Oral Answers to Questions

Debate between Neil O'Brien and Jim Shannon

Tuesday 17th October 2023 Commons Chamber

[Neil O’Brien]

I pay tribute to my hon. Friend for all his work on this important issue. We will assess all the evidence and reply before the end of the year. Opt-out testing is not the only thing we are doing to drive down HIV transmission. We have had a 40% rise in the number of people getting pre-exposure prophylaxis, and we have increased the number of people testing, with 20,000 free testing kits handed out this year. We are doing everything we can to meet that visionary goal to stop HIV transmission in this country.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answer to the question from the hon. Member for Darlington (Peter Gibson). It is clear that today, HIV is not the death sentence that it once was, because of the progress of medication and healthcare in prolonging life and improving quality of life. In Northern Ireland we are proactive, as the Minister will know, on PrEP and young people. We are doing progressive things through the Department of Health, Social Services and Public Safety in the Northern Ireland Assembly. Has the Minister had the opportunity to discuss with the Northern Ireland Assembly and the Health Department how we can work better together? I always say we are better together in every case.

[Neil O’Brien]

The hon. Gentleman is completely correct. He has been a fantastic champion on this issue. The UK is leading the world on this issue, hitting the UN’s 95-95-95 goals, driving down transmission and reducing stigma. People increasingly realise that as well as suppressing the virus, the treatment makes it impossible to transmit, transforming the lives of people with HIV.

Stem Cell Transplant Patients

Debate between Neil O'Brien and Jim Shannon

Monday 12th June 2023 Commons Chamber

[Neil O’Brien]

I would agree with the hon. Gentleman. I was talking about one scheme, the healthcare travel costs scheme, but patients might also be eligible for non-emergency patient transport, on which we spend about £500 million a year across England. We will continue to look closely at the future of that, not least because of the hon. Gentleman’s comments this evening.

[Jim Shannon]

Patients in my constituency who come to me feel almost compelled to go back to work because they do not have the finances, but they cannot do so because they are not fit enough. Could the Minister’s Department ensure that those people who find themselves in difficult financial circumstances have someone to speak to who could perhaps direct them through the process so that they can get help?

[Neil O’Brien]

The hon. Member makes a good point, and I am happy to continue this conversation with him after the debate. He always provides thoughtful ideas and I am keen to continue talking about that one with him.

For those people who are going through all this at the moment, I have mentioned some of the schemes that are available for transport, such as the healthcare travel costs scheme and non-emergency patient transport, but we will continue to look at those to make sure that they are adequate to get patients to the specialist treatment they need.

In closing, let me again thank the right hon. Member for Alyn and Deeside for securing today’s really important debate and for his thoughtful contribution. Stem cell patients and their families and carers show tremendous courage in the face of incredible challenge, and we will continue to do whatever we can to support this vulnerable community.

Question put and agreed to.

Oral Answers to Questions

Debate between Neil O'Brien and Jim Shannon

Tuesday 6th June 2023 Commons Chamber

[Neil O’Brien]

I was seized by the thoughtful comments that my hon. Friend made in that Westminster Hall debate. We are working on all those ideas, and the plan will be out very shortly.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Would he consider encouraging more students to go into dental work by writing off student loans for those who go into NHS dental work for a five-year period—in other words, we get something back if we invest in them?

[Neil O’Brien]

At every stage, we are taking action to get more dentists doing NHS work. There are 6.5% more dentists doing NHS work than in 2010. The hon. Gentleman has an important idea. We are doing other things to retain NHS dentists, such as the important reforms that we made to pensions, which have helped both GPs and NHS dentists.

Oral Answers to Questions

Debate between Neil O'Brien and Jim Shannon

Tuesday 7th March 2023 Commons Chamber

[Neil O’Brien]

The Better Health: Rewards pilot that we are funding in Wolverhampton is very exciting, and more than 10,000 residents have already registered with the app. We will be monitoring the lessons of the pilot closely and looking at how we can apply them more broadly.

[Jim Shannon (Strangford) (DUP)]

For such families it is about not necessarily the right food, but the cheapest food, which means that, in many cases, young children become obese through no fault of their own. What can be done to help families to buy healthier foods on a budget that is often minimal?

[Neil O’Brien]

The hon. Gentleman is completely correct. As well as the actions that we are taking on healthy eating and obesity, that is exactly why we are spending £55 billion to help households and businesses with their energy bills this winter—one of the biggest packages in Europe. It is also why we have the £900 cost of living payment for 8 million poorer households, we are increasing the national living wage to its highest ever level, and we are spending £26 billion on the cost of living support this year. He is completely right and I commend his work on it.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We will be setting out our next steps on smoking shortly, but we already have the lowest smoking level on record: it has fallen to 13%, partly as a result of the doubling of duty on cigarettes and partly owing to the introduction of a minimum excise tax. We will be investing £35 million in the NHS this year to ensure that all smokers who are admitted to hospital are given NHS-funded tobacco treatment.

[Jim Shannon (Strangford) (DUP)]

T3. Recent analysis from Macmillan Cancer Support shows that 2022 was the worst year on record for cancer waiting times. Will the Minister consider the introduction of an urgent support package for UK cancer services in the upcoming Budget to support our hard-working staff and to ensure that there is additional capacity to deal with the current pressures on the system?

Oral Answers to Questions

Debate between Neil O'Brien and Jim Shannon

Tuesday 24th January 2023 Commons Chamber

[Neil O’Brien]

Absolutely; we are looking at that issue. We have already brought in a new minimum UDA value, and we would like to deliver more. We will look at measures to encourage people to work in areas with the greatest shortages.

[Jim Shannon (Strangford) (DUP)]

T8.   On World Cancer Day 2022, the then Secretary of State for Health and Social Care, the right hon. Member for Bromsgrove (Sajid Javid), announced a 10-year cancer plan to make us a world leader. Today, cancer services are buckling under immense pressure. Can the Minister confirm that the strategy will be fully resourced and will she commit to working with cancer charities to ensure that it is delivered?

Eye Health

Debate between Neil O'Brien and Jim Shannon

Thursday 15th December 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important debate. He has been a strong advocate for eye health for a long time. He speaks from huge knowledge and personal experience, and I listened to his speech with great interest. Given that health is a devolved matter, a lot of my response will focus on England, as he suggested. I understand that the devolved nations are facing similar challenges. We are always interested in sharing ideas and working with our counterparts, in answer to the question asked by the hon. Member for Motherwell and Wishaw (Marion Fellows).

There are 2 million people living with sight loss, and that is predicted to double to 4 million by 2050 as a result of an ageing society. Sight loss is often preventable, and that is why prevention and early detection, along with access to diagnosis and timely treatment, are key. One of the best ways to protect our sight is to have regular sight tests. The hon. Member for Strangford rightly underlined why that is so important with his powerful story about the tennis ball-sized tumour that his constituent had taken out.

When combined with early treatment, sight tests can prevent people from losing their sight. That is why we continue to fund free NHS sight tests for many, including those on income-related benefits, those aged 60 and over, and those at risk of glaucoma and diabetic retinopathy —two of the main causes of preventable sight loss. More than 12 million NHS sight tests were provided to eligible groups in 2021-22. We also provide help with the cost of glasses and contact lenses through NHS optical vouchers. Eligible groups include children and those on income-related benefits. The NHS invests over £500 million annually to provide sight tests and optical vouchers.

The risk factors for sight loss include ageing, medical conditions such as diabetes, and lifestyle factors such as smoking and obesity. We are taking action to reduce obesity and smoking. Smoking rates in England are already the lowest in history, and we remain committed to going further to be smoke free by 2030. We are working to drive down the number of people who take up smoking, and we are supporting those who wish to quit. We are also working with the food industry to ensure that it is easier for people to make healthy choices, and we are supporting adults and children living with obesity to achieve and maintain a healthier weight.

Turning to the medical conditions that lead to sight loss, diabetic retinopathy—a common complication of diabetes—is a potentially sight-threatening condition. The diabetic retinopathy screening programme now provides screening to over 80% of those living with diabetes annually. Between 2010 and 2019-20, the number of adults aged between 16 and 64 who are registered annually as visually impaired due to diabetic retinopathy has fallen by 20%, meaning that it is no longer the main cause of sight loss in adults of working age. The screening programme has played a major role in that.

[Jim Shannon]

I thank the Minister for his helpful response. The target of providing retinopathy screening to 80% of those living with diabetes has been achieved. Are there any plans to try to reach the other 20%? I am diabetic. I had my retinopathy test about four weeks ago; I get it every year. I know the encouragement and confidence that testing gives people once they know they are okay. Are there any ideas for how we can get to the other 20%?

[Neil O'Brien]

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

--- Later in debate ---

[Neil O'Brien]

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.

[Jim Shannon]

The answers are very helpful. One thing that all three Members referred to was the waiting list, and those who lose their eyesight just because they have been on a waiting list for diagnosis, examination and investigation. I know the pandemic created lots of problems in relation to the waiting list. Does the Department intend to have a strategy that will reduce the number of people on waiting lists to ensure that those waiting for a diagnosis retain their eyesight?

Covid-19: PPE Procurement

Debate between Neil O'Brien and Jim Shannon

Thursday 24th November 2022 Commons Chamber

[Neil O’Brien]

The people who came through the high-priority route were not politically connected people, except in the sense that they were being referred by MPs across the House. I do not know the exact details of the north-east supplier that the hon. Gentleman mentions. If he gets in touch, I will be happy to take that up and provide him with a full explanation of what the issue was with that bid for a contract.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for the answers he has given. There was a heavy use of direct award contracts to purchase PPE items. As of April 2021, £371 million had been paid for PPE direct award contracts in Northern Ireland. Does the Minister agree that, in hindsight, there should have been better insight into the supply chains of this PPE, where it came from and who was making it, given the reports that PPE contracts were given to Chinese firms using labour schemes?

[Neil O’Brien]

The hon. Gentleman always makes constructive suggestions, and today is no exception. He knows that we have an ongoing inquiry into the lessons that can be learned and a dialogue with the Health and Social Care Committee about many of these issues. Given its heritage, Northern Ireland was an important supplier of textiles and PPE equipment. Inevitably, given the global balance of production, a lot of items did come from China, as he says, but as part of the lessons learned, we should be thinking about domestic supply.

The National Health Service

Debate between Neil O'Brien and Jim Shannon

Wednesday 23rd October 2019 Commons Chamber

[Neil O’Brien (Harborough) (Con)]

I thank Ministers and everybody at University Hospitals of Leicester for the role they played in securing the fantastic £450 million investment in our local hospitals that was announced the other day. I also thank Ministers for the role they have played in today’s announcement that there will be a new £46 million investment in an urgent care hub at Kettering General. That means that constituents at both ends of my constituency will benefit from huge new investments. I am incredibly grateful.

Those are not the only pieces of good news my constituency has had recently. We have the gleaming new treatment centre at St Luke’s in Market Harborough. We have had the wonderful news that we will be keeping the world-leading children’s heart unit at Glenfield—a service that is not just brilliant for everybody in this country, but through the charity Healing Little Hearts provides help for people across the entire world. We also have the futuristic new A&E at Leicester Royal Infirmary. Those things are all great, but the investment we are about to receive will be even more transformational.

The Secretary of State came to the Royal Infirmary the other day. As we walked around, we heard about both the challenges and the opportunities that we have locally. We saw the difficulty of working in maternity when it is split across two sites. When my son was born just two weeks ago, I saw how having two different sites meant that the staff had to work all day without breaks to fit us in. Their lives and patients’ lives will be much better when we have a single new maternity hospital. As we walked around with the Secretary of State, we saw the brilliance of our intensive care staff, but we also saw that they were working in fundamentally out-of-date facilities. We saw the brilliant work that the A&E team were doing, particularly in enhancing data to improve services, but we also saw the incredible growth in demand for those services.

The investment we are about to get means a new maternity hospital, a new children’s hospital, two super-intensive care units with 100 beds in total and a planned new major treatment centre at Glenfield Hospital, as well as modernised wards, new operating theatres, new imaging facilities and, brilliantly, new additional car parking. Anybody who has ever tried to park at Leicester Royal Infirmary will realise that that is a huge boon. These local improvements are part of a wider series of improvements we are making across the NHS. It is great that we now have a long-term plan for the NHS, with a long-term budget for the NHS that allows NHS managers and staff to plan for the future.

[Jim Shannon]

I very much welcome the Government’s commitment and the money they have set aside, but is the hon. Gentleman aware that 16 million people in England live with the pain of a musculoskeletal condition? How will the Government ensure that people with arthritis are able to access the interventions that need to be in place—from joint replacement operations to physiotherapy—in a timely fashion? I think there is an opportunity to address those issues. I have the same problems in my constituency, but it is a devolved matter. I have been made aware of this issue in England. Does he agree that it is time for that?

[Neil O’Brien]

The hon. Gentleman raises an important point, and I was about to come on to it. It is great that we are making record investment in services such as mental health and spending more than we did before. It is great that we are introducing new targets, such as basic standards for help with eating disorders. It is great that we have more doctors, more nurses and more money. However, we are conscious, as we speak to people in the NHS, that unless we can deal with the sources of demand, fundamentally we will never be able to spend enough on all the priorities, including musculoskeletal services.

What do we need to tackle those causes of demand? We of course need the long-term plan for social care. The Minister needs to stick to his guns on public health: the sugar tax has worked. Things like the campaign against the anti-vaxxers and their pseudo-science are incredibly important, as is action on preventive social care. We should keep going with things such as the migrant health charge, which is raising money for the NHS; we could increase it. We should keep going on technology. It is so important for Ministers to help GPs to upgrade their telephone triage facilities, which would make the experience of using primary care so much better and reduce the burden.

Some of the things in the Queen’s Speech are incredibly important to help deal with these growing burdens. We need new technologies, which is why it is important to get more clinical trials going more quickly. That is why I welcome the measures in the Queen’s Speech. This is about building on the life sciences review—the Bell review—and it is very important to build on the work that the academic health science networks are doing. The potential advantage of our NHS is that it should be one of the best places in the world to do clinical trials—we have the scale—but at the moment there are too many gatekeepers and too many things stopping them.

Last but not least, there is the wonderful improvement in the NHS safety body that we are creating. From personal experience, I can say that when my daughter was born some things went wrong. We had a wonderful junior registrar who did lots of things right, but a few things went wrong, and my wife gave birth without anaesthetic. After that, unfortunately, her placenta did not deliver and the consultant—we never found out who this was—removed the placenta manually with no anaesthetic, and it was incredibly painful for my wife.

It is important, as my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) said, that we learn lessons in the NHS without attributing blame. Not attributing blame was one of the fundamental recommendations following the Mid Staffs inquiry: we have got to be able to learn lessons. When we started to complain about what happened to my wife, people closed ranks. My wife is a doctor, and we would never in a million years have sued the NHS, but they did not know that. We never even found out who the consultant was who had got things wrong, so I do not know whether the lessons were learned from that mistake; I hope they were.

Having a no-blame culture, having this new body and learning from the experiences of painful things such as the Bawa-Garba case are the ways in which we can have truth and reconciliation, with a system that learns. One of the most important things we could ever do to improve the NHS is to make it a self-improving system that is constantly learning and constantly getting better.

Small and Village School Funding

Debate between Neil O'Brien and Jim Shannon

Wednesday 17th July 2019 Westminster Hall

[Neil O'Brien]

My hon. Friend is completely correct. However, rural schools, partly because they are small schools, have been much more likely to close in recent years. I thank the Department for Education for the historical data it provided to me on this, and Pippa Allen-Kinross at Schools Week for helping me to analyse it. Since 2010, 61% of schools that have closed and not reopened in another form have been rural schools, meaning that rural schools have been twice as likely to shut as urban ones. Since 2000, 150 rural primaries have closed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing the debate. What he outlines in his constituency and other parts of the United Kingdom mainland is replicated in Northern Ireland. I know that the Minister does not have responsibility for this, but for the record, is the hon. Gentleman aware that since September 2010, 98 of the 230 schools that closed in Northern Ireland—42%—were rural, according to Schools Week analysis? Does he recognise the difficulties that creates for rural dwellers and socially isolated children?

[Neil O'Brien]

The hon. Gentleman is completely correct. This challenge affects all of the United Kingdom. For rural schools that closed, the average walk to the next nearest school is 52 minutes, which in practice means driving or getting a bus. There is a cost to the taxpayer for this transport, and a cost to parents and children for driving a long way, so there are all kinds of reasons why we should want to preserve our village schools.

I will turn to small schools more generally, including those in urban areas. I am grateful to the House of Commons Library for digitising older data for me that revealed a dramatic transformation in the scale of our schools over recent decades, and a decline in the number of small schools. The number of pupils at state primary schools in England is roughly the same as in 1980, but the schools that they attend are completely different. In 1980 there were 11,464 small primary schools with fewer than 200 pupils, but in 2018 there were just 5,406. The number of such schools has halved over the decades.

In contrast, in 1980 there were 949 large primary schools with more than 400 pupils, but in 2018 there were more than 4,000, so the number of large schools has quadrupled. The number of really big primaries with more than 600 pupils increased from 49 to 780, while there are now more than 100 what I call “super jumbo” primary schools with more than 800 pupils, which often have playtimes in shifts and hundreds of staff. This is a huge change in the nature of our primary schools, and it is visible in Scotland, Wales and Northern Ireland too. In fact, since 2002 Wales has seen the most dramatic decline in the number of small schools, followed by the north-west and Yorkshire.

This huge change in our primary schools has come about without any real discussion or political choice. It seems to me a move away from the natural small scale for small children, and there is no obvious policy rationale for it. Small schools are not bad schools. Schools with 200 pupils or fewer are just as likely to be “good” or “outstanding” as other schools. In fact, schools with fewer than 100 pupils, which account for about one in eight schools, are more likely than average to be “good” or “outstanding”, so this is not about academic standards.

I think two different things are driving it. The first is planning, which is outside the DFE’s remit. We do not build new small schools, and we do not make developers pay enough for the infrastructure needed for new housing. Instead, our bitty, piecemeal development allows developers to get out of paying for new schools, and we cram more pupils into existing schools, building classrooms on playing fields. Secondly, wider catchment areas mean more car journeys to those schools, and because builders often put schools in residential areas, there are a lot of cars driving into streets that were never intended for them, leading to a lot of congestion. People tell me that makes their village no longer feel so much like a village.

However, the DFE could do some things about the declining number of small schools. We should increase the lump sum element of the national funding formula. Do not get me wrong: the national funding formula is extremely good and has meant that the funding rate per pupil in my constituency has gone up twice as fast as the national average. It helps underfunded areas such as mine to catch up with the national average, although there is still a long way to go. It would be very helpful to increase the lump sum—the part of the national funding formula intended to help small schools.