only 4% meeting accident and emergency targets, I am grateful to the Health Committee for flagging up the dire financial state of the NHS in England, as evidenced by its letter to the Chancellor. We learn from that document that the £10 billion figure is a bit of a fallacy. In Scotland, the SNP Government are committed to investing an additional £2 billion by 2021, but any reduction in new money for the NHS from the UK Government would have an impact on Barnett consequentials. Given that the UK Government have already slashed Scotland’s budget by 10% between 2010 and 2020, they need to be honest and transparent about what that reduction will mean for Scotland’s funding. With the Department of Health having accidentally not adjusted its books for an extra £417 million from national insurance contributions, and having broken its control total by £207 million, will the devolved Governments get any share of that additional £624 million?

[Mr Hunt]

Many people in Scotland will be somewhat surprised by the hon. Gentleman’s comments, because in the last Parliament spending on the NHS in England went up by 4%, whereas in Scotland it fell by 1%. The IFS confirmed that at the time of the independence referendum, saying:

“It seems that historically, at least, Scottish Governments in Holyrood have placed less priority on funding the NHS in Scotland…than governments in Westminster have for England”.

In this Parliament, the hon. Gentleman’s party has already lost a vote on NHS cuts in the Scottish Parliament and been criticised by Audit Scotland for its performance. When the SNP has the courage to increase NHS spending in Scotland by the amount we are increasing it in England, we will listen, but until then it should concentrate on looking after Scottish NHS patients in Scotland.

Young People’s Mental Health

Martyn Day Excerpts

Thursday 27th October 2016 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a privilege to take part in the debate. I thank the Backbench Business Committee for selecting it, and extend my praise to the Youth Select Committee for its excellent report on young people’s mental health. It is a genuinely superb summary of the current situation, backed up by sensible recommendations, and it makes a welcome contribution to the wider debate.

The details of the debate have already been clearly outlined by the hon. Member for Dulwich and West Norwood (Helen Hayes). I agree wholeheartedly that it is a debate about resources and the framework for their use. I also agree that the current situation is not acceptable, and that the demand for services is indeed increasing. I thank the hon. Lady for her clear explanation of the position, and for giving some powerful statistics.

The importance of this issue to the young people of the UK nations is illustrated by the fact that it has been repeatedly chosen as a priority campaign by the UK Youth Parliament, and voted for in the British Youth Council poll. The issue has also been the subject of research by the Scottish Youth Parliament, with the report “Our generation’s epidemic”. So we need not wonder what issues are of concern to young people; they have clearly, intelligently and repeatedly told us and it is incumbent upon us as elected politicians to address the concerns highlighted. The fact mentioned already today by several Members, including my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), that more than half of all mental ill-health starts before the age of 14 serves to illustrate the seriousness of this issue.

I am also grateful to the hon. Member for High Peak (Andrew Bingham) for illustrating the risk of the issue going unnoticed and undiagnosed and for highlighting the generation gap technology has developed and the issue of cyber-bullying. I am sure I am not alone in this Chamber in being glad that my youthful teenage years are not preserved for posterity on the internet and in social media.

As well as highlighting an important issue, the Youth Select Committee report shows the importance of young people being engaged in our democratic debate. In Scotland we are already making good progress with this engagement, and our 16 and 17-year-olds had the right to vote in the 2014 Scottish referendum and 2016 Scottish Parliament election. That, however, is an issue that needs revisiting in another debate. I endorse the call of the hon. Member for East Worthing and Shoreham (Tim Loughton) for an annual debate in Government time on the good work of the YSC.

The issue of mental health is widespread. It affects every part of the country and people from all parts of our society. All ages, races, classes and backgrounds are susceptible to this illness.

The hon. Member for West Ham (Lyn Brown) highlighted the disparity between mental and physical health problems and emphasised the scale of the issue. We have heard many examples from across the House showing how young people have been affected and that more needs to be done.

All of us will be aware of local examples, and of groups working to address these issues. One such group which covers my area is the Falkirk and District Association for Mental Health, the subject of early-day motion 125 tabled by my hon. Friend the Member for Falkirk (John Mc Nally). Among the wide range of support the group offers is a befriending service to help combat the isolation experienced by young people suffering from mental health issues. The group also offers a health and wellbeing drop-in, counselling, support groups and other services.

But it is not just specialist mental health groups that help to tackle this illness. For example, the Open Door project, which provides supported accommodation for young people in the West Lothian area, carries out a risk assessment of every young person who approaches it for help. If following the assessment it feels there is an issue it refers them to “moving into health”, psychiatric nurses from the health and homeless team. Some 89 people were assessed in 2012-13, of whom 33 presented with mental health issues. Indeed, the project believes that the number of people presenting with mental health issues is increasing, a theme highlighted by several Members today.

Another example is the Chill Out Zone, or COZ, in Bathgate, a healthy living centre for young people aged between 12 and 20. It is a partnership between Children 1st, West Lothian Council and NHS Lothian. COZ provides a drop-in service that young people can use in their own time to get information, counselling and advice, or if a young person prefers they can make an appointment with a nurse or a counsellor to talk about sensitive physical, emotional, mental and sexual health matters.

I could go on highlighting many other examples, but I think everyone gets the picture. It is not just our young people who are telling us this is an “epidemic”; the evidence of support groups and the impact on other organisations locally demonstrates this for all to see, and highlights the need for action.

Of course in Scotland health and education are devolved to the Scottish Parliament, and many of the devolved issues were covered succinctly by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow. I am grateful for her professionally informed opinions in today’s debate.

Mental health is a priority for the Scottish Government, as demonstrated by the fact that Scotland has the first dedicated Minister for Mental Health in the UK, and while across England funding for young people’s mental health services has been reduced since 2011 the SNP-led Scottish Government have doubled the number of child and adolescent mental health service psychologists, as part of an additional £150 million to improve mental health services.

The Scottish Government have welcomed the Scottish Youth Parliament’s recent research “Our generation’s epidemic”, which I mentioned earlier. That research was undertaken as part of the Scottish Youth Parliament’s Speak Your Mind campaign on mental health. Maureen Watt, the Minister for Mental Health, met representatives of the Scottish Youth Parliament in September and took note of their recommendations that relate specifically to the Scottish Government. They will be considered as part of the public engagement on the new 10-year mental health strategy for Scotland. The SNP will continue to review the legislation in Scotland to ensure that the interests of children and their need to form and maintain relationships with key adults in their lives are at the heart of any new statutory measures.

The Youth Select Committee report highlights the importance of ending stigma around mental health, and the SNP is committed to playing its part in ending that stigma. Education Scotland is developing a national resource to support the development and practice of nurturing approaches for primary schools. A whole-school nurturing approach can promote school connectedness, resilience and the development of social and emotional competences, all of which are key aspects of promoting mental wellbeing.

It is completely wrong that people with mental health issues should suffer discrimination and stigma, but sadly too many still do. The Scottish Government, in collaboration with Comic Relief, fund the See Me initiative to help address this, and they do invaluable work, but the truth is that each and every one of us has it within our power to do our bit to end this stigma and to be more understanding of people who have mental health problems.

It has been a pleasure to take part in this well-informed and largely consensual and good-natured debate.

National Arthritis Week

Martyn Day Excerpts

Thursday 20th October 2016 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Betts. I start by thanking the hon. Members for Strangford (Jim Shannon) and for Congleton (Fiona Bruce) for leading today’s interesting and timely debate. It is surprising that it is the first such debate for five years.

We have heard from many speakers how arthritis affects people, including young people and working-age people, and I thank my hon. Friend the Member for Glasgow South West (Chris Stephens) for his excellent example of a person in work and the real troubles that they face. We have heard how it is a fluctuating condition with symptoms that can change on a daily basis, as well as many personal cases and constituents’ experiences that highlight this problem affecting many people. We all know members of our own families who are affected.

[Steven Paterson (Stirling) (SNP)]

I do not come to this debate with any great expertise, but my gran suffered greatly with arthritis, which affected the joints in her hands and legs and basically left her housebound. Does he agree that one of the real benefits of today’s debate—I pay great tribute to those who have secured it—is that we can raise awareness of the condition more widely, and that it is incumbent on all of us to go forward from this debate and do that?

[Martyn Day]

I agree entirely with my hon. Friend.

The scale and significance of this issue has been clearly illustrated by several key statistics that we have heard today. Several speakers have told us how each year, a fifth of the population consult their GP about musculoskeletal problems. There are 30.6 million working days lost each year to arthritis, which account for a fifth of all working days lost. Scottish estimates tell us that 60,000 people have rheumatoid arthritis, and 2,500 people are diagnosed each year. One in five people in Scotland experience chronic pain and one in 20 experience severe, disabling chronic pain, with the back and joints being the most common location for chronic pain. Arthritis Care has estimated that approximately 800,000 to 900,000 people in Scotland alone are living with osteoarthritis.

All those figures highlight the enormity of the issue. However, we must remember that data collection and management is particularly poor for arthritis and musculoskeletal issues and it needs to improve if we are to get a clearer picture of the numbers across Scotland and the rest of the UK. That point was made by my colleague, the hon. Member for Strangford.

On a positive note, Scotland is the only nation in the UK to routinely publish data on chronic pain. That is welcome, as we have one in 20 living with disabling chronic pain that has a serious impact on physical wellbeing and mental health issues. There is no doubt that arthritis and musculoskeletal conditions can be very disabling, and we must take action to raise awareness about the conditions and improve musculoskeletal health —be that by promoting physical activity, tackling obesity or using medicines.

The hon. Member for Heywood and Middleton (Liz McInnes) made a point that we should all echo about carers’ work, which is often overlooked. In my constituency —I am sure this will be the case for most—we have a number of support groups for arthritis sufferers. The central arthritis self-help group in Grangemouth is a good example, with monthly meetings including entertainment and social events, along with talks on health and other subjects. The group also organises outings, hydrotherapy and exercise sessions. As a society, we owe a debt of gratitude to groups such as that for the work they do and to everyone else who is helping sufferers.

There is much that can be done for sufferers. One of the most important things is faster diagnosis of conditions such as inflammatory arthritis, as with earlier treatment, they can be controlled better. In Scotland, there is much focus on tackling obesity, both to prevent and to treat musculoskeletal conditions. We must strive to do more to improve diets and encourage physical activity—in saying that, however, I recognise the point made by the hon. Member for Neath (Christina Rees) about sport-related conditions.

In my area, a good example is Together for Health—often known as T4H—which is a community-based project that works to promote healthy lifestyles in the Armadale and Fauldhouse areas within my constituency and that of my hon. Friend the Member for Livingston (Hannah Bardell). It works in partnership with a range of local organisations, businesses and community groups to promote healthy lifestyles and delivers a variety of activities and events to encourage people to move more and eat better, with the overall aim of reducing childhood obesity.

Key messages of the project include the benefits of a balanced, affordable diet, and encouragement of children and families to be more physically active and spend less time doing sedentary activities. That is not just a Scottish or a UK problem, of course. We have a global ageing population and although the link between arthritis and ageing is well known in our own countries, there are fewer data on how older people in lower and middle-income countries are affected.

What we do know, however, is alarming. The World Health Organisation estimates that 9.6% of men and 18% of women aged over 60 have symptomatic osteoarthritis, and that 25% of those with osteoarthritis cannot perform the major daily activities of life. Taking action internationally is important for the millions of older people who are directly affected, but it also has an impact on the lives of many of those who depend on them. Often older people in developing countries are the main carers of children whose parents have had to leave for work or who have been orphaned due to conflict or illnesses such as HIV.

In conclusion, it is important that we do more locally and internationally to help alleviate these conditions, and we must make preventive measures a greater priority.