Access to Migraine Treatment

Philip Hollobone Excerpts

Wednesday 20th March 2024 Westminster Hall

[Dehenna Davison (Bishop Auckland) (Con)]

I beg to move,

That this House has considered access to migraine treatment.

It is, as ever, a pleasure to serve under your chairmanship, Mr Mundell. Let me start by stating the blooming obvious: migraine is not just a headache. It is a complex neurological spectrum condition, of which a headache is just one possible symptom. This is a very strong early message to anyone suggesting that migraine attacks can be cured with a couple of paracetamol: it is time to learn and to be better. Listen to this debate and to the testimonies of those living with this debilitating condition, and help us together overcome the stigma surrounding migraine, which for centuries has acted as a barrier to accessing quality treatment for those suffering.

Before I get into the full swing of things, I want to express my gratitude to the House authorities for organising a survey to which more than 500 migraine patients responded. I am grateful to each and every one of them, and to others who reached out to me separately to share their experiences. Some of those testimonies have been eye-opening and some have been quite harrowing. I will endeavour to include as many as I can in this speech. As ever, my thanks go to the National Migraine Centre and the Migraine Trust not only for their support for this debate but for their round-the-clock work to support people living with migraine.

We cannot have a Westminster Hall debate without a bit of a history lesson at the beginning, so I did a bit of a dig through the history of migraine and found that the earliest known references to it date back thousands of years to ancient Egyptian times. The father of medicine, Hippocrates, was the first to document clinical observations about migraine in about 400 BC. Classifications of headache were first outlined in the first century AD by Aretaeus of Cappadocia, whose category of heterocrania displayed many similar symptoms to migraine. Galen wrote of severe pain affecting almost half the head in the second century, and the Iranian physician al-Rāzī devoted an entire chapter of his book to the symptoms and treatment of migraine in the 9th century. Then in the 17th century, Thomas Willis published his theory that megrim owed to the dilation of blood vessels within the head.

Throughout the years, key figures are reported to have experienced migraine. They include leaders such as Julius Caesar and Napoleon Bonaparte, Ulysses S. Grant and Robert E. Lee, Woodrow Wilson and John F. Kennedy; great thinkers such as Sigmund Freud, Friedrich Nietzsche and Charles Darwin; artists such as Van Gogh; writers such as Virginia Woolf; and actors such as Elizabeth Taylor, Hugh Jackman and Gwyneth Paltrow. There is even strong speculation that the trippy nature of “Alice in Wonderland” was inspired by Lewis Carroll’s own migraine attacks with aura. In his diaries from 1885, Carroll talks of the

“odd optical affection of seeing moving fortifications followed by a headache.”

His works led to the term “Alice in Wonderland syndrome” being coined to describe

“Certain hallucinations peculiar to migraine”.

In Carroll’s diaries of 1856, he records a trip to see William Bowman, one of the top ophthalmologists of his time, to discuss the visual disturbances in his right eye, which Bowman was unable to formally diagnose. Perhaps that was because it was not until the 1870s that visual manifestations of migraine began to gain more widespread recognition among medical professionals.

Migraine is than twice as likely to affect women, but in that period it was believed that we weak women merely had hysteria and fragility of the mind, unlike the ambitious men who got migraine only because of how hard they were working. Women being taken seriously in healthcare is a bit of a pet peeve of mine. Although I greatly welcomed the women’s health strategy, I was a little disappointed not to see migraine more formally mentioned. Perhaps the Minister will discuss that with me separately.

The 1870s were 150 years ago, and we might naively assume that in that time the magnificence of medical innovation has created cures and solutions that mean that people no longer suffer the terrible symptoms of migraine. Back in 1954, the then Minister of Health told those affected by migraine:

“Cheer up; there is a good deal of work going on, mostly under the Medical Research Council”.

That led to a response in 1960 by John Rankin, then the hon. Member for Glasgow, Govan, who said.

“For six years, and long before that time, the good work, so we are informed, has been proceeding, yet nothing appears to be happening.”—[Official Report, 4 March 1960; Vol. 618, c. 1671.]

More than 60 years later, despite migraine affecting roughly 10,000 people in every constituency in the UK, a Hansard search informs me that there has been no full debate on migraine in Parliament since the 1960s.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate my hon. Friend on her powerful and extremely well informed speech. One of those 10,000 in the Kettering constituency is Lisa, who has written to me to say,

“I spend most of my weeks, either with a migraine or with the after effects, which include complete exhaustion that can last two or three days. I have medication that does not always work. I get facial paralysis and will often have slurred speech, light sensitivity, nausea, dizziness, along with immense pain and pressure in my head. It is an awful existence.”

I want to pass on to my hon. Friend that Lisa adds,

“I am so glad to know that it is being debated in Parliament today.”

[Dehenna Davison]

I am grateful to my hon. Friend for passing on Lisa’s remarks. She is one of millions in the country living with this condition and experiencing the debilitating effects. I hope that, following today’s debate, we will see improved access to treatment. I ask my hon. Friend please to pass that on to Lisa.

As I said, there are 10,000 people in every constituency but no debates in Parliament since the 1960s. I make special mention of Lord Londesborough for raising a question on migraine in the other place in October last year, rightly arguing that this invisible disability deserves much greater priority and resourcing across the NHS.

It is 60 years since the last parliamentary debate. Those suffering the crippling effects of migraine alone might feel that, even now after all that time, little progress has been made, but I am here to be optimistic. New treatments, such as CGRP blockers, are proving highly effective for many migraine patients, helping to reduce the severity, longevity and frequency of migraine attacks. For many taking CGRP blockers, they are often called a lifeline. One patient responded to our survey, saying that CGRP injections have “virtually eradicated my migraines”.

Although new effective treatments are being developed, they are not easy to access through the NHS. Across today’s debate, I will outline the key difficulties being faced by patients at each stage of the migraine journey, and will outline possible solutions to improving access to treatments and, ultimately, the lives of migraine patients. That is something that I think we can all agree is very much beyond politics.

Let us start with the basics and discuss what it is like to live with migraine. We had an example from Lisa, the constituent of my hon. Friend the Member for Kettering (Mr Hollobone). When experiencing a migraine attack, common symptoms can include a severe headache; nausea and/or vomiting; visual disturbance, such as blurry vision, spots of light or zig-zag lines; sensitivity to light and sound; an inability to concentrate and brain fog; difficulties forming words, which is not helpful in this place; and fatigue.

Interestingly, I had experienced migraine for years before I recognised some of the symptoms linked to it. I recall sitting at home reading “Managing Your Migraine” by Dr Katy Munro last autumn, with a coloured pen in hand, underlining all the symptoms that I experience when I get a migraine attack; and there were eight different symptoms. A severe attack can leave sufferers bed-bound in agony, with curtains closed, cowering in the darkness, unable to eat, unable to think clearly, and utterly miserable. Attacks can be completely debilitating, and I have experienced my fair share of them.

I am not the only hon. Member who lives with migraine. The hon. Member for Caerphilly (Wayne David) is unable to attend today but asked me to read his testimony in his absence. He said:

“I have suffered from migraine since I was a young man. It used to be extremely debilitating, but in recent years I have been able to minimise significantly the severity and frequency of attacks. There are so many different causes and triggers of migraine. For me, it is stress related. Manage my stress and I can usually manage my migraine.”

The hon. Member for Banff and Buchan (David Duguid) said:

“I first experienced migraine in my early teenage years, when I regularly had to be excused from school. I remember being particularly distressed at the disorientation and confusion, as well as the extreme headache and nausea, of course. Migraines have become no less debilitating as I have grown into adulthood but they have become less frequent, and I generally know what to expect when symptoms start, and what medication to take. Like my father before me, I now watch my 12-year-old son experiencing his first migraines and the confusion it brings. As much as I can empathise with my son, I am only too aware of how little I can do to relieve his distress.”

The frequency of migraine attacks can vary. Some people will experience a small number of attacks over a lifetime, some one or two a month, but for others migraine can become chronic, meaning that headache is present more than 15 days a month, with at least eight of those having other migraine symptoms. That is the condition that I live with, as do around a million other people in the UK. For me, that means that I have a headache all day, every single day. Although they vary in severity, they are none the less draining, particularly on the many days when they are coupled with other migraine symptoms.

Recently, I spoke to Mollie Campbell, a brilliant young woman who like me lives with chronic migraine. Her journey helps to outline some of the difficulties that patients face in accessing treatment. In her own words, she remembers her first attack vividly:

“on a normal day, I woke up in agonising pain in my eye, eyebrow, and head. When I say ‘pain’, I mean torturous and excruciating pain, the kind that makes you roll around on the floor sobbing in agony.”

Mollie sought help from her GP, but it took months, several misdiagnoses, a number of unsuitable drugs being prescribed and, eventually, her paying to access a scan privately before she was eventually diagnosed with chronic migraine. Unfortunately, Mollie’s story is not uncommon. It can take patients months, if not years, to get a diagnosis.

A commonly expressed sentiment is that GPs do not always take the condition of migraine seriously. One patient who responded to our survey explained that they waited

“five and a half years from first presenting to a doctor taking them seriously and investigating”.

Another said that

“it took 19 years to be diagnosed with migraines”,

and another:

“Doctors just don’t seem to know or understand enough about it and I have been fobbed off a lot.”

Eating Disorders Awareness Week

Philip Hollobone Excerpts

Thursday 29th February 2024 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered Eating Disorders Awareness Week 2024.

It is a pleasure to serve with you in the Chair, Mr Hollobone. Across the UK, 1.25 million people have eating disorders, which include binge eating disorder, bulimia, anorexia, other specified feeding or eating disorders, and avoidant/restrictive food intake disorder.

Left undiagnosed and untreated, eating disorders can be silent killers. Anorexia has the highest mortality rate of any mental illness, and results from one study have shown that a third of people with binge eating disorder are at risk of suicide. For too long, sufferers have been left feeling trapped and alone. Urgent action is needed to tackle this rising epidemic.

The theme for Eating Disorders Awareness Week 2024 is avoidant/restrictive food intake disorder, or ARFID. The condition is characterised by a limited range of food intake. Sufferers may eat only “safe” foods, and can avoid entire food types. That means that they have difficulty meeting their nutritional and energy needs, and can experience weight loss and health problems.

ARFID can come from sensory sensitivity and fear of negative consequences from eating. Beliefs about weight and shape do not necessarily contribute. Be Body Positive, an NHS-backed psychoeducation website, has shared a story of what life can be like with this condition. Tahlia was diagnosed with ARFID when she was 20. She was initially misdiagnosed as a fussy eater before eventually being misdiagnosed with anorexia as a teenager as a result of her significant weight loss. Because she was misdiagnosed, she missed out on early vital treatment. In her own words:

“Growing up, I felt misunderstood and isolated because of my eating habits…Knowing that ARFID exists has been a validating experience, connecting me with a community of people who share similar challenges.”

The helpline run by Beat received more than 2,000 phone calls from people looking for support for ARFID last year—2,000 only last year! However, awareness of ARFID is still very limited. Misperceptions that it is just fussy eating leave sufferers like Tahlia feeling alone. There is no solid data on how many people in the UK have ARFID; it could be anywhere from less than 1% of the child and adolescent population to over 15%.

Because of those perceptions, accessing specialist treatment can be a lottery. There is a lack of standardised treatment pathways for ARFID, and it is hard to find out what support is available. A recent survey of NHS websites found that only six of the 55 NHS providers of eating-disorder services for children and young people explicitly stated that they provided treatment for ARFID, and only one of the 49 NHS providers of adult eating-disorder services said the same—one out of 49!

Rigid stereotypes of eating disorders persist in other areas. Despite their high prevalence, eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. I have been appalled by stories of people being turned away from treatment because their body mass index was too high, and have long supported Hope Virgo’s “Dump the Scales” campaign to change that.

National Institute for Health and Care Excellence guidelines state that single measures such as BMI should not be used to determine whether someone receives treatment. However, those guidelines are not being uniformly implemented. Some services are still using those barriers due to severe mismatch between demand and capacity in chronically underfunded services.

It is not uncommon for patients to get to a worryingly low BMI before they are considered appropriate for an in-patient bed. That requires investment, but eating disorder treatment is cost-effective at any stage. We know that early diagnosis is critical: the earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for someone to recover. Healthcare should focus on prevention before cure. Access to the right treatment and early support is life changing. If we want to save money, prevent hospital admissions, save lives and improve outcomes for all sufferers, we need to ensure full implementation of clinical guidance around diagnosis.

There are many wonderful organisations working up and down the country to get people the help they need. I pay tribute to SWEDA, previously known as the Somerset and Wessex Eating Disorders Association, which provides invaluable support to so many families across my local area and is expanding its operations this year. Last year, SWEDA told me that it saw a 150% increase in people attending support and guidance appointments for eating disorders compared with pre-pandemic figures. Its children’s service was overwhelmed with young people and their parents desperately seeking help.

Eating disorders wipe out adolescence. Young people suffering from eating disorders miss out on so many educational and social opportunities. Those years are stolen from them—not to mention the potentially irreversible effect on their physical health. I welcome the access and waiting time standards already set for children and young people’s services. However, those targets have still not been met; 6,000 children and young people are stuck on the NHS waiting list for treatment. In two thirds of those cases, patients have been waiting for over three months, despite the standard stating that for routine cases, treatment should start within a month. Between 2022 and 2023, fewer than three quarters of children’s urgent cases started treatment within one week—well below the 95% standard. If we have standards, the Government must provide the resources to meet them.

For adults, there are not even targets in place. Adult eating disorder services in England are severely under-resourced, especially now that demand has risen to even higher levels as a result of the pandemic. Those services typically have either long waiting lists or strict referral criteria. That means that many adults are unable to access the treatment they need until they have become very ill. On average, people wait almost three and a half years to get treatment for their eating disorder, and adults wait twice as long. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care.

Delays have deadly consequences. In 2017, the parliamentary health and service ombudsman published a damning report into the failings that led to the death of 19-year-old Averil Hart from anorexia and that of two other adults with an eating disorder. Last February, the Health Service Journal identified at least 19 adults with eating disorders whose death sparked concerns from coroners about their care. At least 15 of those were deemed avoidable and resulted in formal warnings being issued to mental health chiefs. We can never allow that to happen again. We must remember that eating disorders are treatable.

Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen. Having clear standards can facilitate service improvement. They enhance the experience for patients and drive up health outcomes. Although there is still a way to go, the standards introduced for waiting times for children and young people’s eating disorder services have driven some crucial service improvements. We need to see the same for adults.

Our health service is simply neither equipped nor empowered to deal with eating disorders. I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England; instead, they developed and published a major conditions strategy, which included mental health alongside cancer, cardiovascular disease and dementia. We need targeted and varied strategies for targeted and varied issues.

I again point the Government towards Hope Virgo’s eating disorders manifesto. It calls for the Government to implement an evidence-based national eating disorders strategy, with a plan outlining how they will tackle the huge rise in the number of people affected by eating disorders. I would also like to see the appointment of an eating disorders prevention champion to co-ordinate the Government response.

The strategy should integrate obesity and eating disorder prevention plans, because there are so many overlapping factors between the two. The Government should also consider reforming treatment approaches. For example, an Oxford University study found that using the integrated CBT-E or enhanced cognitive behaviour therapy approach rather than the current in-patient approach reduced readmission rates for people with anorexia by 70% over the course of a year.

We should also consider the other available options. The all-party parliamentary group on eating disorders, which I chair, is currently conducting an inquiry into intensive out-patient treatment. Such programmes are designed to support people with severe eating disorders for whom traditional out-patient treatment is not working. Patients go home in the evening and at the weekends, and have access to increased meal support and therapy. They can be treated in a familiar community-based setting. Such programmes are recognised as an effective and less expensive alternative to in-patient care. Importantly, both patients and their loved ones often find this form of treatment far preferable to other forms of treatment.

However, intensive out-patient treatment is not widely available across the country and there is no up-to-date information about exactly how many services are providing it. Again, we return to the importance of appropriate early intervention. Universal access to intensive out-patient services could minimise the need for disruptive in-patient stays. I hope to hear comments from the Minister about investment in such treatments.

Much of what I am talking about comes back to resources. The Government funding needs to reach frontline services, but the APPG on eating disorders found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the frontline. The Government must ensure that their funding pledges are not empty words and that money gets to where it is needed. A one-off boost is not enough. Soaring demand for underfunded services will leave people missing out on care when they need it most.

To tackle eating disorders, we also need to understand them fully. From 2015 to 2019, eating disorders accounted for just 1% of the UK’s already severely limited mental health research funding. The APPG on eating disorders previously conducted an inquiry into eating disorder research funding, which found that a historic lack of investment has led to a vicious cycle of underfunding. The APPG also emphasised that we need to diversify the research agenda.

Certain eating disorders and patient groups have not been served by current research. That is a real barrier when it comes to efforts to improve care. We cannot identify the obstacles that exist without having more information. Some progress is being made. It has been encouraging to see some increased investment into eating disorder research and a commitment to actively involve people with lived experience in emerging research collaborations. We now need to see targeted investment and ringfenced funding.

Eating disorder sufferers are being abandoned. We are well aware that the NHS is in crisis. However, although we have heard harrowing stories about delays in ambulance services and accident and emergency departments, the impact on mental health services has received little attention. Eating disorders are an epidemic and the sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness and nor should anyone die of an eating disorder in 2024.

[Mr Philip Hollobone (in the Chair)]

This debate can last until 4.30 pm. I am obliged to call the Front Benchers no later than 3.57 pm and the guideline limits are 10 minutes for the SNP, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Then the mover of the motion will have two or three minutes at the end to sum up the debate. In the meantime, it is Back-Bench time. I call Olivia Blake to speak.

--- Later in debate ---

[John McDonnell]

Thanks to the work that the hon. Lady, the campaigners and others have done, the media reporting of this issue has, to a certain extent, changed dramatically, but that has taken years to achieve. I agree that this is still seen as a lifestyle choice. It is not seen as serious; people do not relate deaths to this condition, but we all know from dealing with our constituents that that is what happens.

The other issue about the access to hospitals and clinics is that we have all had to map out, across the country, where constituents can go. Often, what happens is that they are discharged from one unit and it is then almost impossible to get them into another, particularly if there are specialist concerns.

The issues that we are reiterating today include the fact that the funding needs reviewing again, because the situation has moved on since we last discussed funding with the Government. There is also a lack of clarity, so we need a concrete action plan for the coming period. One of the issues is how we bring people together. There is a real concern about the lack of monitoring. One of the proposals, which I think Hope Virgo first raised, is to have a discussion about how we are monitoring this situation, both in terms of incidents and the effectiveness of different treatments. A proposal from one of the discussions we had is that it is time to bring together again those with experience of the condition and the key clinicians in the field, so that we can stand back and objectively look at where we are at. When we have dealt with homicides and suicides in other fields, we have set up independent inquiries because of the seriousness of the matter. In some instances, I feel that we need some form of inquiry to see where we are at and what is needed in the future.

The hon. Member for Bath and my hon. Friend the Member for Sheffield, Hallam mentioned the staff. The impression I get from the discussions I have is that, because of the increasing demand, staff are experiencing a level of exhaustion and a morale issue about simply being able to cope with the numbers and severity of the conditions they are dealing with. One thing we can do today, as others have, is to acknowledge the commitment and dedication of those staff, while recognising that they need greater support, in terms of both numbers and pay, to demonstrate just how valued they are.

The issue around the NICE guidelines has already been raised, and my experience is the same as others’, really. It is hit or miss; there is a postcode lottery in the provision of treatment under the guidelines. The Dump the Scales campaign by Hope Virgo and others has been effective at moving the debate on from just talking about BMI, so that a wider range of discussions are now taking place, which I really welcome. However, there is still no recognition across services that eating disorders are a mental health issue, and that therefore mental health practices that have been effective elsewhere need to be applied here. I argue very strongly for the need to fund cognitive behavioural therapy, which has a success rate of 70%, I think. It has also reduced readmission rates down to about 15%, so it is a huge money saver for the NHS. Again, we need to look at the levels of investment, both in training staff for that and in ensuring access.

I want to mention another issue that has been raised before. We have found too many examples of the provision of palliative care to eating disorder sufferers, which we are hoping will end. Palliative care should be offered only if there is another life-threatening condition; it should not be offered just because of this condition. We hope that that has now been ended, but it needs monitoring again to ensure that the message is out there. Our overall view is that, with the right support and early enough intervention, people’s lives can be saved, and that their lives can be transformed as a result, but it does need adequate funding.

The hon. Member for Bath mentioned the ringfenced fund that is needed for research. At this stage, it is time to stand back, bring together sufferers and clinicians, and look at what the strategy should be. We need an adequately funded, concrete strategy that we can all sign up to. This is a cross-party issue; it is not party political. As I say, I welcome what the Government have done so far. We are now at the stage where we know so much more about the escalation of the problem and the need for therapeutic interventions, and about what works and what does not.

My final point is to pay tribute, as others have done, to all the campaigners who have put this issue on the agenda and provided support throughout. I pay tribute to all the clinicians, of course, and to one group in particular, which is the school nurses—Members may recall that we held a session with them. They brought forward their programme for how they would provide advice and assistance to pupils, which proved to be incredibly effective. Of course, I also pay tribute to all those who have supported the all-party parliamentary group of the hon. Member for Bath with such expert advice, as well as consistent nagging.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front Benchers, the first of whom will be Patricia Gibson for the SNP.

New Dementia Treatments

Philip Hollobone Excerpts

Thursday 11th January 2024 Westminster Hall

[Damian Green]

My right hon. Friend has huge expertise over the entire health field and therefore in this area as well. He is completely right, and I will come on to savings, particularly potential savings in the social care budget as well as the health budget, in a couple of minutes. It is one of the points I want to emphasise to the Minister.

To return to the treatments, the Medicines and Healthcare products Regulatory Agency has already started consideration of lecanemab and donanemab—I wish treatments had more pronounceable names—two very important breakthrough drugs, and I believe a final decision is expected by the middle of this year. Inevitably, at this early stage of the development of drugs in any particular field, there are many more out there. Another 140 drugs are undergoing clinical trials around the world at the moment. They will not all work, but some of them will, so in scientific and research terms, this is genuinely an exciting period in this field.

Perhaps the most significant point I want to make to the Minister is to express the hope that the way in which the system decides whether to approve a drug is fit for purpose for this type of drug. That is genuinely in question and gives rise to the point my right hon. Friend the Member for West Suffolk (Matt Hancock) made about costs. There are inevitable gaps in our knowledge about the efficacy of new treatments in an area where, up to now, there have been no treatments. Much of the usual comparative work one would expect to be done in clinical trials cannot be done in these circumstances, so there is a task for Ministers to make sure that NHS bodies and the industry develop a joint plan to allow these new treatments to be available to the NHS at a reasonable price.

There is also an important specific point that could affect whether the National Institute for Health and Care Excellence gives financial approval to these treatments in the first place. The bulk of the current costs of dementia falls on the social care system, particularly on unpaid carers. Estimates suggest that around £22 billion a year of costs fall on informal or formal social care. The direct costs to the NHS are only £1.7 billion a year—a small fraction of the cost to the social care system. The current NICE assessment process will take into account only the NHS costs, and clearly that could adversely affect a decision about whether drugs are affordable.

Whether the current NICE system provides the proper result for this type of drug and disease would be questionable at any time, but it is particularly questionable when other arms of government are concentrating on getting more working-age people back to work. More than 1 million people between the ages of 25 and 49 are out of work because of caring responsibilities, and some of those will be caring responsibilities for people suffering from dementia, perhaps in its early stages, when we are not using technology well enough to allow people to lead more or less normal lives.

[Mr Philip Hollobone (Kettering) (Con)]

My right hon. Friend is making an excellent speech and a particularly pertinent point about NICE considering only the cost to the NHS. Is that not even more surprising given that NICE stands for “National Institute for Health and Care Excellence”? Clearly, the guidelines need urgent revision.

[Damian Green]

I am delighted to have my hon. Friend’s support. Since the old Department of Health was renamed the Department of Health and Social Care, it has been particularly important that, in all its manifestations, and indeed in all the manifestations of the bodies that report to it, the Department should reflect the treatment of health and social care as equals. That is a wider point that my hon. Friend should not tempt me to; I can go on at great length about it, and do not wish to in this debate.

As I said, caring responsibilities are a significant reason why so many people of working age are not working. I cited the figure for those between 25 and 49, but if we extend the age range up and down, less than a fifth of people who care for someone with dementia are in paid work. If someone is caring for someone with dementia, it is very likely that they will not be in paid work. I am grateful that others support my point that NICE should be instructed to consider the full cost of dementia to social care, as well as the NHS, to arrive at a proper evaluation of the economic case for the new treatments.

The prospect of these drugs becoming available also throws a spotlight on the need for better and, in particular, earlier diagnosis. At the moment, the drugs are effective only in the early stages of Alzheimer’s, and there is nothing like enough capacity for timely diagnosis. The latest NHS figures suggest that more than a third of the over-65s estimated to have dementia do not have a recorded diagnosis at all. There are significant regional variations within that figure. Some areas of the country are much worse: for example, diagnosis rates in Herefordshire and Worcestershire are as low as 53%. There is also evidence that minority groups, including black people and those of south Asian heritage, have higher rates of under-diagnosis. Without an increase in the effectiveness and timeliness of diagnosis, the beneficial effects of the new treatments will therefore be massively reduced.

For the new hopes I am discussing to be realised, we therefore need a revolution in our diagnostic capacity. At the moment, the most effective ways of diagnosing dementia—namely, PET scans or lumbar punctures—are accessible only to 2% of those seeking a diagnosis. The best short-term solution is to increase access to lumbar puncture, which is much cheaper and more scalable than expanding the expensive scanning equipment. Alzheimer’s Research UK suggests that the annual capacity for lumbar punctures should be increased from 2,000 to 20,000 a year. I am conscious that the Government are analysing the responses to the consultation on the major conditions strategy and that dementia is one of the six conditions covered by the strategy. My appeal to the Minister on that front is that, as we do in many cases in health and social care, we think at least as much about prevention as we do about cure.

Given the demographic pressures, it seems unarguable that, if we carry on as we have done since the NHS was created, concentrating almost entirely on treatments while relatively neglecting public health and preventive measures, we are heading for even more difficulties in the long run. But that is a much wider debate. In the specific area of preventing dementia, a number of factors, including hearing loss and high blood pressure, can and should be part of a preventive approach, which would reduce demand for expensive treatments in the long run and, even more importantly, allow people to continue to lead more or less normal lives.

One other point about the new era that we are hopefully entering with these treatments is that, as a country, we are well placed to contribute to the vital research that is needed. We have the scientists and the companies, but too few people are currently aware of the possibilities. Only 2% of people with a dementia diagnosis are currently registered to hear about clinical trials. The total UK share of the current clinical trials for dementia around the world is 7%. I hope that the Government will look at that aspect as part of the overall plan for dealing with dementia, which we are looking forward to.

Before I sit down, I should emphasise that I do not want to be ungenerous or over-critical about the Government’s action in this area. I am conscious that the Government have committed to doubling the funding for dementia research to £160 million by the next financial year, and I also very much welcomed the launch, last summer, of the Dame Barbara Windsor dementia mission; I am glad that the Government have put £95 million behind that. I know, of course, that the Minister and the Government widely recognise the horror of this disease, the fact that it is becoming more widespread and affecting more and more families and the fact that not just more money, but more creative thinking, will be needed to turn the tide.

I want to end on a hopeful note. This generation has the chance to see the end of the terrible situation whereby a diagnosis of dementia is a life sentence of an inevitably long degeneration. This absolutely needs to be a turning point for the millions of people who are touched by this dreadful disease. I hope that the Government and the medical authorities recognise the scale of the opportunity that scientific advance has given to them and all of us. This year could be key to setting the UK on a path to a more hopeful future. I am very confident that the Minister will be determined to lead us on that journey.

NHS Winter Update

Philip Hollobone Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

As I said earlier, strikes have very serious consequences for the NHS. We cannot pretend that the NHS can be switched on and off at whim. My one ask of the junior doctors committee was that it stop the strikes so that we can return to the table. As the number of patient safety mitigations has revealed—by the way, it is the highest number of patient safety mitigations that local NHS leaders have ever asked for, because of the unprecedented length and timing of the strike—and because the BMA has refused even those derogations, with the exception of two, we have to get to a place where it returns to a more reasonable frame of mind and comes back to the table with more reasonable expectations, so that we can try to find a solution. I will not put patients’ safety at risk: I have to enable NHS England to make preparations and continue the work it is doing day by day, hour by hour, to safeguard hospitals and patients during this very damaging strike action.

[Mr Philip Hollobone (Kettering) (Con)]

My right hon. Friend the Secretary of State will be as concerned as my constituents in Kettering that, for every three days of junior doctor strikes, the cost to Kettering General Hospital is a staggering quarter of a million pounds, with hundreds of operations cancelled or delayed for patients in pain. In confirming that the 35% pay demand is both unrealistic and unaffordable, will she call for junior doctors to return to their posts so that that money can be better spent on reducing waiting lists and improving patient outcomes?

[Victoria Atkins]

My hon. Friend puts it eloquently; there is a real human cost to these strike actions. It is why I did everything I could when we were in negotiations to try to find fair and reasonable settlements for junior doctors. I was very disappointed when they walked out, but we have to find solutions for the sake of our patients and of all 1.3 million people working in our NHS across England. There have been some brilliant examples of local trusts, local clinicians and other members of staff working really hard and pulling together to cover these damaging strikes, but all we ask of junior doctors is to come back to work, do their jobs and look after our patients.

International Health Regulations 2005

Philip Hollobone Excerpts

Monday 18th December 2023 Westminster Hall

[Andrew Stephenson]

My hon. Friend tempts me, but he will remember that we did not provide a running commentary on the Brexit negotiations. We do not provide a running commentary on our trade negotiations. We do not believe that is in the national interest. Indeed, it is very clear that no text in the latest draft of the accord, published in October and available on the WHO website, has been agreed yet. The whole text is still under negotiation. The draft is just a basis for negotiations, and it will evolve. There are areas of the new draft that we clearly reject and there are areas that we would like to make even stronger. This is an active negotiation between 193 member states to come up with revisions to the IHR that we all believe, by mutual consensus, will be in our global interest.

[Mr Philip Hollobone (Kettering) (Con)]

Would the Minister be kind enough to answer the question posed by my hon. Friend the Member for Devizes (Danny Kruger)? Who is actually negotiating on this country’s behalf, and which Minister has ultimate responsibility?

[Andrew Stephenson]

The negotiations are being led by civil servants across Whitehall. [Interruption.]

--- Later in debate ---

[Andrew Stephenson]

I reiterate: this is a member state-led process, with 193 member states negotiating. It will be a difficult negotiation, but all previous regulations have been agreed by consensus. If the text ends up in a position where the UK Government do not feel that we can sign up to it, the other member states may decide to proceed, but they will not be regulations that we are bound by, because we will not agree to them. This is an evolving situation and we have agreed a pathway for negotiations. As right hon. and hon. Members know, the text and the amendments are available online.

May I turn to some of the contributions? I will start with those paying tribute to my right hon. Friend the Member for Rayleigh and Wickford in paying tribute to his wife and other NHS staff, who did an incredible job during the pandemic. Sometimes, when debating technical issues such as this, we can overlook their incredible contribution, but it is right what my right hon. Friend said today. He also talked about the importance of data sharing globally, which I think we would all agree is vital.

My hon. Friend the Member for Devizes asked when the next iteration of the text will be available. No new texts or amendments have been agreed yet, so there is nothing further to be shared. However, we expect negotiations to continue until May 2024, when member states will agree completion at the World Health Assembly. I am actively exploring ways in which I can keep the House informed of further developments, although as I say, the standing position of the Government on such issues is that we do not do a running commentary on negotiations. I am actively looking at what more we can do to keep Members informed.

That leads me on to another question that my hon. Friend asked about the costs of these measures. Obviously, as we have not agreed the provisions of the treaty, we cannot yet estimate how much it might cost and whether we would publish our red lines. Unfortunately, as I say, I will decline to say more on red lines now; I have set out one clear red line today and we have a very clear red line on sovereignty. However, I do not believe that we should run through these negotiations in public; I believe that we should give our negotiators time to reach as much international consensus as possible.

[Mr Hollobone]

The Minister is being extremely generous in giving way. One of the lessons from the Brexit negotiations was that civil servants in the room negotiating were not always following the ministerial line, so may I encourage my right hon. Friend to go himself to the negotiations, repeat what he has told the House today, and make sure that the civil servants who are in the room when he leaves get the message that he has just delivered?

[Andrew Stephenson]

I will certainly bear in mind what my hon. Friend has said. Some of the civil servants involved in the negotiation have already heard clearly from me, the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield, and my hon. Friend the life sciences Minister about various red lines and other things that we are very clear about, so there is clear ministerial input. There will be a part in this process where Ministers can get involved, but I will certainly look into what my hon. Friend the Member for Kettering (Mr Hollobone) suggests and what more I can do to ensure that UK sovereignty is in no way compromised, so that I can continue to provide further reassurance to all those right hon. and hon. Members who have spoken today.

We all want—well, maybe not all of us, but I believe the Government want a strong World Health Organisation that is fit for purpose and able to respond rapidly to global health challenges and future threats. The UK is working with our international partners to shape the WHO in that way.

Our priorities for the amendments and for the accord are global in scope but they are also in pursuit of our national interest. It is in our national interest to prevent another pandemic. Should—God forbid—another pandemic should occur, it is in the national interest to co-operate with others to slow and stop its spread. In these negotiations, I can assure right hon. and hon. Members that I would never countenance acting contrary to our national interest. We will protect our country from future public health emergencies without ceding an inch of sovereignty.

Question put and agreed to.

Resolved,

That this House has considered e-petition 635904, relating to the International Health Regulations 2005.

World Stroke Day

Philip Hollobone Excerpts

Thursday 23rd November 2023 Westminster Hall

[Sir Robert Neill]

That is right and that is why I commend the Stroke Association for raising awareness and recognition of symptoms. It promotes the Act FAST campaign, which details the symptoms that should be looked out for: if someone shows facial weakness, arm weakness or speech problems, then it is time to call 999. That has been important in raising awareness. I thank the Stroke Association for the briefing it has provided, as well as others who have assisted in the preparation of my comments, including the Royal College of Radiologists and, from the private sector, Ipsen UK, a biopharmaceutical company that works in this field. I will refer to its research.

The essence of the matter is this: stroke is not often recognised, but even when it is, the quantity is not talked about enough. In the UK, stroke strikes every five minutes and more than 100,000 people have strokes every year. It is a leading cause of adult disability; two thirds of stroke survivors leave hospital with a disability. Sadly, it is also a leading cause of death in the UK. Leaving aside the human cost, there is also an economic cost. Too many survivors are unable to return to work. A conservative estimate of the cost to the economy is some £26 billion a year. Some would suggest that it is even more. Never mind the care costs and the burdens on unpaid carers, which some of us know all too well.

Stroke is preventable. In about 80% of cases, it can be treated by changing risk factors, checking for high blood pressure and atrial fibrillation, but we still lag behind other countries on stroke outcomes. The Stroke Association told me that, for every minute a stroke is left untreated, nearly 2 million brain cells die. The brain is both extraordinary and fragile, which is why fast treatment and swift responses are so important. That means getting somebody to a specialist stroke unit as soon as possible. In Anne-Louise’s case, we were lucky that that was not far away, but sadly there will always be disability thereafter. However, that can be reduced through investment in treatments, such as mechanical thrombectomy. If a patient gets mechanical thrombectomy swiftly, their level of impairment is greatly reduced.

Sadly, access to mechanical thrombectomy greatly varies across the country. In Greater London, where my constituency is, the percentage of patients given a thrombectomy in 2021—there may be updated figures, but this is the latest one the Stroke Association had—was 7.8%. In the east of England, it was 0.3%. In most other parts of the country, it hovers around 2%. Even if that has grown somewhat, it is still far less than we would wish to see. I welcome the Minister and am grateful to see him in his place, and I am sure that he is aware that investment across the piece would greatly improve people’s outcomes. That needs to be mainstreamed into investment plans, and we certainly seek to do that. I hope the Minister will commit to removing that postcode lottery in survival according to where a person is when they have the misfortune of having a stroke. If we do not do anything about this, the cost I referred to is predicted to increase to about £75 billion by 2035. We cannot afford for that to happen, either economically or in human terms.

We have talked about prevention and thrombectomies, which can be a game changer, but we do not have anything like the numbers accessing them that other countries do and the figures are not in line with the Government’s own targets. Perhaps the Minister could tell us what is being done to catch up and spread availability across the piece, because at the moment only about a third of the people who need that treatment receive it. That is simply not good enough for the two thirds that were unlucky enough to be in the wrong place at the wrong time. That is important, but there is also the issue of the workforce. I am indebted to the Royal College of Radiologists on this point. Early diagnosis, of course, can help through either thrombectomy or other interventions, but we have a shortfall in the number of clinical radiology consultants of some 30%. They are needed to do the imaging—the MRIs and all the other things—that could enable those other treatments to take place swiftly. Without further action, that shortfall of consultants in radiology is forecast to increase to 41% by 2027—2,890-odd posts. What is being done to address the shortfall in that specialism and, indeed, others?

Only 48% of hospital trusts can provide adequate 24/7 interventional radiology services, largely because of that workforce shortage. I am sure the Minister will once again agree that that is not satisfactory. The use of interventional radiology—image-guided surgical treatments, effectively—is critical in the modern treatment of strokes. When we look at the national health service’s workforce plan, what are the plans specifically to recruit the workforce—the skilled specialists we need to support those new procedures, which will save lives and improve lives for survivors?

As well as the key issues of intervention and treatment, the other issue I want to touch on is what happens thereafter, because the outcomes can vary greatly. Some people, as we all know, are fortunate enough to be out of hospital quite quickly, whereas others—my wife included—spend much longer there. What troubled me was when Anne-Louise eventually left the rehabilitation unit in Orpington, where she had excellent care, we were lucky enough to be able to continue care at a proper level, through our own resources as a family. There was a young woman in there, probably in her mid-40s, who was a single parent. She lived on her own and had no one to take care of her. She was there before Anne-Louise arrived in the unit; she was still there when Anne-Louise left. What happens to someone in that condition is a real worry to us.

I am sure the Minister will rightly observe that the percentage of patients discharged into community stroke services has risen from 53% to 61% in 2022-23, but the quality and consistency of the community service provision is very variable. There are real shortfalls in the number of specialists—again—so we have a workforce problem in the community as well when it comes to physiotherapists, speech and language therapists and neuropsychiatrists.

We sometimes forget that, as well as the very real physical impacts of stroke—which can be a lack of mobility or balance, a level of paralysis, speech impairment and post-stroke spasticity, as it is called, which I will come back to in a moment—there is very frequently a degree of mental ill health associated with such a life-changing event. Many stroke survivors suffer from varying degrees of depression, and the lack of neuropsychiatrists and psychologists to assist them is very stark.

We know that nearly half of stroke survivors experience some degree of post-stroke spasticity within six months of having a stroke, and some will be classed as severely disabled. We then find that some 80% of survivors may develop it at some point unless they get that proper and consistent treatment. At the moment, we do not deliver the recommended levels of community care in the therapies, of all kinds, that are recommended by the nationally accepted guidelines. What is being done to improve that?

At the moment, in the community setting, post-stroke patients experiencing post-stroke spasticity may have to wait four to seven months to be seen for a multi- disciplinary-team assessment. That is far too long. I have a constituent who has been waiting for nearly a year to be assessed to receive the multidisciplinary treatment that she needs. Accessing that support surely should not be done on such a fragile basis.

Ipsen has recently published a report, “Neuro- rehabilitation: State of the Nation”, which discusses this issue. It found that there is a lack of foundational awareness about spasticity and that it is not picked up often or soon enough. In fact, there are issues with the sporadic nature of treatment and a five to six months average waiting time for spasticity services. One in four NHS sites in England do not have access to specialist services for spasticity—there are only 0.26 consultants per 1,000 in prescribed specialist services in England and Wales compared with two to three in most European countries. Something like two in three stroke survivors do not receive a six-month review of their care, and that is one of the fundamental targets set out in the national guidelines. If two thirds are not receiving it, then clearly something is failing us badly.

We would like the Government to designate stroke as a major condition, and they also ought to consider post-stroke spasticity management as an integral part of the major conditions strategy. Perhaps the Minister will take that away and consider it. What can be done to level up the commissioning and provision of those rehabilitation services? What can be done to look at the high-level priority areas for stroke research that have been identified? These are important matters and we would hope that that could be done. There are other things that I hope the Minister will take a look at. Can we continue to improve availability at community level? Can we ensure that everybody receives the treatment set out in the National Institute for Health and Care Excellence guidelines? As I say, at the moment we are falling significantly short.

In conclusion, having set out those points—I could go on for much longer if we wanted—I hope that my speech highlights some of the real areas of concern. I also want to say a word about the voluntary groups; most of us in the field have become aware of the work of the very well-established Stroke Association, but we have a number of other groups, and in some cases entirely survivor-led groups give each other mutual self-support without any support from public funding.

I want to pay tribute to one group—frankly, the one that helps my wife and that she has received a great deal of assistance from being a member of. It is called Sidcup Speakability Group, and, as the name implies, it operates in our part of south-east London. It is the group’s 10th anniversary, so I just wanted to put on the record what it has done. It works entirely off its own back, and the level of conditions that people have varies greatly. But it proves that there is willingness. It is also worth remembering, as any senior consultant in the field will say, that there is sometimes a myth that a patient gets to a stage where they can never improve any more. Obviously, a patient has the best improvement earlier on. That is why early treatment and interventions are so important, and why the waiting times are so unacceptable. But even if the rate might be less, if people work continually, gains can still always be made incrementally. That is what the people at Speakability have found. To do that, we cannot expect the burden to fall simply upon friends and families. We need specialist treatment to be consistently available. That can turn people’s lives around. In our case, it may not be enough to turn it around in time, but it will be for others. That will be worth our while. The more people we can get back into work, as they wish, the more people can lead enriching lives, to a greater or lesser extent, as many stroke survivors do. There is light at the end of the tunnel, but we have to give them those fundamental services to start with.

I am very grateful to the Minister for paying great attention to the issue, and I hope he will take away those specific asks. Perhaps he could keep in touch with us, as a group, on how we could roll out services much more consistently and give people the level of treatment they deserve. I know a number of us in this room have been affected by stroke within our families, and I think we all want to work together—there is no party political issue in this—to have a proper strategy to sort it out.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 10 minutes past 3. I am obliged to call the Scottish National party spokesperson no later than 2.37 pm. The guideline limits are 10 minutes for the SNP; 10 minutes for His Majesty’s Opposition; 10 minutes for the Minister; and then Sir Bob Neill will have three minutes to sum up at the end of the debate. We have half an hour of Backbench time, and I have to decide which of two stellar Members I should call first. I will go on the principle of ladies first, but also because I understand that the hon. Member for York Central (Rachael Maskell) is vice-chair of the all-party parliamentary group on stroke, so is probably far more qualified to talk about these issues than the delightful hon. Member for Strangford (Jim Shannon).

--- Later in debate ---

[Rachael Maskell]

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

[Mr Philip Hollobone (in the Chair)]

No Westminster Hall debate would be complete without a contribution from Jim Shannon.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 17th October 2023 Commons Chamber

[Steve Barclay]

I discussed this with Henrietta Hughes, the patient safety champion, just yesterday as part of the sprint that we have commissioned in the Department in response to Martha’s rule. We are doing considerable work with NHSE colleagues on how we better respond to the concerns of patients, whether it is through the work on Martha’s rule or the complaints process, and a significant amount of work is ongoing as part of that.

[Mr Philip Hollobone (Kettering) (Con)]

T5. The Secretary of State has seen for himself the dilapidated steam generators at Kettering General Hospital. The new £34 million net zero energy plant designed to replace them faces challenges from rising costs and new design requirements. Will he ensure that the final business case approval process for this new power plant is completed as soon as possible, so that spades can hit the ground on time in spring 2024?

[Steve Barclay]

Yes I will. I pay tribute to my hon. Friend for the way he has championed this issue. I have visited the hospital; I have seen it for myself. As he will be aware, the full business case was received by the Department this morning. While the cost has increased, it is still within the wider funding envelope for the scheme on that site and I will do everything I can to expedite the process as he asks.

NHS Long-term Workforce Plan

Philip Hollobone Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

That repeats the previous question, so I will not repeat the answer. It is slightly ironic to call for a plan for a new hospital programme and for a long-term workforce plan, and then criticise us when we deliver on both of those, as we have done with more than £20 billion of investment in the new hospitals programme, which we announced last month, £2.4 billion in the first ever long-term workforce plan and the biggest ever expansion of workforce training in the history of the NHS. Of course we need to take action in the short term to deal with the consequences of the pandemic. That is what our recovery plan does. The urgent emergency care plan that I announced in January takes specific action on demand management in the community. There are measures upstream on boosting capacity in emergency departments and downstream on things such as virtual wards. A huge amount of work is going on. We are putting more than £1 billion into 5,000 more permanent beds to get more bed capacity into hospitals. On social care, in the autumn statement the Chancellor committed up to £7.5 billion of further investment over two years, and it was part of our reforms to better integrate health and social care.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the NHS long-term workforce plan and in particular its emphasis on training, retention and reform. At the moment, about a quarter of NHS staff are recruited from abroad. Can the Secretary of State confirm to the House and my constituents that this plan enables the development of a strong pool of homegrown talent, so that we can reduce foreign recruitment more towards 10%, which would be a lot more sustainable for the long-term future of the NHS?

[Steve Barclay]

My hon. Friend is absolutely right. As we boost our domestic workforce training, there will be scope to reduce the number recruited internationally. From 1948 onwards, international recruitment has always played an important role in the NHS, and we are hugely grateful for the service offered by those recruited internationally, but we also recognise that as demography changes in other countries, there will be increasing competition for healthcare workers around the world, so it is right that we boost our domestic supply. That is what this plan does, and it is why this is a historic moment for the NHS in making that long-term commitment that will in turn reduce the demand on the international workforce.

Lung Cancer Screening

Philip Hollobone Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

First, may I express regret about the hon. Gentleman’s own family experience of this condition? On the roll-out programme, we need to build that capacity and to do so in a sustainable way—that point has been raised by Members across the House. We are following the science in targeting those communities that are most deprived; they have the highest prevalence of smoking. Of course we will look at evidence of other risk factors, which colleagues across the House have highlighted, but it is important that we roll this programme out in a sustainable way. What is clear, however, is that it is making progress and it is welcome that so many communities want the programme to be rolled out to their area as soon as possible.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the Health Secretary’s announcement. If I heard him correctly, it means that up to 9,000 cases will be caught early, which is equivalent to about a quarter of the 35,000 who sadly die every year from lung cancer. How much will the national lung cancer screening programme cost? Why can it not be paid for in its entirety from the profits of the cigarette companies?

[Steve Barclay]

My hon. Friend, an experienced parliamentarian, opens two different issues there. As he well knows, one is a question of tax, which, rightly, I say as a former Treasury Minister, is a matter for the Treasury. As for the roll-out of the programme, the additional cost of the programme will be £1 billion over the seven years. That is the additional cost of that expansion, but how it is funded will be an issue for the Treasury.

Obesity and Fatty Liver Disease

Philip Hollobone Excerpts

Thursday 8th June 2023 Westminster Hall

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 3 o’clock, and I am obliged to call the Front Benchers no later than 2.28 pm. The guideline limits are 10 minutes for the SNP, 10 minutes for His Majesty’s Opposition, 10 minutes for the Minister and two minutes at the end for Mr David to sum up the debate. There are three highly distinguished Back-Bench Members seeking to speak in this debate. I hope you will allow each other enough time to get your contributions in. The first exemplar of that will be Maggie Throup.

[Maggie Throup (Erewash) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to participate in this extremely important debate. I congratulate the hon. Member for Caerphilly (Wayne David) on securing the debate, which is timely because it coincides with International NASH Day. International NASH Day aims to raise awareness of fatty liver disease and non-alcoholic steatohepatitis, which affects more than 115 million people globally. Up to one in five people in the UK have non-alcoholic fatty liver disease, and almost 12% of the population have NASH. I am sure it comes as no great surprise to anyone, as the clue is in the name, that one of the key causes of non-alcoholic fatty liver disease is obesity.

The need to tackle obesity as a priority was first identified by the Government in the early 1990s in the “Health of the Nation” White Paper. In the three decades since then, there have been policies such as the soft drinks industry levy, the pilot of the “Better Health: Rewards” scheme in Wolverhampton, restrictions on product placement and calories on menus, which have been introduced effectively with the aim of reducing obesity. I am particularly proud that many of those measures were introduced or reinforced during my time as public health Minister. However, despite those policies being implemented successfully, the obesity rate continues to increase, so more needs to be done.

A recent report by the Obesity Health Alliance argued that obesity is the new smoking. That comparison was reinforced yesterday by the announcement of £40 million to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients. That is an acceptance that obesity is a disease and should be treated with drugs, in the same way that lung disease is treated with drugs. Following that argument through, immense effort has gone into stopping smoking measures and reducing exposure to cigarettes, so immense effort should now be put into reducing everyone’s exposure to foods that are more likely to cause obesity—that is, ultra-processed foods. The delayed 9 pm watershed and action on two-for-one offers will do just that.

Research by the Obesity Health Alliance shows that 72% of people believe a 9 pm watershed on junk food adverts should be brought in during popular family TV shows. The measure has public support, so why hold back? When will the Minister’s Department introduce those important measures? Provisions are on the statute book, so let us just get on with it.

Statistics provided by the House of Commons Library highlight how obesity is steadily getting out of control in England. Since 1993, the proportion of adults in England who are overweight or obese has risen from 52.9% to 64.3%, and the proportion who are obese has risen from 14.9% to 28%. It is no surprise that the UK has the third highest obesity rate in Europe. Furthermore, the alarming rate of child obesity is of real concern. Data from the national child measurement programme outlines that in England, 10.1% of reception-aged children —aged four to five—were obese in 2021-22 and a further 12.1% were overweight. At ages 10 to 11—in year 6—23.4% were obese and 14.1% were overweight. Obesity prevalence is highest among the most deprived groups in society: children in deprived parts of the country are twice as likely to be obese than their peers in more affluent areas.

The health and economic impacts of obesity are devastating. Obesity is a force multiplier on fatty liver disease, cardiovascular disease, stroke, type 2 diabetes and cancer, and that, of course, puts ever-increasing pressure on the NHS. The combined cost of obesity to the Treasury—that is, to the NHS, the Department for Work and Pensions, and the economy as a whole—is projected to be £58 billion a year. I feel, however, that that could be a conservative projection, as there are many factors that have not been taken into consideration.

Those who are obese cost the NHS twice as much as those who are not. It has been estimated that those who are obese take four extra sick days a year, which equates to 37 million sick days across the UK working population. Those stats are clearly very concerning, and there needs to be a collective effort to tackle this widespread problem. If action is not taken now, we will embed ill health and low productivity into generations to come.

Non-alcoholic fatty liver disease is triggered by a build-up of fat in the liver, and as its name suggests, it is usually caused by obesity. Early-stage non-alcoholic fatty liver disease does not usually cause any harm. However, if left untreated, it can lead to serious liver damage, including cirrhosis. Some 90% of liver diseases are preventable, and in the UK, the most common causes of cirrhosis are excessive alcohol consumption, hepatitis and NAFLD.

What can we do to avert this public health crisis? As individuals, we can all take measures to help us to avert the risk of NAFLD—simple measures including eating a balanced and healthy diet, and in particular, not eating ultra-processed foods. Additionally, we can all increase our activity levels, as the hon. Member for Caerphilly indicated. It has been estimated that if those who are overweight or obese lost just 2.5 kg—5½ lb for people of my generation—that could save the NHS £105 million over the next 15 years. I am sure that most people would want to lose more than just 5½ lb, and doing so would save the NHS even more money—5½ lb, or 2.5 kg for the younger ones in the room, is not a lot.

We need to do more to promote early diagnosis and raise awareness of the different causes of liver disease. It would be remiss of me, as chair of the all-party parliamentary group for diagnostics, not to mention the possible impact of community diagnostic centres. Community diagnostic centres provide a quick and easy way to access checks, tests and scans, providing routes to early diagnosis. The recent announcement by the Department of Health and Social Care that fibroscan services will be made available in 100 community diagnostic centres is welcome. It could result in thousands of people being made aware of the poor condition of their liver, which could still be reversible.

Despite that positive news, I would like to see an expansion of liver testing in areas where obesity levels are higher and the risk of fatty liver disease is more extreme. Lives are saved when diseases are caught early. I am interested to hear the Minister’s comments regarding the expansion of fibroscan services to all CDCs. My own local integrated care system in Derbyshire is currently categorised as green, indicating that an effective pathway is in place for the early detection and management of liver disease. Will the Minister therefore look at emerging good practice throughout the country and emerging good practice pathways at the ICS level, with a view to establishing a national pathology pathway to accelerate early diagnosis? Government policy towards obesity over the last 30 years has mainly been focused on individual responsibility, rather than mandatory policy, but we can all see that that is not working.

Monday night’s BBC “Panorama” highlighted just how harmful ultra-processed foods are, and how they contribute massively to diet-related ill health. However, they are among the most profitable foods that companies can make. I know that this may sound unlikely, but there is a willingness among food manufacturers to reformulate; however, as the hon. Member for Caerphilly said, they want a level playing field. Sadly, no company is willing to step out of line and lead the way, yet if the consumption of ultra-processed foods continues at the current rate and the obesity rate continues to rise, our nation will be economically poorer and very unhealthy. To be bold, I believe this country is addicted to ultra-processed foods, similar to the way it was addicted to smoking in past decades. We tackled smoking addiction by intervention; it is now time to tackle ultra-processed food addiction by intervention too.

To conclude my remarks, this debate has undoubtedly helped to raise awareness of the problem of obesity and the detrimental impact it has on people’s health, including liver disease, as well as the economy and the NHS. Clearly, more needs to be done to tackle the health inequalities of obesity and improve early diagnosis of fatty liver disease. The Government need to be bold and brave for the sake of the individual, the NHS and the economy.

[Mr Philip Hollobone (in the Chair)]

I call Jim Shannon.