World ME Day

Jim Shannon Excerpts

Wednesday 1st May 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I certainly will do exactly that; I had planned a five-minute contribution.

I congratulate the right hon. Member for Bromsgrove (Sir Sajid Javid) on highlighting World ME Day. I listened to the right hon. Member for Hayes and Harlington (John McDonnell). When I was first introduced as an elected representative, as a Member of the Assembly at Stormont back in 1998, a person with ME came to me one day. I will be honest: I had no idea what it was. But I knew one thing, which was that that lady was ill. I am no wiser or smarter than anybody else, and I am not a doctor, but I can recognise pain. I can recognise a disability that hurts. It was making her life absolutely unworkable.

I helped her with her benefits; incidentally, we won on appeal. We won because if I could see what that lady was going through, the four people on the panel could see it, too. The right hon. Member for Hayes and Harlington referred to the appeals process. I always ask the person, “How many days a week are you ill?” and the person will tell you. Sometimes they are ill for a week, sometimes they are not ill and sometimes they are ill for three of the seven days. The point I am making is that they are ill, and it is a case of proving that.

The article by Hope 4 ME & Fibro Northern Ireland really summarises how the ME community feels:

“In recent times, the landscape of ME has undergone a transformation, with COVID-19 emerging as the most common trigger for this chronic illness. The intersection of these two health challenges has resulted in a significant increase in the number of people affected by ME. An estimated 55+ million individuals worldwide are living with the debilitating effects of this condition.”

It is an epidemic across the world.

“Amidst these escalating numbers, Hope 4 ME & Fibro Northern Ireland proudly stands alongside World ME Alliance members across the globe. We collectively amplify support for initiatives that seek to address the multifaceted impact of ME on individuals and communities alike.”

As an active Member of Parliament, a former Member of the Northern Ireland Assembly and former councillor—I think this is now my 39th year in elected service—I have seen the debilitating effects suffered by those with ME suffer. One of the harsh realities is that there is no cure. Individuals grappling with ME often endure both the physical toll of the illness and the stigmas that accompany it. It is imperative that we as a global community and in this House come together to address these gaps in understanding, treatment and research. That is where we in this place have a part to play. The right hon. Member for Bromsgrove set the scene well, as did others who have spoken; those who follow will tell it again.

I do not believe that we have done more than scratch the surface of fulfilling our obligation to those who are in inexplicable pain daily and who are made to feel as if it is somehow only in their head. It is not. I am not a doctor, but I can see pain; I can see agony; I can see trauma. I can see people who need help. If I can do that, everybody in this room could do the same, because that is what we do every day when we deal with people. They live feeling ashamed of an illness, when most other illnesses are accepted as being out of the victim’s hands. There is work to do in how our health and benefits Departments view ME—there is a big role for them to play—and subsequently treat those who suffer from ME and associated illnesses. Support should be offered not just to them, but also to the families—never forget the families. It is not just that one person suffering; the whole family suffers, because they can see the pain and the agony. Undoubtedly, the burden is often shared with the entire household, emotionally, physically and financially.

On World ME Day, we need to be aware that the people we may see for a brief moment may be fighting a battle with pain that we cannot fully understand. We cannot share that pain, but we can hopefully appreciate what they are saying. It is our job in this place to fight harder for them. For them, this debate is a continuation of that very battle they have fought. We fight today alongside them.

Preventable Sight Loss

Jim Shannon Excerpts

Tuesday 30th April 2024 Westminster Hall

[Margaret Greenwood]

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector”

and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

Glaucoma and Community Optometry

Jim Shannon Excerpts

Tuesday 30th April 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered glaucoma and community optometry.

First, a special thanks to the Backbench Business Committee for selecting the debate for this morning. I am my party’s health spokesperson—it is no secret—and am particularly interested in health issues. As such, I secured this debate off the back of a number of people who had contacted me. What I am particularly pushing for—I am sorry for the short notice; I put the request in the Minister’s hand only two minutes ago—is that we do something now so that we can save sight further down the line. If I were pushing for one thing only, that is the one thing I would wish to have.

Optometrists in my Strangford constituency—I will send them a copy of this debate in Hansard afterwards—asked me to secure this debate. A number of bodies here on the mainland asked me the same thing. That is my purpose, but the issue of sight and sight-loss problems affects every constituency equally throughout this great United Kingdom of Great Britain and Northern Ireland. Therefore, the approach to making the system more fit for purpose must also be UK-wide.

I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place. We are sparring partners, although when I say that I do not mean that we hurt each other—we fight things together. I am also especially pleased to see the Minister in his place. He has a deep interest in this subject, as well as a deep interest in Northern Ireland, which I much appreciate. He has told me about his times in Northern Ireland in the past month or so, and how much he loves going there. Indeed, every MP who visits Northern Ireland—including you, Dame Caroline—always comes back with the most wonderful memories of the occasion and of the people they meet. Just this morning, a Conservative Whip was telling me that he was in Hillsborough two weeks ago, and about how much he enjoyed it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I want to place on the record the fact that a month ago I made my first visit to Belfast. I had an incredible time meeting Members of the Assembly at Stormont, and going to Harland & Wolff, around Belfast and to an inclusive school. It is a remarkable place, and I just wanted to add, as the hon. Gentleman is putting on the record that everyone else has been to Northern Ireland, that so have I—although I know that is not the subject of our discussion, Dame Caroline.

--- Later in debate ---

[Jim Shannon]

Thank you for bringing me and us all back to focus, Dame Caroline. The reason why I said that is that the Minister has been to Northern Ireland and always has an interest in health issues, and I know that his journey was to Queen’s University to explore such issues. That is the connection. The fact it is a lovely place is just wonderful, but that is not the reason why we are here.

The approach to making the system more fit for purpose must be UK-wide. Whenever we ask for what we are going to ask for at the end of this debate, I know that the Minister and the shadow Minister will have similar ideas to mine. I understand that health is devolved in all the regions, but it is clear that we need joined-up thinking to a joint problem. That is what I wish to highlight this morning.

Visual impairment and sight loss cost the UK economy some £36 billion each year, yet we allow 22 people to lose their vision to preventable causes each week. That is the thrust behind what I am aiming for today: to stop 22 people losing their eyesight this week. We can work alongside the optometrists and the opticians, and have a partnership whereby people can have their eyesight tests done more often. I will give some examples. Maybe people do not think of having their eyesight tested regularly, but they should. Optometrists in my area have told me that they are happy to work with the NHS or the health and personal social services in Northern Ireland to make that happen.

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

I congratulate my hon. Friend on securing the debate. On the frequency of eye testing, does he agree that the issues we are discussing today are symptomatic of other parts of the health service? People ignore eye problems and get to the point where problems could have been solved had there been earlier detection and more frequent eye testing. Even if nothing else transpires from this debate, if we do a little to try to ensure that people have regular eye tests, we can prevent some of the problems we are discussing from getting worse.

[Jim Shannon]

I thank my hon. Friend for his intervention, and say to the Minister: that is the thrust of this debate. If nothing else comes from this debate but the answer was along those lines, I would be more than happy. That does not mean that I will sit down now, Dame Caroline— I want to give a wee bit more background and a couple of examples.

Visual impairment and sight loss cost the UK economy £36 billion. The loss of sight is the loss of independence and confidence, and for many it is the loss of their life as they know it. If it can be prevented, it must be, so it is about prevention, early diagnosis and checks. This morning my focus—excuse the pun—will mainly be on glaucoma, a group of eye diseases that damage the optic nerve, usually due to changes in pressure inside the eye, or ocular hypertension. Data from Specsavers revealed that there have been some 30,000 referrals for glaucoma in people aged 40 to 60 just in the last year. Many more have been missed, accounting for nearly a third—30%—of all glaucoma referrals.

Some years ago I spoke at an event in Cambridge. I was asked to come along as a health spokesperson to an eyesight and visual impairment event that took place at a university in Cambridge—not the University of Cambridge but one of the other ones. They were doing tests and I got my eyes tested for glaucoma. It was rudimentary, but the guy said, “I don’t want to worry you, but I think you need to go and have your eyes tested when you get home.” Whenever I got home I went to my optician right away. I could not understand it, because I had seen the optician a month before and was sure that my eyesight was okay, but the Cambridge guy had given me a wee graph that seemed to show that there were issues relating to glaucoma that needed to be addressed fairly quickly. Why is that important? Because my father had glaucoma, and they say it needs to be checked because it is hereditary and passes from generation to generation.

When I got home I went to see my optician right away and told her what was going on. I explained the circumstances and took her the graph. She said, “Look, Jim, I checked your eyes. I do not see anything wrong with them, but do you want them checked thoroughly?” I said, “Yes, definitely.” So she sent me to the eye clinic in Belfast’s cathedral quarter and I got my eyes checked. Everything is done there, 24/7—all the eye checks that are humanly possible. For ages after, my eyes were stinging. The guy came out after an hour and said to me, “I have done every possible check on your eyes. There is nothing wrong with them.” That was good news after a very thorough check. Since then, my optician has done a thorough check for glaucoma on my eyes, simply because it is hereditary and to ensure my peace of mind. I tell that story because it worked out well for me, but it does not work out well for everyone.

Typically, there are no symptoms to begin with, as glaucoma develops slowly, affecting the periphery of the vision at first. That means that hundreds of thousands of people in the UK currently have glaucoma. Betty in my office gets an annual eye test because her father had glaucoma and she was aware of the issue. When I asked my younger staff when they had last had their eyes tested they said, “Not since school. I don’t need glasses so why should I get an eye test?” I immediately asked them to book a test, and told them that it is like an MOT that needs to take place. The MOT tells us if our car runs okay and what repairs we need; it is the same when we get our eyes tested. The eyes may be known as the window to the soul, but they are also undoubtedly the window to the view of overall health that can be found in an eye test. Eye tests are imperative for finding an early diagnosis of diabetes, for example, and a host of other health concerns.

I remember two occasions when opticians saved the lives of gentlemen who came to see me in my office. One guy I know well came in and he was a terrible colour. I said, “Are you okay?” and he said, “To tell you the truth, I don’t feel at all well. I have been to the doctor who told me to see an optician, and I’m going there now.” I said, “I hope you’re okay.” He was as grey as a badger and it was really quite worrying to see him. He went straight from the optician, who referred him, just up the road to the Ulster Hospital. He had a tumour close to his eye and brain, which was removed in an urgent operation. The other person, who went to a different optician in Newtownards, had the same problem, was also referred to the hospital and also had a tumour removed.

Tests at the optician’s are incredibly important. They can diagnose not only glaucoma but many other things, so it is important to have them. Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them to manage their condition.

Alarmingly, a fifth of the population—some 21%—still do not know how often they should visit the optician for a routine check-up. The same percentage either cannot remember their last eye examination or have never had one. Opticians in my Strangford constituency, and particularly in Newtownards town, have told me they are anxious and keen to ensure that people have regular tests. It is about how to ensure that can happen. I hope the Minister will respond to requests, including from the shadow Minister, and is able to reassure us on how we can encourage a UK-wide method to help.

For those with glaucoma or suspected glaucoma who are referred to hospital, long NHS waiting lists, exacerbated by the pandemic, remain a problem. Alarming figures show that around 650,000 people are waiting for NHS ophthalmology appointments. Will the Minister indicate the steps that can be taken to reduce that number and help those 650,000 people to retain their eyesight? There are steps that we can and must take. I always try to be constructive; it is important to come with a positive attitude on how to do things better. We should be big enough to accept that changes need to be made, and then we can do it.

Although optometry services remained open for urgent care during the covid-19 pandemic, the number of sight tests dropped by 4.3 million in 2020—my goodness—which was a 23% decline compared with tests administered in 2019. In respect of that dramatic drop and the need for improvement, perhaps the Minister could suggest methodologies to address and target those who have fallen out of the system. The drop in the number of eye tests resulted in large reductions in referrals from primary care to hospitals. That is where the fall seems to be, and perhaps where it needs to be addressed. As a result, sight loss has increased hugely since the pandemic.

How can we increase referrals from primary care to hospitals? If we do that, we will have moved a long way. I will give some examples from Northern Ireland—not about how nice it is to visit, Dame Caroline, but about the issues of vision and health. In Northern Ireland there are two glaucoma referral and refinement pathways. By contrast to England, they are available at all community practices, as long as clinicians have the right accreditation in glaucoma care. It is fortunate that my GP service and many others have such access. Through the services, patients have their glaucoma tests completed in the community, and the results are then shared securely with the patient’s ophthalmologist. This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient. I always try to be constructive in my comments and give examples of what we do, because if we do something well, others need to know, and if the Minister does something well here on the mainland, we need to know about that in Northern Ireland as well.

There is also an ocular hypertension monitoring service in the community across Northern Ireland. The scheme allows optometrists to manage in the community patients who would previously have been seen by the hospital eye services. A significant number of patients—some 2,000 to date—have been discharged to the scheme. That is an example of how it is proactively engaging and working. It has helped to free up the capacity in secondary care to manage more complex cases.

Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity. What we have is an example of how things can be done—and perhaps spread across all of this great United Kingdom—in a better way. Those working alongside optometrists, who wish to ensure that people have their tests regularly, are keen to assist and to make changes. When the Minister speaks to the Association of Optometrists—as he probably already has—I believe he will find that he is pushing at an open door and that the ideas that he and the Department have are ones that optometrists have too.

Overall, Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective. The challenge in Northern Ireland is that these services sit outside the general ophthalmic services—GOS—contract, which means that they rely on non-recurrent funding and are not subject to a regular uplift in fees; indeed, fees have never been reviewed. Given the success of these services, the push in Northern Ireland is for their funding to be put on a more stable, recurring footing and to be subject to the same process for fee uplifts as GOS. I have another ask to put to the Minister, in a constructive fashion: will he see whether the fees in place can be reviewed and how best the system could be used to improve things?

I know that the shadow Minister will make an incredible speech. By the way, I am not giving him a big head; that is what he always does, because he understands these issues incredibly well and brings forward his own ideas and his party’s ideas to this process.

I want briefly to highlight the difficulties arising with cataract surgery. It is wonderful how cataract surgery can improve people’s eyesight. I am a type 2 diabetic, but some years ago, before I was a diabetic, I went to see about surgery, not for cataracts, but to improve short-sightedness. I did not have the surgery, because I was not entirely confident about it, and shortly after, I became a diabetic. I tell that story because a good friend of mine in Greyabbey—I will not mention his name—was a type 1 diabetic and went for some corrective surgery to his eyes. Unfortunately, he ended up losing his eyesight; that is not the fault of anyone, but the diabetes complicated the issue, and he is now registered blind. Again, there are complications in relation to eye surgery for those who are diabetic, just by the nature of what happens.

Cataract surgery is currently the most common NHS elective surgical procedure, accounting for the majority of the large ophthalmic backlog facing the NHS. My mother has had one of her cataracts removed; she has a second one to remove, but I suspect that, unfortunately, her state of health means that the second procedure will not be done. Between 10% and 15% of those with cataracts suffer from concomitant glaucoma, and I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together—the glaucoma and the cataract surgery.

I have been informed by a company named Clarity that there is an opportunity to treat patients for cataracts and glaucoma at the same time. It is obviously more cost-effective, and although I know we should not always dwell on the cost, we cannot ignore it. If there is a way of doing simpler, easier and cheaper surgery more effectively, let us look at that. I am ever mindful that the Minister has four competent members of staff behind him, who will clearly keep him right, so might they be able to do some research on that?

Treating cataracts and glaucoma together expedites patient backlog reduction and helps save people’s sight by preventing the further progression of glaucoma. The treatment is quite innovative, new and effective, and it is important that we should do it. Micro-scale injectable therapies produced by Glaukos can advance existing glaucoma standards of care and improve patient safety by removing the need for invasive secondary surgery and tackling ophthalmic backlogs. So many people wait for their cataract operations and for improvements to their glaucoma. If we catch things early, we can save the sight, and that is a critical factor. Again, can the Minister look at that and ascertain whether the approach I have just referred to could be a cost-effective way forward? I am sure he knows about it, but if he—and indeed the shadow Minister and others—does not, I would be happy to have a response later. The treatment seems to me to be a win-win, so will the Minister confirm whether the Government will initiate it urgently?

Local optometrist services form a vital part of the eye care patient pathway and of directing patients to vital sight-saving medical technologies. It is incredible to live in an age when 50% of all cancer patients can survive and people’s eyesight can be saved if it is checked and their problems with glaucoma are diagnosed. Are we not fortunate to live in this age? Although I am not the oldest person in the room—I suspect that my colleague on the left-hand side, my hon. Friend the Member for East Londonderry (Mr Campbell), might just be a tad ahead of me by a couple of years—I have seen the great advances we have made in medical technology. We are doing great things, and we could do more. Is it not incredible that all we really need is to check? It is not terribly costly, but if we check, we make the difference.

Optometrists are the ones who are properly trained in the pathway. We must ensure that pathways are clear and that funding is available to ensure that, instead of 22 people a week losing their sight in the United Kingdom of Great Britain and Northern Ireland, no one at all loses their sight and their independent life—something that could have been prevented. I know that the Minister shares my goal and that the shadow Minister definitely shares it, as does my hon. Friend the Member for East Londonderry. As a result of today’s debate, I hope we will have a progressive strategy going forward, and I am anxious to hear what the Minister and the shadow Minister have to say, so that we can feel that they understand the path towards achieving this goal and will focus on and direct it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I start by passing on the apologies of my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), who leads for the shadow health team on the issues we are focusing on today. She is otherwise detained on the Tobacco and Vapes Public Bill Committee, which is taking place at the same time.

I sincerely thank my hon. Friend the Member for Strangford (Jim Shannon)—I know that the custom in this place would be for me to call him “the hon. Gentleman”, because he is not of my party, but he is a friend—for securing this crucial debate and for the positive spirit he always brings to these proceedings. Glaucoma is a common yet serious condition that, if left untreated, can cause real damage. Anyone is at risk of developing glaucoma at any age, but it particularly affects people as they get older.

I declare a bit of an interest here: my grandmother had glaucoma. Because my mum died at the age of 50, they do not if the condition was hereditary, so every time I go to my opticians I have to have the glaucoma test in case it is hereditary. However, it is really important that people are tested routinely, because it is a serious condition that, if left untreated, can cause real damage.

Several factors increase an individual’s risk of glaucoma, including a family history of the condition; being of African, Caribbean or east Asian origin; and having long or short sight, diabetes or blood pressure problems. Glaucoma tends to develop gradually, and it is often entirely symptomless for a long period. As a result, many glaucoma patients are diagnosed only during routine eye tests. The impact of glaucoma can vary greatly, ranging from misty or blurry patches in vision to struggling to complete day-to-day tasks such as reading, and permanent sight loss.

When it comes to accessing basic care, many glaucoma patients face significant challenges. Across eye care, more than 600,000 patients are currently on waiting lists for treatment. Given the risk that glaucoma poses if left untreated, such extensive waiting lists are a serious threat to patient outcomes. Sadly, that statistic shows no sign of changing, and demand for ophthalmology services is set to increase by more than 40% in the next two decades. Given an estimated annual cost to the economy from sight loss of more than £25 billion, the case for action could not be clearer.

I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.

The next Labour Government are committed to reforming the system so that those with glaucoma and other eye health conditions can access care when and where it is needed. We will provide 2 million more operations and appointments on evenings and weekends, paid for by clamping down on tax dodgers, so that patients can be seen on time again. We will have a laser-like focus on prevention, tackling the social determinants of ill health and ensuring that eye conditions such as glaucoma are tackled at source. We will ensure that the NHS shifts from an analogue to a digital service, embracing the latest developments in technology and artificial intelligence to provide the best possible care and deliver the best possible patient outcomes.

Again, I declare an interest: being a bespectacled Member of Parliament, I obviously have routine eye tests. I am short-sighted, although age is catching up with me, and this is the first time that I have had varifocals for reading and for distance. However, my optometrist, Dr Shen of Boots opticians in Denton, has brought in and embraced some of the latest technological advances for testing different eye conditions. At my last eye test, I was amazed at the wizardry and machinery they have brought in, revolutionising the way they can diagnose.

[Jim Shannon]

The hon. Gentleman is speaking very powerfully and I endorse those comments. What I have seen with optometrists in Newtownards in my constituency of Strangford is the amount of money and investment that they have put in. They have not asked for any help from the NHS for those things. They are doing it themselves. I think there is a wonderful opportunity for a partnership with optometrists who are investing money—all they need is the people to come in for testing—and that, I believe, is a role for Government.

[Andrew Gwynne]

I could not agree more with the hon. Gentleman. Boots Opticians in Denton is a franchise, and the owner of that franchise has invested in this remarkable technology. I have now seen parts of my eyes that I never believed it would be possible to be able to see. It is incredible digital technology, and it allows opticians to diagnose eye stroke. That is particularly important for people with diabetes, glaucoma, high blood pressure and cardiovascular disease. The technology can also be used to diagnose diabetic retinopathy, in which people’s retinas are leaky, which can lead to temporary vision loss, and age-related macular degeneration. That detailed eye care allows other eye problems, which ordinarily would have gone unchecked, to be found and the appropriate treatments to be provided. I have seen how transformative the use of modern technology by my own optician can be for testing for a whole range of conditions and eye health.

That is why this debate is relevant and why changes across the system are clearly needed. That is most evident in community optometry. There is a real potential to utilise, as the hon. Member for Strangford has said, the existing capacity on our high streets and in our town centres—crucially, where people are—to get a firm grip on the crisis in eye care. That is why the next Labour Government have committed to seeking negotiations with high street opticians to strike a deal to deliver more NHS outpatient appointments. That partnership, which the hon Gentleman was rightly discussing, will underpin Labour’s eye care policy.

With 6,000 high street opticians serving communities across the country, we cannot afford to sit back and waste their incredible potential. We will work with high street opticians to beat the backlog and to get the system moving again. By utilising community capacity, we can free up specialists in the NHS to support those patients with the greatest need, providing greater accessibility, convenient care and, most importantly for all of us taxpayers, better value for money for the public purse.

This approach is backed up by evidence, proving the tangible impact of community-based eye care and eye health services. A 2014 study of the introduction of minor eye care services in Lewisham and Lambeth showed how significant that impact is. GP referrals to ophthalmology specialists in Lambeth decreased by 30%, with an even greater reduction—75%—in Lewisham. Costs in areas without minor eye care services increased, while there was a drop in costs in Lewisham and Lambeth of 14%.

Given that the sector is in clear need of reform, with patient outcomes continuing to suffer, will the Minister back Labour’s plan to unlock the potential of community optometry? With more than 550 patients suffering sight loss because of delays in the NHS since 2019, does the Minister accept that further inaction is simply not an option? These are people whose lives, and those of their loved ones, have been fundamentally changed through no fault of their own. We owe it to them to fix this system once and for all, working in partnership with the devolved Administrations across the United Kingdom, as the hon. Member for Strangford says, so that there is not a postcode lottery on these services, and we get the best outcomes for all British citizens across the United Kingdom. We owe it to them to ensure patients with glaucoma and other eye health conditions get the care they need, when they need it, and where they need it.

We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is always a pleasure to see you in the chair, Dame Caroline. Can I start by thanking the hon. Member for Strangford (Jim Shannon) for raising the importance of eye health to the wellbeing of people across our United Kingdom. No Westminster Hall debate is the same without him. I also thank the hon. Member for East Londonderry (Mr Campbell), and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their contributions.

Losing one’s eyesight can be devastating. I pay tribute to the charities that have done so much to help people living with glaucoma, or which are researching a cure: Glaucoma UK, the Glaucoma Foundation and the Royal National Institute for Blind People to name just a few. This morning, we are focusing on glaucoma and the role that can be played by community optometry. This afternoon, there will be a debate on the broader issue of preventable sight loss. I am responding to both debates on behalf of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is the Minister responsible for primary and secondary eye care services. She is otherwise engaged, as she is a member of the Tobacco and Vapes Bill Committee. I know she would want me to put it on the record and reassure Members throughout the House that that remains one of her top priorities.

As I am standing in today, I want to reassure Members that this is a subject close to my own heart. Glaucoma affected several people on my father’s side of the family—my great aunt, Emily Stephenson, lost her eyesight in her 60s because of glaucoma. I remember visiting her as a child and seeing the RNIB talking book cassette tapes, which she loved, and I am delighted that that service continues today in more formats and with more titles than ever before. My mother, too, lives with glaucoma, so I take this issue very seriously.

Up and down the country, community optometry plays an essential role in protecting people’s eye health. It also plays a key role in the early detection of glaucoma, as most glaucoma patients are identified through routine sight tests. Glaucoma cannot be felt—it does not cause any symptoms, and the eye pressure does not cause any pain. That is why regular sight tests are essential, so that problems such as glaucoma can be diagnosed and treated as early as possible.

As the hon. Member for Strangford suggested, everyone should have a sight test every two years. The NHS invests over £500 million every year in providing sight tests and optical vouchers. Between 2022 and 2023, we delivered over 12 million NHS sight tests free of charge. The tests are widely available for millions of people and the budget is entirely demand led, meaning that there is no cap on how many we will provide. We understand that some people may not prioritise sight tests compared with other healthcare, or they might not know that eye tests are recommended every two years. That is why we are always looking for opportunities to remind the public to have a test, through social media and other campaigns. Sight-test providers such as Specsavers and others on the high street display information about NHS sight-test eligibility.

We are committed to making greater use of community optometry to help to alleviate pressures in secondary care. Many integrated care boards are already commissioning a greater range of services on the high street, including minor and urgent eye care services, pre and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.

Glaucoma referral filtering schemes have delivered fantastic results, with additional tests that double-check whether a patient really needs to be referred to secondary care. These are tried-and-tested schemes that can save patients time and worry while freeing up space for those who most need specialist attention in hospital. Devon is a great example of that. An old Nightingale ward has been repurposed with equipment to screen large numbers of glaucoma and medical retina patients. The diagnostics hub has demolished the hospital’s backlog from just under 4,000 in April 2022 to just below 500 in October 2023—almost a 90% decrease. In Milton Keynes, 70% of suspected glaucoma patients were discharged following refinement of initial referrals made on the high street. About 50% of integrated care boards currently have a version of those schemes in place, and we are assessing the potential for encouraging the roll-out of those schemes even further.

It is vital that patients who need secondary care have access to timely diagnosis and any necessary clinical treatment. The hon. Member for Strangford is right to say that those services suffered during the pandemic, just as they have across the NHS. That is why we have set an ambitious target to recover services through the elective recovery plan, supported by more than £8 billion of dedicated funding, and it is why we have expanded surgical hubs and harnessed the capacity of the independent sector, so that more patients can be seen more quickly. That has been particularly successful for cataract surgery.

Our plan is working and it is delivering results, as waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further. As well as cutting waiting lists today, we are looking at how we can reform eye care services to meet the demands of tomorrow. NHS England’s transformation programme is running seven projects across each integrated care system area, such as those that test how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually, saving them time and freeing up more hospital capacity for patients who need specialist face-to-face care the most. NHS England is gathering data and evaluating different interventions, looking to develop a convincing case on what works best and supporting further expansion.

We are going further and faster to free up hospital capacity. Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Finally, on research, I want to recognise just how much potential there is for research and innovation to change the lives both of people who suffer from sight loss and of their families. The UK leads the world in research; we could not be more committed to pioneering new treatments and improving our understanding of sight loss. We put our money where our mouth is by awarding the Moorfields Biomedical Research Centre £20 million to carry out another five years of world-leading research in December 2022. Thirteen out of the 100 leaders and innovators in ophthalmology across the world who were included in The Ophthalmologist’s “Power List 2023” were researchers from Moorfields, and we should be proud that that centre of excellence is right here in London.

[Jim Shannon]

I thank the Minister for his very positive and helpful response. The shadow Minister referred to ophthalmology services increasing by 40% over the next 20 years—those figures might not be entirely accurate, but I think that is what he said. That certainly indicates to me that we need to have a progressive and active programme to ensure that people can get tests in partnership with opticians. The Minister mentioned ICBs and how that will be done; I say this respectfully, but can we have some meat on the bones as to how that would work? I am ever mindful that the Minister wants to see that, but we wish to see that as well.

[Andrew Stephenson]

NHS England is looking at a range of different interventions across the country. One of the benefits we have across England, and of course across the United Kingdom, is that we can try different things, such as models of delivery, in different parts of the United Kingdom and learn lessons from one another.

The current strategy pursued by the NHS is to look at different programmes across England and evaluate them to see what delivers the best outcomes for patients. That will help us to improve access for patients and deliver quality treatment. We hope that that evaluation will enable us to suggest best practice. It will still be up to ICBs to commission services—we believe they should be commissioned locally—but we hope that by providing an evidence base for them they can take decisions in the best interests of their local communities. To address the point made by the shadow Minister, that will address the growing demand for services. We recognise the fact that there will be more demand in the years to come. It will also help to address some of the backlogs with which we have struggled since the pandemic.

I hope I have said a few things to convince the hon. Member for Strangford that, while we still have much to learn from Northern Ireland, the Government take glaucoma extremely seriously. Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients.

We should be under no illusion about how many people watch Parliamentlive.tv. I think it was Stanley Baldwin who once said that the best way to keep a state secret was to announce it on the Floor of the House of Commons. Nevertheless, I wish to end with an appeal to anyone watching this debate at home: remember to take an eye test and please check the NHS website to see whether you are eligible for help. In preparing for today’s debate, I decided to do just that and I will be having my eyes tested tomorrow morning.

--- Later in debate ---

[Jim Shannon]

I thank the Minister. That appeal was a wonderful way to end this debate. I began the debate today by asking that we move towards measures to getting more people tested. The Minister has just done that. He has thrown out a challenge to everyone across this great United Kingdom of Great Britain and Northern Ireland, to do just that.

My hon. Friend the Member for East Londonderry (Mr Campbell) is well aware, as I am, of the merits of what we do in Northern Ireland, of the investment that optometrists are making personally and the need to work together. I am encouraged by the helpful contributions of the Minister, the shadow Minister and my hon. Friend.

The hon. Member for Denton and Reddish (Andrew Gwynne) referred to the fact that routine glaucoma testing can save eyesight. We all know that, and that is the purpose of the debate. We need more people to take the test—that is the purpose of the debate. The response from the Minister outlined a plan. I loved the term the hon. Member for Denton and Reddish used when he referred to turbocharging access to ophthalmology services. Wow! That is exactly what we need: a turbocharger. The Minister, in his response, turbocharged the challenge of eye tests and optometry.

The hon. Member for Denton and Reddish also referred to Labour’s commitment to making eye care a priority, which I welcome. I think that is where we are, and that that will follow hard on what the Minister and the Government are doing. The hon. Gentleman also referred to the 6,000 opticians on the high street with whom we can have a better partnership, and he stated that inaction was not an option—how true that is. He said that it was important to ensure there was not a postcode lottery, and he said that Labour would act.

The Minister always tries to be helpful, positive and proactive in his responses. That is what I like in any Minister, and it is what I particularly like about this Minister. It is helpful to have something to be encouraged by. The Minister has grasped the modus operandi of the debate, and why it is important, even though the subject is not in his portfolio. He referred to the need for people to have an eye test every two years, and said that the Government were working with high street opticians to ensure ICB involvement. He also said that the Government were pushing to increase the number of ICBs engaged with that. He said that the pandemic had created some problems, but also referred to an increase in cataract surgery. I think that is positive. Another positive that is sometimes forgotten, to which the Minister referred, is research. Well done, Minister and well done to the Government.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.

[Dame Caroline Dinenage (in the Chair)]

Thank you very much.

Question put and agreed to.

Resolved,

That this House has considered glaucoma and community optometry.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Andrew Stephenson]

The GMC and other professional regulators have a statutory duty to investigate any concerns about the fitness to practice of one of their registrants and to take appropriate action to protect the public when that is needed. The regulators are overseen by the Professional Standards Authority for Health and Social Care, which has the power to appeal cases where, in its view, a sanction imposed by a regulator is insufficient to protect the public.

[Jim Shannon (Strangford) (DUP)]

The GMC has seven principles of decision making and consent. How will the Minister ensure that GPs can fulfil their obligations when time constraints on appointments mean that they do not have time to listen to every complaint? People have to book a double appointment to talk about more than one issue. What further support can the Government give GPs to enable them to fulfil their GMC-ordered standards of care?

Hospice Funding

Jim Shannon Excerpts

Monday 22nd April 2024 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

We have a Marie Curie hospice in Belfast that gives excellent care to those who have cancer. Does the hon. Lady agree that, while it is important to have the financial part in place—without it, hospices cannot go on—the faith aspect is important as well? Many people need hospice care on their last journey, ever mindful that their last journey is not in this world; the next world is the one that matters. When it comes to ensuring that moneys are available, does she agree that faith is important as well, and that the faith care that the Marie Curie hospice gives in Belfast is an example of what we all need? Whatever our faith may be—Christianity or another religion—it is important to have something that looks after the hereafter.

[Sally-Ann Hart]

Faith is important for so many people. Even for those without a faith, there is a spiritual aspect that needs to be looked after.

My hon. Friend the Member for Darlington will cover the report in more detail. Hospices need to be able to plan and invest in their services and develop and train specialist staff, so they need to know in advance how much funding they are getting. Hospices already face issues of training and recruitment, and whether they will be able even to provide an adequate service because of funding restraints should not be another worry. My goddaughter is a young doctor who wants to specialise in palliative care, which is remarkable for a young person. We need more young people—more medics, nurses, occupational therapists and so on—in this growing area. A three-year funding cycle at least is required, as it would allow hospices and palliative care providers to plan accordingly.

I conclude my remarks with a worrying Hospice UK statistic: it estimates that the end of life care sector is on track for a £77 million collective deficit for the financial year 2023-24. That would present the worst end of year figures for the sector in around 20 years of tracking. Those losses are not sustainable, and our right to end of life care is at risk unless immediate action is taken. Our hospices, palliative care and end of life services need to be properly funded. Will the Minister outline what steps she is taking to ensure that that happens?

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for setting the scene so well, as well as all those who have made substantial contributions. Hon. and right hon. Members have been incredible in their joint efforts to support hospices across this great United Kingdom of Great Britain and Northern Ireland, and I want to add my bit from a Northern Ireland perspective.

There will be no Member in this House who has not had some form of contact with hospice care, either through our roles as Members of Parliament or in a more personal nature, as many of us have. I will tell the House a quick story about that. We cannot talk about hospice care without acknowledging the level of care that is provided by the world- class staff in hospices. Every one of us knows that, having dealt with those who give that care. Having seen the work that they carry out and the compassion with which they do so, I know that it is certainly a calling, because money could not pay enough to deal with the emotional toll of this work.

I knew a lady who worked as an occupational therapist in the national health service, and we got on quite well. She went on holiday to Greece one September, and she came back and went to the hospice. She was not feeling well, and the doctor told her that she had only four weeks to live—she had cancer of the liver. I remember going to see her at the Marie Curie hospice care headquarters on Knock Road, Belfast; it was my first introduction to hospice care. I said to the girl on the desk, “Would you tell Anne that I came to speak to her?” And the lady said, “Just a minute, and I’ll go and see if she wants to speak to you.” I said, “No, don’t worry about that, because it’s not important—just tell her I called.” I realised that day that Marie Curie hospice care is incredible, having seen what it did for Anne and her family.

As I said in my intervention on the hon. Member for Hastings and Rye, I believe that faith and family are important whenever our heart is breaking and our world is falling apart. The Marie Curie hospice in Belfast makes sure that people have faith to help them through those difficult times, which is important.

From offering light-hearted banter while helping people in embarrassing situations to being the scapegoat for anger or frustration, to being the last person to hold a person’s hand when their family do not make it in time, being a care giver in a hospice is more than a job. From the bottom of my heart, and from the bottom of all our hearts, I thank all those who do what most of us could not do—love and serve to people’s last breath, day in and day out. I thank every healthcare attendant, every nurse, every doctor, every porter and every pharmacist, and the entire team who provide the best end of life care and offer a support system to lost and grieving families.

[John McDonnell]

The shops that do the fundraising for our hospices have been mentioned, but an unmentioned group of heroes are the shop volunteers who provide a wonderful service in my constituency—a wonderful recycling service, as well—and funding for many of our hospices.

[Jim Shannon]

That is good to remember. I will mention the volunteers.

The hon. Member for Walsall North (Eddie Hughes) is no longer here, but he mentioned a sponsored walk and encouraged the right hon. Member for Hayes and Harlington (John McDonnell) to be involved. Like the right hon. Gentleman, I could not run a marathon, and I probably could not walk it, but he and I could probably dander it—that is the third category. We are danderers. I could do 26 miles, but it would be at my own pace. I am sure everyone else would be on their way home whenever he and I crossed the line—that is a story for another day.

We cannot pay hospice workers enough, but we have a responsibility to ensure that there is enough money to pay them. I do not feel we are currently doing enough, as other Members have said very clearly. The consensus is that we all want to see them paid better, and we want to see the care continue.

Northern Ireland Hospice provides specialist palliative care for more than 4,000 infants, children and adults in Northern Ireland with life-limiting conditions. The charity, which includes the only children’s hospice in Northern Ireland, says that it faces a number of challenges,

“not least of which is the ever-growing cost of this service. Government funds approximately 30% of service costs”.

The hon. Member for Darlington (Peter Gibson) spoke about Foyle hospice, which has to find 65% of its service costs. Well, every other hospice in Northern Ireland has to find 70%, relying on the

“goodwill and generosity of voluntary donations and other fundraising activities.”

[Peter Gibson]

One thing that has not yet been brought out in any of the speeches is the fact that a significant amount of the money that goes to our hospices through their fundraising and charitable fundraising comes in the form of legacy giving. That in itself, because of the size of estates and the value of properties, creates a postcode lottery. Is that part of the problem? Could we use this debate to highlight legacy giving to hospices?

[Jim Shannon]

I understand the issue that the hon. Gentleman highlights, and I will speak about donations.

The people of Northern Ireland are generous to a fault. Understanding Society data suggests that Londoners donate the most, with an annual average of £346 per donor. That is due to a handful of large donors, which I understand is the issue. People from Northern Ireland donate £344 a year to charities in all sectors, not just hospice care, and last week’s figures show that Northern Ireland donates more than anywhere else in the United Kingdom of Great Britain and Northern Ireland. Scotland, at £282 a year, and the south-east, at £270 a year, are the next highest donors. I am proud that we in Northern Ireland are givers, but this has allowed what is tantamount to an abdication of responsibility by those whose duty it is to see this care carried out.

We all support the Marie Curie coffee mornings. They are bun fests, which is not good for a diabetic. People make their donation and drink their tea or coffee. That is what it is about. It is not about what people get out of it; it is about what they give. To me, the Macmillan coffee mornings and Northern Ireland Hospice events should be about providing additional help, not providing the foundation of their funding. We and the Government must step up.

People do not have great disposable incomes, so the coffee mornings intended to raise money for a nurse raise less than half the amount needed to pay for a nurse’s pay increase. We can no longer rely on public generosity to make the difference, and I therefore believe that we must step up and see hospice care not as a charitable extra but as an integral part of the NHS. That is what it needs to be, otherwise we have failed.

I am ever mindful of the seven-minute time limit, Madam Deputy Speaker. If we cannot supply children’s hospice places with specialised staff, we are failing, and we cannot afford to accept failure. The Minister is a good lady, and she believes in hospices. I know she will respond positively, but I want to ascertain how we can do better for palliative care hospices, not in the next budget round but starting here and now. There is a consensus on wanting it to happen, and I believe the Minister and the Government should ensure that it does.

Tobacco and Vapes Bill

Jim Shannon Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Victoria Atkins]

To be clear, is my right hon. Friend suggesting that we repeal the Misuse of Drugs Act 1971, under which cannabis is prohibited? Although I have no experience of it, I understand that the consumption of marijuana also involves the consumption of tobacco and cigarette papers. The point is that we are trying to move away from the idea that current youngsters will be able to buy their cigarettes legally in shops from the age of 18 in 2027, precisely because we want to ensure that they can lead longer, healthier lives. In a moment I will come to some of the myths that the tobacco industry has put around about the impact of introducing age restrictions on cigarettes, which will be interesting evidence for those who are concerned about that.

[Jim Shannon (Strangford) (DUP)]

First of all, I commend the Secretary of State and the Government for bringing forward this legislation. I support it because I believe it is right, but I have been contacted by vaping groups. My right hon. Friend the Member for Belfast East (Gavin Robinson) and I met some last week. They sent me a small comment, and I want to ask the Secretary of State a quick question about it, so that we move forward with consistency to try to achieve something.

Those groups referred to the impact assessment report by the Department of Health and Social Care, and said that it fails to consider potentially detrimental effects of restricting vape users and smokers looking to switch. I think we all try to be helpful and constructive in our comments in this Chamber, so being constructive, they requested a vape retailer and distributor licensing scheme in the Bill. The industry has developed a comprehensive framework for such a scheme, which is designed to deal effectively once and for all with underage and illicit vape sales—a situation that could get worse. Does the Secretary of State intend to develop a vape retailer and distributor licensing scheme?

[Victoria Atkins]

I am extremely grateful for the hon. Gentleman’s support. We understand the level of lobbying that has been undertaken by both the vaping industry and the tobacco industry. We know that the vaping industry has pushed that as one of its lines. In the current vapes market, when walking into a local shop or a newsagent the vape products can be seen on sale next to the till, often next to the sweets—the part of the shop that children will be very attracted to, if my experiences are anything to go by. The industry markets them in very cynical ways. We are saying that it is already unlawful to sell vapes to under-18s, but we want to take the powers in this legislation to consult on flavours, design and so on, to ensure that vapes are sold as they are intended—to help adult smokers to quit, because no child should ever vape.

Health Services: Cross-border Co-operation

Jim Shannon Excerpts

Tuesday 16th April 2024 Westminster Hall

[Virginia Crosbie]

I thank my hon. Friend for his intervention, which gives me the opportunity to thank him for his hard work in fighting not only for his constituents, but for everyone across Wales. They deserve a better service than they are getting, and it is only by working together that we can get action, so I am delighted that he is here today. He is a doughty campaigner and a doughty champion for his constituency.

[Jim Shannon (Strangford) (DUP)]

The Northern Ireland-Republic of Ireland cross-border initiative was officially closed in December 2020 due to the withdrawal of EU funding. It was a scheme that many of my constituents bought into and did well out of, getting their operations down south before coming back to Northern Ireland, thereby skipping long waiting lists.

The hon. Lady is absolutely right to ask for better cross-border health co-operation between Wales and England, and I understand the reason that she does so, but I believe that there is an argument to be made for a scheme across the whole United Kingdom of Great Britain and Northern Ireland, because I think that there are cross-border opportunities that we can all take advantage of. Although she is asking specifically about Wales and England, the title of the debate, if she does not mind my saying so, is “Health Services: Cross-border Co-operation,” and that is something that we can all ask for.

[Virginia Crosbie]

I thank the hon. Member for his intervention, and in particular for that feedback on how cross-border co-operation actually works. Of course I am focusing on Wales, but he quite rightly highlights that this is the United Kingdom. By working together, we can solve these issues and provide a collaborative approach to healthcare for people across the UK.

I also wanted to add to my list of failures the near-collapse of local NHS dental services. I could honestly stand here and reel off story after story of lives drastically and sometimes irreversibly impacted by the failures of BCUHB. In Holyhead, the largest town in my constituency, two GP practices were merged during the pandemic into Hwb Iechyd Cybi, or Cybi Health Hub. That practice has suffered a series of problems, including twice facing the threat of having no GPs—and that is in Holyhead, the largest town in my constituency.

One of the main things that would make a difference to Hwb Iechyd Cybi and the people it serves would be to co-locate the two original practices. Proposals have been made for that and, in the longer term, for a state-of-the-art healthcare centre for Holyhead. The co-location project would deliver economies of scale that would vastly improve the service that the practices can deliver and, therefore, patient outcomes. The project was allegedly given the go-ahead two years ago, but it has stalled and stalled in BCUHB’s hands, and now it has completely stagnated. Likewise, the integrated health centre has been under discussion for years, but it remains under discussion, with no progress likely. Lack of funding is the problem that is generally cited.

Hwb Iechyd Cybi serves 9,000 patients, and there are around 15,000 people in its catchment area. Holyhead is not a minor backwater in north Wales; it is a large town, yet it has no integrated healthcare. It has an A&E that is 25 miles away across a bridge that closes in high winds, and it has a massive shortage of doctors. I have launched my own petition to raise awareness of this issue and to call on BCUHB to proceed with the co-location project, as well as starting work on the new health centre with urgency. I recognise that the NHS faces significant pressures across the UK, but people are actually moving out of my constituency to live in other parts of Britain because they are scared of becoming ill in north Wales.

There are too many stories of avoidable death and harm. Unfortunately, it is almost impossible to compare the situation across the devolved nations in order to see just how bad it really is, because the Welsh Government produce different data from that produced by the UK Government. That makes it almost impossible to compare patient outcomes across borders.

What we do know are facts like these. In 2023, over 22,000 paramedic hours were lost in Wales just waiting outside A&E. In January 2024, more than 3,000 people in north Wales waited for more than 12 hours to be discharged from A&E, and nearly 60,000 BCUHB patients had been waiting for more than 36 weeks to start treatment; six years earlier, that number was just under 10,000. Over 57,000 people across Wales have been waiting for more than a year to start treatment, with 24,000 patient pathways waiting more than two years. Since 2010-11, the Welsh Government have increased health spending by 30.6%, well short of the UK Government’s increase in England of 38.9%.

We have asked the UK Government for help on behalf of our constituents. Last year, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), wrote to the Welsh Government to offer a right of access to NHS services in England for people in Wales. Unfortunately, the Welsh Health Minister claims not to have the additional budget to facilitate that proposal, despite the clear benefits it could offer our constituents. The Welsh Government can, however, find an estimated £100 million to increase the number of Senedd Members from 60 to 96; £4.25 million to buy a farm that it now cannot develop; and over £30 million to implement the much-derided default 20 mph speed limit.

The Welsh Government approach is also highly inconsistent. Take the covid pandemic. The Welsh Government seemed to be unaware that they would have to provide their own response to the threat, despite having been in charge of healthcare in Wales for years. They prevaricated and created different measures and responses, but they want to be part of the UK covid inquiry rather than holding their own. They seem to think they can pick and choose when they are accountable. It would be fantastic to see the Welsh Government prioritising health as the UK Government are doing, for example by enabling pharmacies in England to prescribe medication for common conditions such as earache and impetigo. It is challenging to be a UK MP in Wales when a matter such as health is devolved. Many people do not realise that it is devolved and blame Westminster for failings.

Cass Review

Jim Shannon Excerpts

Monday 15th April 2024 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I do not want to say that the Secretary of State could ever be wrong, but on her last judgment I have to say that the show is never over until the hon. Member for Strangford (Jim Shannon) has spoken.

[Jim Shannon (Strangford) (DUP)]

You are most kind, Madam Deputy Speaker. I know that I have now caught the Secretary of State’s eye.

May I thank the Secretary of State for her fortitude and determination, and Dr Cass for all her endeavours? Both ladies—honourable ladies, I believe—have been incredibly impressive and capable. We should be taking on board Dr Cass’s report in Northern Ireland. Indeed, I will make it my business to ensure that the Minister in Northern Ireland takes this in, so I shall be sending him a copy of the report. What help and support is available for all those patients who have been in the Tavistock since its inception? Importantly, what steps can be taken by the Government to stop this malpractice and to stop the movement of the vulnerable—some have called this tantamount to abuse—into privately funded abuse? How quickly can that protection be put in place?

[Victoria Atkins]

Let me offer the hon. Gentleman my sincere apologies; I am out of practice and should have known that his would be the last question.

I genuinely look forward to working with my Northern Irish counterparts on this, as we have already worked together on other matters. The hon. Gentleman makes a point about private practices. That is one area that I am working on at pace. What we do not want is to have any idea forming that somehow people can get round the strict rules that the NHS is setting the system to get these drugs to young people and children. I promise to come back and update the House when I have more news on that, but the hon. Gentleman is right to identify that issue. It shows the complexity of the matter and the real need for a very clear, detailed and principled approach to help reform our NHS so that we make it faster, simpler and fairer.

Defibrillators

Jim Shannon Excerpts

Wednesday 20th March 2024 Westminster Hall

[Jonathan Gullis]

I could not agree more with my right hon. Friend about the need, which I will come to later, to ensure that devices are registered. Having visited AEDdonate myself, I can say that it is made up of fantastic custodians working incredibly hard, not just in rural Staffordshire and Stoke-on-Trent but across the country, to make sure there is access. I know that my right hon. Friend is a doughty champion for its cause, as well as for the community he serves in ensuring access to these lifesaving devices.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Stoke-on-Trent North (Jonathan Gullis) for bringing this subject forward. Many in the House, and others, will be aware that I brought the Automated External Defibrillators (Public Access) Bill to the House in 2020. The Government at the time accepted the necessity of having defibrillators in schools, and that was a fantastic milestone in this campaign, which the hon. Gentleman has taken further. Does he agree that it is one thing to have defibrillators installed, but that more must be done to educate people in schools, such as teachers, and teachers’ associations, to use defibrillators properly and make the most out of them, thereby saving more lives?

[Jonathan Gullis]

I thank my hon. Friend for that intervention. He is a great champion for the people of Strangford and it was an honour to visit his local community with him and see the fantastic work that he is doing there. That Bill still has my full support. I will come to the importance of improving education, so that it is not just a one-off. It needs to be repeated year in and year out, so that children in particular are immune to seeing what will be a distressing scene but, most importantly, have the muscle memory and are able to put that lifesaving support into action. The Minister himself is regularly saving lives, not just in his constituency but across his wider region, with the work that he does, so I am sure that he will understand the importance of persistent and regular education and training.

In September last year, I was pleased to see the Department introduce the community automated external defibrillator fund. This £1 million investment will help to increase access to these lifesaving devices and put an extra 2,000 defibrillators on the streets. That is an important step forward by the Department, but I urge the Minister to do far more to address the clear imbalances that I outlined.

The APPG on defibrillators and I have concluded that there is no co-ordinated national strategy to ensure that defibrillators are placed in areas with the highest need. With previous research illustrating that cardiac arrest is more likely in deprived areas, the Government must ensure that those areas have better or at least equal access to lifesaving equipment to more affluent areas. At this moment in time, that is simply not the case.

With over 30,000 out-of-hospital cardiac arrests in the UK each year and a survival rate of just one in 10, it is crucial that bystanders and emergency responders can locate and access the closest defibrillator immediately. The British Heart Foundation, NHS England, St John Ambulance and Resuscitation Council UK provide the NHS with vital information about the location of defibrillators. The Circuit is a nationwide, data-led map of defibrillators in the United Kingdom. Currently, over 86,000 have been registered, but it is estimated that tens of thousands are still unaccounted for.

Health and Wellbeing Services: Essex

Jim Shannon Excerpts

Tuesday 12th March 2024 Westminster Hall

[Priti Patel (Witham) (Con)]

I beg to move,

That this House has considered health and wellbeing services in Essex.

I am grateful that you are chairing the debate, Mr Henderson, and pleased to see that my right hon. Friend the Member for Pendle (Andrew Stephenson) is the Minister responding. He has been very good on many issues that I have taken to him thus far. I will cover a wide and diverse range of health-related issues affecting my constituents and people across Essex. I appreciate that some of those issues fall outside of the Minister’s portfolio, but I know he will take them on board and will feed back to colleagues. He is an excellent Minister, and I know he will respond in a helpful way. I am particularly pleased to welcome to the debate colleagues from neighbouring constituencies, my right hon. Friend the Member for Maldon (Sir John Whittingdale) and my hon. Friend the Member for Colchester (Will Quince), because we care about the provision and quality of health and wellbeing services. It is important to our constituents, and it is important that our constituents know we will work together as neighbouring MPs on some of the issues.

As the Minister and colleagues will be aware, just over a year ago, in March 2023, we were in this very Chamber having a similar debate with a similar title—I think we stretched it to the east of England last time round—and this debate follows on from that one. Everyone here will know that Essex is an amazing county. Our residents, businesses and communities are hard-working, resilient, entrepreneurial, ambitious and aspirational. They obviously back all the Conservative values around lower taxes, being a county of entrepreneurs and the engine of economic growth. We are net contributors to the Exchequer. I never tire of saying that because, as net contributors, we in Essex do not always get our pound of flesh back from the Exchequer when it comes to investment in our public services. It is fair to say that our constituents expect that from the Exchequer, particularly the fact that we should be supported when it comes to our public services, including the NHS, but also wider health and wellbeing services that do not always require medical interventions or diagnostics.

Parts of our county—mid-Essex in particular—have experienced considerable population growth and demographic changes, and that covers the constituencies of Colchester and Maldon. For clarification, we share district boundaries, so our council boundaries are intertwined—we are effectively three integrated MPs, I think it is fair to say, on many of the issues that we stand up and speak for. Those living within Essex County Council’s boundary totalled more than 1.5 million at the 2021 census, up by more than 100,000 people on the 2011 census, which is more than 7% and above England’s average of 6.6% at the time. That includes areas such as Southend and Thurrock. When we include those areas, our county population totals just under two million, at 1.9 million. We are one of the fastest-growing counties in the country, and growth in the city of Colchester, which covers parts of my constituency, continues to grow. With that, demand on public services continues to grow. We see from the census that we have over 300,000 people aged 65 or over, which is 21% of our population. That is higher than the average in England of 18.6% and, by 2035, that number will grow by up to 27%, so just under 400,000 people in Essex. The number of those over 85 will rise by 60%, so we can see that the numbers are growing. We are an ageing not just county but country and, that impacts on the working-age population of 18 to 65-year-olds which, by contrast, is set to rise by only 4%.

We can see the counter-cyclical issues resulting from the fact that a greater part of our population will be elderly. Interestingly enough, with that ageing population we are seeing increasing numbers of young families coming to Essex, which will mean more house building. Our schools are rated good and outstanding, and we are commutable territory, so our towns are thriving and growing.

As I said in the debate last year, there are pressures on social care which have had a very significant impact on the integrated care systems that have been introduced, with further integration taking place. In particular, those pressures have had an impact on spending at the county, district and city council level. We have a number of integrated care boards that cover Essex: NHS Hertfordshire and West Essex; NHS Mid and South Essex, which predominantly covers mid-Essex; and NHS Suffolk and North East Essex, covering Colchester and Tendring.

We also have a number of hospitals, the biggest being Broomfield Hospital, Colchester Hospital, the Princess Alexandra Hospital, Basildon University Hospital and Southend University Hospital. Our emergency services are provided by the East of England Ambulance Service NHS Trust, and the South Essex Partnership NHS Foundation Trust provides mental health services. I am shortly going to discuss those areas, and those trusts in particular.

As hon. Members have heard, we have a range of trusts, hospitals and challenges in Essex. When I was first elected we had the old-fashioned primary care trusts and strategic health authorities. Those were deeply unpopular, hugely problematic and bureaucratic and massively resource-intensive, and the changes in structures we have seen now provide greater integration. What really matters to all my constituents and residents across Essex is not so much the configuration and structure of services, but how those services work together effectively to deliver what those people and their families need: primary care, appointments and access to health services.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady on the debate. It is clearly about health services in Essex, and is therefore not to do with Strangford. However, to add my support to what the right hon. Lady is saying, I note that the problems in Essex she has outlined are replicated across my constituency as well. They include the closure of the local minor injuries unit, which is integral to the local community. That means that constituents have to travel further to get their healthcare—the very thing that the right hon. Lady is referring to. Does she agree that health bodies must focus more on community health and wellbeing to ensure that all constituents have the local access they deserve to efficient health and care services? Again, I commend the right hon. Lady on introducing the debate.