Liver Disease and Liver Cancer

Navendu Mishra Excerpts

Thursday 25th April 2024 Westminster Hall

[Navendu Mishra (Stockport) (Lab)]

I beg to move,

That this House has considered health inequalities in liver disease and liver cancer.

It is a pleasure to serve under your chairship, Sir Christopher.

I thank the hon. Member for Glasgow Central (Alison Thewliss), who is covering Front-Bench duties in this debate, and who was kind enough to co-sponsor the application for it with me to the Backbench Business Committee. She is a long-standing champion of public services and better healthcare provision for all.

I am grateful to several organisations, including charities, that have helped me with my speech: the British Liver Trust—several representatives are in the Public Gallery—Liver Cancer UK and the Roger Williams Institute of Hepatology. Alcohol Change UK has also been good. I have met its representatives in the past, although not recently, and it has been a long-standing campaigner on this issue.

Before I start on the main points of my speech, I pay tribute to Bob Blizzard, a former Labour Member of Parliament in Norfolk. He did a lot of work in this House on the Hunting Act 2004 and in the fight for animal rights. His family have been in touch and wanted me to mention him. Sadly, he passed away in 2022, with a rare form of cancer, having been diagnosed with it in December 2020. His family therefore wanted me to mention the work of the Alan Morement Memorial Fund, which helps patients and healthcare workers.

To start on my key points, this is an important debate about health inequalities in liver disease and liver cancer. It is particularly timely, given the shocking new data released this month, which shows that we are facing the worst mortality and hospital admissions rates for liver disease in a generation. Ninety per cent of liver disease is preventable and, if diagnosed early, damage can often be reversed and the liver can recover fully. Tragically, however, premature deaths from liver disease have surged to their highest levels in decades, and hospital admissions due to liver disease have risen by almost 80% over the past decade alone, driven by obesity, alcohol and viral hepatitis.

We have seen more than a decade of cuts under this Government. Successive Conservative Governments have neglected patients and failed to take liver disease seriously. Our most marginalised communities, the most at risk of liver disease, have been silenced, overlooked and left behind. The liver disease crisis is almost entirely preventable and reflects a decade of decline in our nation’s health, widening health inequalities and worsening life expectancy.

Geographical inequalities in health outcomes for patients are stark, and the north of England is disproportionately impacted, accounting for more than a third of premature deaths in liver disease in 2022, or 3,728. New data from the Office for Health Improvement and Disparities highlights that the north-west, my own region, has the highest mortality rate for liver disease in the country, at 35% higher than the national average. The healthy life expectancy in Blackpool is now the same as in Angola, at 54.5 years.

The Government have failed to deliver on their manifesto pledge and levelling-up mission to narrow the gap in healthy life expectancy. They scrapped the promised White Paper on health disparities, repeatedly cut the public health grant and in effect decimated the Office for Health Improvement and Disparities. They have also overlooked liver disease entirely in their major conditions strategy, and U-turned on their commitment to roll out non-invasive liver scans to 100 community diagnostic centres. Our nation’s liver disease effort is faltering, which is costing lives and piling huge, avoidable pressure on to our NHS. Thousands of people die unnecessarily without access to specialist care, because liver services are consistently overlooked and under-resourced.

Risk factors such as obesity, viral hepatitis and alcohol are most prevalent in our most disadvantaged communities, and mortality rates from liver disease in our most deprived communities are now four times higher than in the most affluent.

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

I congratulate the hon. Gentleman and the hon. Member for Glasgow Central (Alison Thewliss) on successfully securing this debate. Does he agree that, in the 21st century, the wider expectation in society is that we need to see improving mortality rates from serious conditions? The concern here is that mortality rates are worsening, as he has correctly outlined. That is something we all need to address as a matter of urgency.

[Navendu Mishra]

I thank the hon. Member for his intervention; he makes an important point. As one of the most advanced economies in the world, we expect our population to have the best healthcare, and we want life expectancy increasing for everyone, not just in certain postcodes, so I agree with his point.

Almost two thirds of adults are overweight or obese, and nearly four in 10 children with obesity—38%—are estimated to have early stage fatty liver disease. Deaths due to alcohol-related liver disease in England have increased by 87% over the last two decades, due a rise in harmful and hazardous drinking.

The cost of living crisis is exacerbating inequalities and the risk factors facing vulnerable families in deprived areas, with cheap junk food and high-strength alcohol being widely available. It is estimated that over 206,000 people in England are living with chronic hepatitis B, the majority of those cases undiagnosed and unlinked to care. Undetected, it can lead to cirrhosis, liver cancer and premature death caused by liver failure.

Liver disease is a silent killer that is often asymptomatic in its early stages. Shockingly, three quarters of people with cirrhosis are diagnosed in hospital when the damage is irreversible and it is too late for effective treatment or intervention. The impact of late diagnosis and crisis-point hospital admissions on our already overstretched NHS frontline services is pushing the hepatology workforce to breaking point, yet pressures are projected to increase at pace.

My own constituents are at the sharp end of this public health emergency. In Stockport, the premature mortality rate for liver disease in women has surged by 80% since the pandemic. In 2020, it was 12.5 per 100,000, and 2022, it was 22.5 per 100,000. In Stockport, the overall premature mortality rate from liver disease between 2020 and 2022—a three-year range—was 16.5% higher than the national average. I was greatly concerned to learn that the British Liver Trust’s “Love Your Liver” roadshow visit to Stockport last year identified that one in four members of the public had elevated fibroscan readings, which are indicative of liver damage.

Ethnic minorities are disproportionately impacted by liver disease. South Asian populations are particularly vulnerable to fatty liver disease, due to genetic and sociocultural factors, while migrants from countries where hepatitis B is endemic are at higher risk of developing liver cancer.

Liver disease patients also face stigma and misconceptions, which is hampering earlier detection and costing lives. Liver disease and liver cancer continue to be falsely labelled as self-inflicted, despite being linked to poverty and social deprivation. Almost half of patients with a liver condition have experienced stigma from healthcare professionals, according to recent surveys by the British Liver Trust.

Everyone at risk of liver disease and cancer should have equal access to faster diagnosis, no matter where they live. Accelerating earlier diagnosis is pivotal to tackling health inequalities and narrowing the gap in healthy life expectancy. Yet new research by the British Liver Trust shows that fewer than one in five integrated care systems in England currently have fully effective pathways in place for the early detection and management of liver disease. Alarmingly, my local ICS—Greater Manchester ICS—reported the highest premature mortality rate for liver disease in the country, but it is yet to implement an optimal pathway.

The evidence is overwhelming. We can and must do more to support liver disease and liver cancer patients across the UK. The next Labour Government will have a relentless focus on prevention and earlier diagnosis to turn the tide of this epidemic of preventable deaths. When the previous Labour Government first asked Professor Marmot to review health inequalities, then Prime Minister Gordon Brown said that

“the health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health, they also limit the development and the prosperity of communities, whole nations and even continents.”

Since then, we have had over a decade of austerity and deep cuts to public health, which have caused improvements in life expectancy to slow and even reverse. Health inequalities are widening and a growing number of people live a greater proportion of their lives in ill health.

We need to look upstream, which is why the next Labour Government will be committed to taking bold action to halt the promotion of junk food targeted at children that is high in fat, salt and sugar.

We also need to talk about early detection. To build an NHS fit for the future, Labour is committed to hitting all NHS cancer waiting time and early diagnosis targets within five years. Recently, I tabled a number of written parliamentary questions on this matter, and the answers do not fill me with confidence about the healthcare that my constituents are receiving. We also need to accelerate earlier detection by doubling the number of CT and MRI scanners in hospitals in England.

I urge the Minister to mirror this upstream focus on early detection by committing sustainable funding in the next spending review for new technology, in order to improve the early detection of liver disease in primary and community care. I also call on the Minister to introduce a new nationally endorsed pathology pathway to improve early diagnosis of liver disease and to ensure that every community diagnostic centre has an assessment for fibrosis.

Liver cancer is the fastest rising cause of cancer death in the UK. As one of the six least-survivable cancers, it has a shockingly poor five-year survival rate of just 13%. Yet public awareness remains very low, and liver cancer patients are overwhelmingly diagnosed at a later stage. Outcomes for many types of cancer have seen huge improvements over recent decades, yet deaths from liver cancer in the UK have increased by 40% in the last decade alone, hampered by the lack of funding, research and innovation.

Before I come to the end of my speech, I want to mention a couple of staggering points provided to me by Alcohol Change UK. Sadly, it is a fact that harm caused by alcohol is on the rise. The pandemic has had a serious impact on alcohol consumption in England. People are drinking at harmful levels and increasing their drinking. One in five people in the UK is drinking above the recommended weekly amount; many want to cut down. Alcohol causes the majority of liver disease, and drinking alcohol increases the risk of liver cancer.

Alcohol has become the leading risk factor for death and ill health among those aged 15 to 49 in England. Alcohol Change UK found, only this week, that alcohol-specific deaths in the UK are the worst on record— 32.8% higher than in 2019. In 2022, 76% of alcohol-specific deaths were caused by liver disease.

This is an extremely serious topic. I am grateful to the Backbench Business Committee for allocating time for the debate and I am grateful to everyone who has turned up in the Public Gallery, as well as to the Back-Bench MPs who have come to support the debate.

--- Later in debate ---

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Sir Christopher. I am very grateful to the British Liver Trust for its comprehensive briefings and support for this debate. The Alan Morement Memorial Fund, the cholangiocarcinoma charity, has also provided a very helpful briefing on liver cancer.

I often do not speak in debates on health matters, because they are devolved to the Scottish Parliament, but I have a personal link to this issue. My husband, Joe, was diagnosed with stage 2 non-alcoholic fatty liver disease in 2019. He has taken significant efforts to deal with that condition, because when caught at that stage it is reversible. Like many men, he did not go to the doctor for far too long, and he had that diagnosis when he finally went to get it checked out. He has been clear that tackling it has been challenging—we consciously have to do an awful lot more to keep ourselves healthy; we live in an obesogenic, alcohol-focused environment, so there are always things to tempt us back into bad habits—but he continues to go on with that challenge.

Joe has talked about the stigma around the disease. Almost three quarters of people with a liver condition have experienced stigma, and almost a third feel that it has prevented them from receiving medical care. It often comes from the association of liver disease with alcohol misuse and viral hepatitis. We must do everything we can bust that stigma so that people go and get the treatment they require as soon as possible, rather than putting it off, because the risks of doing so are very serious.

I also want to mention the read-across to the contaminated blood scandal. Some of those infected with hepatitis C did not know they had been infected because of the subsequent cover-up of their medical records, and some did not find out until serious damage had been done to their livers. For some, the news sadly came too late. I have heard stories at the all-party parliamentary group on haemophilia and contaminated blood about people whose death certificates cite chronic alcoholism as the cause of the disease, even though they had never touched a drink. There is a real stigma around liver issues, which we must do our best to bust.

We have a public health emergency that the Government ought to take very seriously indeed. Liver disease and liver cancer continue to be significant issues in Scotland. Liver disease is a leading cause of premature deaths in Scotland, above breast cancer and suicide, and deaths due to chronic liver disease in Scotland have increased by 85% in the last three decades. There was an impact during the pandemic, as the hon. Member for Stockport (Navendu Mishra) and my hon. Friend the Member for East Renfrewshire (Kirsten Oswald) also mentioned. I think that speaks a little to the alcohol culture that we are all focused on. I mean, how many people have heard the phrase “wine o’clock”? It has been minimised and reduced to not really mattering at all, but that alcohol culture leads people into harmful habits, and society downplays that.

I was glad to see the Scottish Government respond to the alcohol culture with minimum unit pricing, which has reduced the consumption of alcohol in Scotland by 3%, reducing deaths wholly attributable to alcohol by 13.4% and hospital admissions due to chronic conditions such as alcohol-related liver disease by 4.1%. Alcohol-specific deaths have risen more slowly in Scotland than in England, highlighting that the situation could have been much worse had Scotland not taken the bold step of introducing minimum unit pricing. The greatest harm reduction impact has been among the more deprived groups in Scotland, so there is an important protective factor.

Will the Minister consider bringing in minimum unit pricing in England? The small weakness of minimum unit pricing is that it puts the profits back into the hands of those selling the alcohol, because we do not have full control over the taxation system for alcohol in Scotland. It would be incredibly useful if we had all those powers in Scotland, but an intervention in England might provide an opportunity to do that. Removing the duty escalator on alcohol has meant that alcohol has got relatively cheaper.

I also want to mention the work happening in Scotland, which is showing signals of incremental improvements following the Scottish Government’s focus on prevention and earlier diagnosis. The same progress has not been seen in England, where liver disease mortality rates are at their highest level in decades; hospital admissions for liver disease have risen by almost 80% over the last decade alone.

In Scotland, by comparison, liver disease death rates between 2021 and 2022 decreased from 17.9 per 100,000 to 17.4 per 100,000, and hospital admissions caused by liver disease decreased by 1.5% between 2021-22 and 2022-23. My own health board area, Greater Glasgow and Clyde, has seen the largest fall in chronic liver disease death rates, which is really quite impressive given the health challenges that we have faced. That is quite significant.

When the British Liver Trust “Love Your Liver” roadshow was on Argyle Street in my constituency, I was struck by the number of people interested. Glaswegians are a very curious bunch; you cannot do anything without somebody asking a question and stopping to find out what is going on. People were like, “Oh, a liver test. I’ll queue up and wait for my liver test in a van in the middle of the city centre.” Around 100 people were scanned that afternoon and 15 of my constituents were later given a referral to their GP as a result, so there needs to be more testing and encouragement of people to go forward and check. It really is important.

Such screening in a community setting is a lifesaving intervention—we should make no bones about that. People should be able to access that at a simple community level. I am sure many colleagues in this place will have had their liver scanned in Parliament, which was welcome. Fibroscan readings have been reassuring in a lot of ways although, with health charities’ propensity to come in and do tests on MPs, I am sure they will find something wrong with me at some stage. However, it is welcome and important that people feel they can go for tests and that there is not a stigma in doing so.

So, there has been progress in Scotland. The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results based on initial blood samples from primary care, so further important development is happening in Dundee. I am sure the Minister would be interested to hear that the technology is also cost-saving to the NHS by over £3,000 a patient, which is significant. The tests are now being rolled out and piloted in parts of England.

I will touch on what my hon. Friend the Member for East Renfrewshire said about austerity and its impact on public health. The Glasgow Centre for Population Health in my constituency has done a lot of research into the subject over the years. It says that the years of Tory austerity have cost people dearly, through damage not just to public health services but to people’s life outcomes. My hon. Friend was correct to point out further cuts to social security for people from the Westminster Government, because that makes it more difficult for people to make good and healthy choices in the foods they buy and the lifestyles they have. The Glasgow Centre for Population Health said that it will take another decade just to get us back to where we were in 2010. That is 20 lost years of people’s good health, which will have a significant impact for a long time to come.

[Navendu Mishra]

The hon. Member is making an excellent speech. We already know that people who live in lower-income and more deprived areas have a lower life expectancy than people who live in more wealthy areas. The data from Alcohol Change UK tells us that people from more economically deprived groups experience higher rates of liver cancer and are less likely to receive treatment. There are also higher rates of liver cancer among people from Asian and black African backgrounds than among people from white backgrounds. That tells us that people who have a lower income or live in more deprived areas will die sooner. On the hon. Member’s point about austerity, does she agree that the Government have not done enough in the last 14 years to address the issues?

[Alison Thewliss]

I absolutely agree. I see that very much from the varied communities that I represent. It is baffling that the more recent Marmot findings have come as a surprise to some in government. I remember doing modern studies at high school and learning about the Black report and the inverse care law. It feels as though this Government are no further forward. In fact, in some respects they are much further back in tackling long-lasting health inequalities.

I shall now discuss the public health aspects. The Scottish Government are consulting on advertising restrictions on food and drinks that are high in fat, salt and sugar, which again are disproportionately marketed towards children and vulnerable groups. That marketing is also found in poorer areas, where there is often a lack of availability of fresh fruit and vegetables. That is significant because one in four children with obesity are estimated to have fatty liver disease, which has huge implications for their health and wellbeing for the future. It is caused by an accumulation of harmful fat in the liver and is present in around 70% of people who are overweight and obese. Fatty liver disease and excess weight together significantly increase the risk of premature death due to cardiovascular disease and a range of cancers, including liver, colon, breast, prostate, lung and pancreatic cancers.

Although Scotland tries to do its best within the devolved settlement that we have, sadly a number of key commitments from the UK Government to curb childhood obesity are yet to be implemented, including the 9 pm watershed plans to protect children from junk food advertising on TV and the ban on multibuy junk food deals. We have brought in some of those things in Scotland where we can. It does make a small difference but an awful lot more needs to be done, particularly for those in younger age groups. They are being targeted with all kinds of multiple snack-type foods, which are largely unnecessary. Both Labour and the Tories need to stand up to the multinational companies that wish to push those foods on our young people. These things do not come cost-free, certainly not to society.

Will the Government build on the simple, cost-effective diagnostic pathways already in place across the devolved nations? Will they commit to sustainable funding in the next spending review for new technology to improve earlier detection of liver disease? The fact that early intervention—that technology—can permit treatment before things get worse is significant. Will they also introduce a new nationally endorsed pathway to improve early diagnosis, and will they ensure that every community diagnostic centre can provide an assessment for fibrosis? All of those things will help to improve this public health emergency that we have.

It is important that we have discussed the issue today, but I hope that the Minister will listen and make the changes that she can, and that the Labour Front Bench, should they form the next Government, take this seriously. The alcohol-soaked and obesogenic society that we have poses fundamental challenges that Government should intervene on to prevent the next generation of people developing liver disease and liver cancer; we can prevent that progression if the public health imperative is there.

--- Later in debate ---

[Navendu Mishra]

I will end on a few remarks. I thank everyone who has contributed to this debate from the Front and Back Benches, though I am a bit surprised that we did not have any speakers from the Government Benches other than the Minister. This is an important issue for everyone.

The rate of hospital admissions for liver disease is higher in deprived areas. In 2021-22, there were 211.4 hospital admissions for every 100,000 people living in areas of multiple deprivation, compared with 125.1 in the least marginalised areas. That is quite serious. Additionally, I agree with the Minister about alcohol consumption; indeed, Alcohol Change UK made the point that it is not anti-alcohol, but against alcohol harm.

I will leave the Minister with a few questions. On a personal level, whenever I have gone to her with various issues, she has been extremely helpful and tried to do her best, but I think this is an important issue for the broader Government and the Department of Health and Social Care. I urge the Minister to take urgent action to improve earlier detection of liver cancer and the less survivable cancers. It is critical that the Government deliver on their pledge to diagnose 75% of all cancers at an early stage by 2030, which is the date I have written down—I think the Minister mentioned 2028, which is even better.

To reduce the staggering health inequalities we still face, the Minister must commit to delivering a cross-Government strategy to curb health inequalities and a prompt, comprehensive review of adult liver services by NHS England. We also need a comprehensive cross-Government alcohol strategy that tackles the social and commercial determinants of health. I also ask the Minister what assessments, if any, the Department has made of the inequalities impact of funding cuts to alcohol treatment services. Those are very serious issues.

I thank the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), for her contribution. I hope to work with the Government on this issue. Once again, I thank all the charities and campaign groups that do so much on it.

Question put and agreed to.

Resolved,

That this House has considered health inequalities in liver disease and liver cancer.

Oral Answers to Questions

Navendu Mishra Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend, and also wish her the very best of luck, as she is due to abseil down the hospital next month for its radiotherapy appeal. I very much hope she lands safely and does not trouble Southend hospital. I was delighted to visit the hospital at her invitation earlier this month, and I was very much impressed by the immediate improvements that the £8 million funding has meant in the Dowsett ward and for discharge and treatment times through accident and emergency. This is part of our plan, both through the urgent and emergency care plan and through our recovery plan for electives and the new hospital programme, to rebuild hospitals and provide that investment so that clinicians can use it to treat their local patients.

[Navendu Mishra (Stockport) (Lab)]

Last month, I met the chief executive of Stepping Hill Hospital in Stockport. She informed me that the primary out-patient building, which provides 85% of out-patient capacity, was recently condemned. While funding has been secured to build two additional wards, they will not be ready for at least 15 months, causing huge disruption in the interim. Fourteen years of underinvestment has left Stepping Hill Hospital quite literally crumbling. Will the Government provide urgent capital investment for Stepping Hill, so that my constituents and our brilliant NHS staff can have the facilities they need?

[Victoria Atkins]

I very much hope that the hon. Gentleman has already spoken to his integrated care board, because he will know that responsibility for local investment decisions rightly rests at local level. I can say that, as a Government, we have very much invested in hospital upgrades, including £4.2 billion going to integrated care boards this financial year. I hear the timetable he cites, but I encourage him to go to his integrated care board to ask what more it is doing.

NHS Dentistry

Navendu Mishra Excerpts

Tuesday 9th January 2024 Commons Chamber

[Navendu Mishra (Stockport) (Lab)]

I receive a large amount of correspondence on dentistry. Since my election just over four years ago, I have had several people come to see me, I have visited practices in Stockport, and I have often received communications from people on the issue. I thank the British Dental Association for all the work that it has done on NHS dentistry over the years, and the Nuffield Trust for providing excellent briefings for this debate, and for its commitment to highlight the issues with NHS dentistry across England.

It is shocking that 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England. The crisis in NHS dentistry is having a disproportionate impact on low-income people and vulnerable groups. This is a class issue. If a person is on a low income, they are much less likely to have access to NHS dentistry than if they lived in a more affluent area.

As has been mentioned, oral cancer is one of the fastest-rising cancers. The reality is that people from deprived communities are significantly more likely to develop it and die from it. It is shameful and unacceptable that the Government are not doing enough to tackle this issue. Dentists are often the first health professional to spot symptoms of oral cancer. This dentistry crisis means that fewer cases of oral cancer will be detected early, adding even more pressure on to the NHS, and, more importantly, detrimentally impacting people’s health.

As I said, this is a significant issue in my constituency. A few months ago, I wrote to every single dental practice in my constituency and included a small survey that they could fill out. The responses that I received from dentists and dental workers did not make for positive reading. I will quote from one of the contributions that I received. The dentist in question wrote:

“The whole service has been underfunded for years. I receive a very low UDA rate compared to other practices in the area. In 2006, I was paid £22 UDA and now it is £27. Patients need to know that we are not just greedy dentists. There is a shortage of dental nurses so they are demanding more money. Where am I supposed to find that extra funding?”

That is just one of the contributions that I received back following my survey. It is a significant issue. People on lower incomes and people with complex health issues often tend to miss out on NHS dentistry. I am glad that the shadow Health and Social Care team has secured this debate today and that the shadow Secretary of State highlighted just some of the key things that Labour will deliver in government, including significantly more appointments, significantly more dentists in the NHS service, and supervised toothbrushing in primary schools.

In April last year, the Government pledged to provide a recovery plan for NHS dentistry. The plan has yet to be published. May I ask the Minister, through you, Madam Deputy Speaker, when it will be published? Why are the Government being so shifty about this? Why will they not address this issue and tell us whether and when it will be published? It seems that, in Stockport and across England, the Government are failing patients badly not just when it comes to dentistry, but with record waiting lists for the NHS. Sadly, the reality is that people’s lives in Stockport and England are being held back by this Government.

[Richard Foord]

The hon. Member mentions the so-called NHS dentistry recovery plan cited by the Government. I am playing a game of NHS dentistry bingo, provided to me by the BDA. One of the 16 things that we were to listen out for today was:

“Our Recovery Plan will be published shortly”.

I have checked that off several times this afternoon. Does he agree that it is dishonest for the Government to claim that NHS dentistry is some sort of universal service?

[Navendu Mishra]

I agree with the hon. Member and thank him for his contribution. I think the BDA tagged me on Twitter in its dentistry bingo. I have not managed to play yet but will definitely be checking it out. He makes the point that the Government are being dishonest. The Government are being more than dishonest; they will not tell us if and when the plan will be published. They clearly do not have a plan to address the backlog in NHS waiting lists or the crisis in NHS dentistry in England. The next Labour Government will tackle the issues of NHS dentistry and the millions of people rotting on the NHS waiting list. They will also improve people’s quality of life in Stockport and across Britain.

Health Inequalities: Office for Health Improvement and Disparities

Navendu Mishra Excerpts

Wednesday 26th January 2022 Westminster Hall

[Navendu Mishra (Stockport) (Lab)]

It is a pleasure to serve under your chairship, Mr Twigg. I will keep my remarks as brief as possible. I am grateful to my hon. Friend the Member for Bootle (Peter Dowd) for securing this important debate, at a time when the NHS is under enormous strain and facing a clear and present threat of relentless cuts and privatisation under this Conservative Government.

As well as leaving our beloved health service on its knees and struggling to cope after two years of a crippling pandemic, this Government have presided over a period of austerity that has seen health inequality become even more prevalent and extreme.

Last week, the other place started its Committee stage of the Health and Care Bill and began discussing proposed amendments about health inequality. Speaking at that Committee sitting, peers from across the House made clear that the Bill is a huge opportunity to eliminate health inequality and for the Government to demonstrate their commitment to tackling the “disease of disparity”, to quote the Secretary of State for Health and Social Care, who pledged to address the issue when he took office last year. However, in the months since, there has been little evidence that the Government are taking the bold steps required to address the crisis.

The Government cannot say that they are not aware of the issue, because research published in 2019 by the Department for Work and Pensions revealed that the highest reported rates of poor health in those under the age of 55 was overwhelmingly in the poorest percentiles, with the bottom 20% of the population having worse health outcomes by a staggering 1,100%.

Three years and a pandemic later, the situation is even bleaker. In 2020, life expectancy in England fell more dramatically than at any other point since world war two, as a result of the covid pandemic. In the poorest areas, life expectancy declined nearly twice as much as it did in the wealthy ones, while ethnic minority people died from covid at much higher rates. Sadly, those with disabilities faced a significantly higher death rate.

In my constituency, the gap in mortality and reported serious illness is stark. In the most affluent areas such as Heaton Mersey, life expectancy for women is 84 years, while for men it is almost 83. However, just a short distance away in central Stockport, the average life expectancy for a man is a staggering 12 years shorter, while in Brinnington a woman’s life will, on average, end a decade sooner. For life-threatening illnesses such as cancer and heart disease, it is a similar picture. On average, the limited life chances of my constituents are particularly acute. Research by the King’s Fund reveals that the north-west experienced a far higher proportion of deaths from covid-19 than the south-west, to give just one example.

Significant investment in our NHS is needed to halt the rise in health inequality. That includes hospitals, which unsurprisingly play a significant role in health outcomes for many people. That investment could be put towards the facility’s funding or its catchment area, or it could improve accessibility for the vulnerable. With the NHS already at breaking point following 12 years of Conservative Government austerity and a crippling pandemic, we cannot afford to be wasteful—a point I have made consistently since my maiden speech, when I criticised this Government’s underfunding of Stockport NHS trust by £170 million in recent years.

Ultimately, I welcome any decision that improves public health outcomes and ensures the best quality healthcare for the people of Stockport. To build a healthier, happier and more equal society we must do more than simply increase NHS funding. I therefore urge the Minister to give a genuine commitment to truly universal healthcare that is fit for purpose for everyone, enabling the NHS to continue to be the envy of the world.

Covid-19 Update

Navendu Mishra Excerpts

Monday 28th June 2021 Commons Chamber

[Sajid Javid]

I should first tell my right hon. Friend that I am happy to be recycled. Recycling is something that we are all in favour of. On his important point about data, I saw the data in the Department for the first time yesterday. I saw the detail that it provides and how granular it is. I was impressed with that data, so I can give my right hon. Friend reassurance that the Government are looking at the data, and are absolutely taking it into account. I would also like to find a way to make sure that we can share as much of that data as possible so that others can benefit from it, and I will certainly look at ways in which we can do just that.

[Navendu Mishra (Stockport) (Lab)]

Despite the best efforts of our hard-working NHS staff, covid-19 has created a backlog in cancer care. Macmillan estimates that the backlog of people receiving their first cancer treatment stands at 37,000 people across England. One of the key ways in which the Secretary of State can help with the Government’s goal of recovering from the pandemic is ensuring that we have enough well-trained and motivated NHS staff now and in future, so will he commit to addressing the cancer backlog and investing in the NHS workforce to build back better for the future now that he is in post? Will he meet me and Macmillan Cancer Support to discuss this urgent matter?

[Sajid Javid]

Cancer diagnosis and treatment has remained a top priority, and rightly so, throughout the entire pandemic. Some 2.47 million urgent referrals have been made and over 618,000 people have been treated between March 2020 and April 2021. The hon. Gentleman may also be interested to know that following the “Help Us, Help You” symptom awareness campaign, many of the so-called missing patients are starting to come forward and urgent referrals are rising. That is what we all want to see.

Coronavirus

Navendu Mishra Excerpts

Wednesday 16th June 2021 Commons Chamber

[Navendu Mishra (Stockport) (Lab) [V]]

Like many areas with some of the highest infection rates during this pandemic, my constituency of Stockport has been in a lockdown of some form for more than a year, along with the vast majority of Greater Manchester. Although the people of Stockport have worked tirelessly to keep our community safe, they have been repeatedly let down by the Government. As a result, thousands of workers risk losing their jobs as businesses struggle to survive, with insufficient financial support packages and an endless cycle of lockdowns and restrictions that has pushed our high streets to breaking point.

I want to hear the Minister tell the House why, 15 months into this pandemic, the Government have failed to take any meaningful action to help businesses, schools and leisure facilities improve ventilation, when we have long known that covid is an airborne virus. He will no doubt tell me that the Treasury has spent billions on furlough payments and support schemes, but businesses know the reality—namely, that measures such as furlough payments are little more than a drop in the ocean when it comes to their bottom line and ability to plan for the long term in order to survive this pandemic. Far more needs to be done if we are to avoid our economy nosediving and millions of people across the UK ending up unemployed. I have heard today that the Government have also repeatedly failed my constituents, and millions of others around the country, on the issue of healthcare. Indeed, we have already heard what the Prime Minister really thinks of the Health Secretary—perhaps it will be the only time in the House that I admit to agreeing with him.

We are witnessing a crisis in our healthcare system, and the Government cannot simply blame the pandemic. Indeed, in the months before the covid crisis began, a source at Stepping Hill Hospital in my town told the Manchester Evening News that patients were “stuck outside in ambulances” and that:

“Every corridor is full of patients on trolleys.”

Many were forced to wait up to 24 hours to be seen for treatment. That is not the fault of NHS workers, who have performed heroically throughout this pandemic. The blame must be laid squarely at the Government’s door, following a decade of chronic underfunding of our health service.

The latest set of official NHS figures has revealed that record numbers of people are on hospital waiting lists across Greater Manchester. Stockport clinical commissioning group, which covers my constituency, has more than 37,000 people waiting for vital hospital treatment. That is the highest level in the region, which is completely unacceptable, and it is compounded by the fact that most people have to wait at least 18 weeks for treatment.

My constituents are not alone. Across the country, more than 5 million people are now waiting for routine treatment such as hip and knee operations, which is the highest level on record. Covid is of course a factor, but the reality is that this crisis has followed years of chronic underfunding by this Conservative Government, and we are now unfortunately having to reap what they have sown. A further contributory factor to the rising number of infections is the scandalous lack of sick pay for workers who are forced to self-isolate, who feel unwell or who take time off to look after loved ones who are ill. They are being punished for following Government guidance, and in many cases they are left with no alternative but to continue to work while potentially infectious due to the lack of available support.

A Unison North West survey recently revealed that 80% of care workers will continue to receive just £95 per week as statutory sick pay if they are ill or following the Government’s advice to self-isolate or shield themselves or loved ones. The right thing to do would be to give them full pay. Does the Minister accept that his Government’s failure to introduce proper financial support for people to self-isolate, and proper sick pay, has contributed to our failure to keep on top of the delta variant and has led to the delay in lifting lockdown restrictions?

As the Prime Minister’s former senior adviser recently said:

“Fundamentally, there was no proper border policy, because the Prime Minister never wanted a proper border policy.”

Our workers, businesses and most vulnerable in society are now paying the price for this wanton disregard for our nation’s health.

Dementia Action Week

Navendu Mishra Excerpts

Thursday 27th May 2021 Commons Chamber

[Navendu Mishra (Stockport) (Lab) [V]]

I express my gratitude to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this important debate. I pay tribute to the Alzheimer’s Society for the vital work it undertakes in raising awareness of dementia, including organising the annual Dementia Awareness Week. I also thank every professional carer around the country, as well as those informal carers who are all too often not recognised, despite working tirelessly to look after our loved ones, and who are an integral part of our care system.

Closer to home, I would also like to take this opportunity to highlight the inspiring fundraising work that one of my constituents, Councillor Janet Mobbs, has done for dementia sufferers over the years. Her mother, Mrs Edith Mobbs, lived with dementia during the latter part of her life, and each year Janet takes part in the memory walk with her family to raise funds for the Alzheimer’s Society.

Dementia is a debilitating syndrome that affects more than 10 million people a year globally. That is equivalent to one new case being diagnosed every three seconds. Given that one in every six people in the UK aged over 80 lives with dementia, it is highly likely that Members will have a friend or loved one who has been impacted by this condition.

Dementia is not only a terrible syndrome to live with; it also takes a terrible toll on family members, who spend years caring for their loved ones, as my comrade Janet explained to me when she said: “My family found it difficult at first as we had little knowledge or understanding of dementia and how this affected mum. We experienced a bereavement but were unable to grieve as we lost the person mum had been long before she passed away. We struggled to cope with the emotional strain of our changing role in mum’s life as we became carers for the person who had always cared for us.”

Janet is not alone. In my constituency of Stockport, almost 4,500 people aged 65 and over have dementia and that is forecast to rise to almost 6,000 by the end of this decade. With the number of people living with dementia in the UK set to double to 2 million over the next 30 years, dementia is a syndrome that must be urgently addressed.

With the growing threat of dementia in our country, it is time that the Government outlined a proper settlement package for our social care sector, not least given the stark estimates that 70% of care home residents and more than 60% of home care recipients live with dementia. It should also not be overlooked that more than a quarter of the 130,000 UK covid deaths—some 34,000 people—died with dementia. That is truly shocking and shows how vulnerable people with the condition are.

The Government must face the reality that the root cause of rising numbers of dementia cases is years of chronic underfunding of our care system, which has left it struggling to cope and difficult to access. Furthermore, it has led to huge unfairness, with Alzheimer’s Society research revealing that people with dementia will on average pay £100,000 over their lifetime for care. Understandably, this outrages and distresses the people affected and their loved ones. I urge the Government to take action.

Oral Health and Dentistry: England

Navendu Mishra Excerpts

Tuesday 25th May 2021 Westminster Hall

[Navendu Mishra (Stockport) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Ms Bardell. My gratitude goes to my hon. Friend the Member for Bedford (Mohammad Yasin), as this debate is timely and important for all our communities. He is a long-standing champion of better public services for all.

I begin by thanking all dentists and dental staff in our country. They do a difficult job and the pandemic has made it even harder. I know from experience that the British Dental Association plays an important role in supporting the dental community and, of course, patients, and I am grateful to it. Earlier this week, there were reports in the media regarding the state of our dental industry. As ever, it is the most disadvantaged in our communities who have borne the brunt of the crisis in the sector. Healthwatch England reported that it had seen a significant rise in calls and complaints at the start of this year. The pandemic has been an unprecedented challenge, but it cannot be acceptable that in one of the richest countries in the world some people have been informed that they have to wait up to three years to see a dentist.

Shockingly, 22% of children under five in Stockport have experience of tooth decay, which compares unfavourably with the best area in England, where only 7% of children have decay. In addition, last year 300 children in Stockport had teeth extracted under a general anaesthetic in a hospital due to tooth decay. In the latest GP patient survey, 14% of adults surveyed in the Stockport clinical commissioning group area said that they had not tried to get an appointment with an NHS dentist in the past two years because they assumed that none would be available. Only 2% said that they were currently on a waiting list for an appointment. The British Dental Association has welcomed the Government’s commitment to dental contract reform, but these reforms must be meaningful. They must expand access to NHS dentists across England because private treatment is not accessible to everyone.

It is an old saying that prevention is better than cure, so these reforms must also prioritise prevention. In the past two years, 135 children were admitted to hospitals in England for extraction of decayed teeth every single day. Shockingly, this continues to be the No.1 reason for children under five being admitted to hospitals in the UK. The data tells us that supervised tooth brushing improves oral health, but also saves money in the long term. We need a dedicated funding package in England for these programmes.

As is often the case, underfunding is the basis of many long-term problems. The data on the number of practices providing NHS dentistry makes for depressing reading. The British Dental Association has reported that the number of practices providing NHS dentistry fell by more than 1,200 in the past five years. Adding the pandemic to this equation means that the nation is facing an exodus of dentists from the NHS. As I said, the upcoming reforms must be meaningful and expand access to NHS dentists across the country.

In March, I tabled three separate written parliamentary questions regarding people on waiting lists to register with an NHS dentist in Stockport, in the north-west region and in England. Unfortunately, the Minister’s answers to all my questions were the same. It is simply unacceptable that the Department of Health and Social Care does not hold this data centrally. How can we expect the Government to tackle the serious and long-term issues relating to NHS dentistry if they do not even hold the data centrally? That suggests that the Government are either not taking this crisis seriously or are woefully underprepared to tackle it.

Frustratingly, as several Members on both sides of the House have highlighted in the main Chamber, we have seen a pattern of behaviour from the Department of Health and Social Care of taking an unreasonably long time to respond to letters, queries and written parliamentary questions from MPs. That is simply not acceptable and makes our role of representing our constituents all the harder.

The Government must reform the system so that everyone has access to an NHS dentist, within a reasonable distance and timescale. We are facing a dental crisis. We must do more to ensure that the most vulnerable in our communities have access to treatment and no longer face the prospect of being priced out of treatment.

Covid-19 Update

Navendu Mishra Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

Yes, Teesside is playing it part. In fact, earlier today I met Ben Houchen, the newly re-elected Mayor of Teesside, to talk about what more we can do to invest in Teesside—in the NHS in Teesside, and in life sciences, such as vaccine production, on Teesside. He is doing a fantastic job of taking the voice of Teesside right into the heart of Whitehall—as is my hon. Friend, of course.

My hon. Friend is quite right to raise this point about the Novavax vaccine, which is going to be manufactured on Teesside. Of course, we will study its impact against the new variants, but we have a high degree of confidence that the Novavax vaccine has a broad coverage. In fact, one of its attractions is that it has that broad coverage, not just against the variant that it was precisely designed to deal with but against a wide range of variants. That is part of the theory of the technology that underpins that particular vaccine. It is a very modern vaccine, it is very exciting, and it is terrific that it is being made on Teesside.

[Navendu Mishra (Stockport) (Lab) [V]]

We are not safe until everyone is safe. Following President Biden’s announcement that the US Government will support an intellectual property waiver to help scale up the volume of safe and effective covid-19 vaccines globally, can the Secretary of State explain why the British Government are still blocking the agreement on trade-related aspects of intellectual property rights—TRIPS—waiver at the World Trade Organisation?

[Matt Hancock]

Because we have a better approach. Our UK approach has led to the vaccination of 400 million people. The hon. Gentleman should take enormous pride in that. We have been able to do that while protecting the intellectual property rights that will lead to the development, for instance, of the new vaccines, the new technologies and the variant vaccines that are going to be necessary in the future. It is that combination of the protection of intellectual property rights plus the giving away of this vaccine at cost to the developing world—to lower and middle-income countries.

I reiterate the point I made earlier, which I hope the hon. Gentleman will take pride in: of the 54 million vaccine doses delivered through the COVAX facility, of which we are a major funder, 53 million have been of the Oxford-AstraZeneca vaccine, delivered with no charge for the intellectual property. That is the approach we should be taking. That is what we will do, and I urge everybody around the world to follow.

Stroke: Aftercare

Navendu Mishra Excerpts

Wednesday 21st April 2021 Westminster Hall

[Navendu Mishra (Stockport) (Lab) [V]]

It is a pleasure to serve under your chairship, Sir Edward. I congratulate the hon. Member for Bromley and Chislehurst (Sir Robert Neill) on securing this important debate and, in doing so, helping to shine a light on the need for greater funding for our stroke services. I associate myself with his earlier comments about a one-stop shop for support for patients and families who have suffered from strokes. I also pay tribute to the work of the Stroke Association, which has done so much to tackle this issue, including vital research and support for survivors of strokes, as well as its core role alongside NHS England in delivering our national programme.

I am proud that my local hospital, Stepping Hill, has consistently been recognised for its stroke provision. Since 2015, Stepping Hill’s stroke unit has been rated the best in England, Wales and Northern Ireland on three occasions in a report compiled by the Royal College of Physicians. There are many other charities and organisations that play an important part in providing support within our communities, including Stroke Information in my constituency of Stockport, run by Nick Clarke, who set up that organisation almost a decade ago.

In England, one in six people will have a stroke in their lifetime. New statistics released by Public Health England reveal that roughly 57,000 people each year suffer their first stroke. Unfortunately, the trauma does not end there for many survivors, with around 30% of people going on to experience another stroke. Strokes are a leading cause of death and disability in the UK, and there are around 32,000 stroke-related deaths in England alone each year. Although many associate the condition with older people, Public Health England research has shown that almost 40% of first-time strokes occur in middle-aged adults—as in, those between the ages of 40 and 69.

Furthermore, the average age for a stroke has fallen by three years over the past decade and, worryingly, most first-time strokes are now occurring at an earlier age than at the same stage 10 years ago. It is highly likely, therefore, that colleagues taking part in the debate will know someone who has been affected by this condition. Indeed, a close friend of mine suffered a major stroke last year, so this is an issue close to my heart. I am pleased that he has made a full recovery, with the incredible care and support of our NHS. My special thanks go to the entire team at Salford Royal Hospital for looking after him.

Despite the ever-present threat of strokes, the reality is that for many years research has been underfunded in comparison with other devastating and debilitating conditions such as cancer. In 2016, research by the Stroke Association revealed that just £48 is spent on stroke research per patient compared with £241 on cancer research. We need more funding for both those serious conditions. The already challenging situation has now been compounded by the devastation that the covid pandemic has had on many charities’ fundraising capabilities, meaning that millions of pounds have been lost. That has reduced their ability to continue their work and carry out critical research.

Strokes are incredibly prevalent in the UK, with one striking every five minutes, meaning that it is a leading cause of adult disability. It is therefore vital that sufficient funding is in place not only to research the causes behind the condition and help to identify preventative measures, but to support our national stroke programme, including the aftercare and rehabilitation services.

Research such as the recent study announced by the Stroke Association—the largest of its kind in the world—to investigate a possible link between covid-19 and life-threatening strokes is crucial. In particular, the report states that stroke patients who have had coronavirus may be younger and experience more severe effects of the stroke as a result, including death. It is an incredibly timely and important study that will need to be supported, given that the charity’s own research director said that the research was

“just the tip of the iceberg.”

Now more than ever, the national stroke programme needs to be given the support and funding that it requires to ensure that it can continue its vital work and deal with the rising number of cases in the UK. I therefore urge the Minister to do all she can to look again at this issue and to push her Department to ensure that the national stroke programme and associated aftercare and rehabilitation services receive increased funding that will help to meet both existing and growing demand on NHS stroke provision.