Oral Health Services

Jim Shannon Excerpts

Wednesday 17th October 2012 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I am pleased to have this opportunity to raise the question of oral health in the UK. Oral health is given far too little attention, in terms of what practitioners can bring to improving a population’s general health, as well as how it can be used to prevent the development of disease. Rather like opticians, our dentists are undervalued, in terms of what they can bring to the table to help to improve our nation’s health. Perhaps it is because dentists are not the most popular group in society—although I suspect that they are outdone by politicians. Why is going to the dentist not seen as a pleasurable experience? I will leave that to others to judge, but although going to the dentist may not be pleasurable, it is absolutely essential, and good practice starts right at the beginning, with the emergence of milk teeth.

Here in the UK we can be proud of many of our successes in achieving a good quality of oral health. The UK is one of the top-performing countries for oral health in Europe, but there is still much we can do. In fact, a recent joint report by Wrigley and GlaxoSmithKline suggests that Britons love their teeth and take very good care of them compared with our European neighbours. More Britons have more of their natural teeth than people in any other European country, and since the 1980s Britain has cut its decayed, missing and filled teeth score by two thirds. That is an impressive step, but there is certainly still room for improvement—I should explain, Mr Speaker, that Wrigley is based in my constituency.

I recently attended the launch of the report and listened with great interest to Professor Ken Eaton talking in detail about the work that has been going on across Europe looking at patterns of dental health. Other speakers included Dr Nigel Carter from the British Dental Health Foundation and Juliette Reeves, a dental hygienist and nutritionist with over 30 years’ experience. All the speakers set out clearly the importance of dental checks in the early identification of a number of diseases, particularly cancers, which we know are growing in prevalence, mouth cancers in particular. There has been a 48% increase in mouth cancers in the last 12 years. Early identification can make all the difference, in terms of the treatment required and the survivability of the patient. Dental health problems can also be indicative of other diseases, such as diabetes. All those issues are easily picked up during a dental health check. One of the good things in the new contract for NHS dentistry is that it recognises the importance of prevention. This will be challenging for some in the profession to implement, as they will have to change the way in which they work, but most dentists will learn to accept that prevention should be a priority.

The report’s evidence showed that although a majority of us in the UK keep to the suggested practice of brushing twice a day, only half of us brush for two minutes or longer—the rest of us just whizz around and hope that is sufficient—and that almost two thirds of us eat or drink between brushing and going to bed at night. There is clearly space to improve our personal oral hygiene practices, and there is scope for policy and campaigns to achieve that.

Personal oral hygiene is essential. Dental disease is completely preventable, and so, therefore, are those occasionally uncomfortable visits to the dentist when invasive treatment is necessary. These diseases constitute a significant public health problem across the UK and Europe. I cannot stress strongly enough that prevention is the key, and it needs to be encouraged. Many will say that the treatment is expensive. Yes, it can be, but when set against the money saved by regular dental checks reducing the likelihood of more complex treatment, the expense looks like good value for families. The prevention of debilitating diseases will certainly reduce the social and economic costs for the country and the individual.

Curative dental care is a significant economic burden across Europe, with spending close to €9 billion. In the UK, the cost is substantial. An estimated 0.5% of gross domestic product was spent on oral health care services in 2010, and that figure is rising. Expenditure on treatment for oral diseases often exceeds that for other diseases, including cancer, heart disease, stroke and dementia, yet the simple fact is that the causes of most oral diseases in the UK are preventable through cost-effective measures that would ultimately save the taxpayer money. Brushing, flossing, using mouthwash and chewing sugar-free gum—a much-maligned practice that is actually quite effective—could all be more effectively promoted to help to keep dental costs down in Britain, and the sharing of good practice should be encouraged.

Policy needs to be designed and implemented to improve research into oral health promtion. There is currently a lack of comparable data across Europe, although the report goes some considerable way towards addressing that problem. To tackle the burden of oral disease we also need to consider taking action in various ways, some of which have been suggested in the report on the state of oral health in Europe, which I hope the Minister has had an opportunity to read. The report suggests the need to address increasing oral health inequalities, improve the data and knowledge base and support the development of the dental work force.

We should be proud that Britain is a high achiever when it comes to oral health in Europe, but there is certainly room for improvement. Despite our successes, oral diseases remain a burden for much of the population, and the economic impacts are significant. There needs to be a greater focus on prevention rather than treatment, and improvements in education and awareness are also needed.

I am proud that we have the Peninsula dental school in Plymouth. I was asked by my local media why I had chosen oral health as the subject for this debate when so many other issues could have been raised. That was a good question. Having the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), here to respond is of course a good reason. There is also the small question of the ballot for Adjournment debates. MPs often put in for a number of debates over the Session, and we cannot tell which one will be lucky enough to come out of the ballot. I was lucky on this occasion.

Also, one of the first major campaigns that I was involved with when I was first elected to Parliament was to get a dental school sited in Plymouth. I remember fighting tooth and nail—the pun is intended—for that, alongside my former colleague, Linda Gilroy, and experts such as Sir John Tooke. It was during that campaign that I began to understand just how important good dental health is, and how essential it is that we train our dentists and technicians to the highest standards. My subsequent involvement in the all-party parliamentary group on dentistry, which is chaired so well by the hon. Member for Mole Valley (Sir Paul Beresford), has maintained my interest in the subject.

The groundbreaking training offered by Peninsula in Plymouth closely links the trainee dentists and technicians to local communities that have historically had very low levels of contact with dentists, and it is making a difference. This was one of the strong points of the case we made for a dental school in Plymouth.

We have an excellent community development team at the dental school who ensure that the training includes opportunities to go out into these communities, taking dentistry to “places it has never gone before”. Some of the projects included highlighting the impact of high-sugar drinks for professional rugby players at Plymouth Albion; making mouth guards for them; offering oral health advice to local schools; and letting children enjoy and play in a clinical environment to make it less scary. The dental school also works alongside experts to support people with drug and alcohol abuse issues, and is certainly doing some excellent work around oral cancer and smoking cessation with young adults and teenagers.

There continues to be concern about access to dentists in some parts of the country. In Plymouth, we have good months and bad months. Since the start of 2012, however, improvements have been made, with an additional 6,500 NHS places coming on stream in our city. This is possible in part because the graduate dentists from the dental school are staying in the area—yet another reason why we so wanted a dental school in Plymouth. I was pleased that the then Labour Government recognised the importance of dental training—unlike the last Tory Government, who closed dental schools.

There continues to be an issue about the cost of dental care and treatment for many families, particularly in the recession. That cost is still not easily met by some families.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way and for bringing this matter to the House for discussion. Oral health is a big issue right across the whole of the United Kingdom. In Northern Ireland, some plans have been mooted to introduce fluoridation in the water. That has been resisted by the Northern Ireland Assembly and resisted by the population of Northern Ireland. A new consultation process has started, but it will again be resisted. Does the hon. Lady feel that the best way of addressing tooth decay is, as she has already indicated, by regular brushing and diet, and not by fluoridation of the water?

[Alison Seabeck]

I know that the hon. Gentleman feels strongly about this issue. I feel equally strongly about it, but I disagree wholeheartedly with him, not least because a lot of toothpaste has fluoride in it in any case. Neither of my daughters, now 30 and 26—they will probably kill me for revealing their ages—has any fillings, and they have lived in an area with full fluoridation. They have had no side-effects at all either.

[Jim Shannon]

The hon. Lady is generous in allowing me to intervene again. There are statistics and information showing that fluoridation of water leads to osteoporosis and other diseases. Is it not important to be careful before pursuing a policy that could affect people’s health negatively rather than help them?

[Alison Seabeck]

I understand the hon. Gentleman’s concerns, and I am sure the population in his area will continue to have that debate, but I am convinced by the data and information that I have seen that, on balance, fluoridation of the water is a good thing. I was intending to touch on it later, but I shall now skip around it.

I will come back to the issue of families and the cost of dental care. Brushing teeth from an early age is certainly something we should all be doing; it has no significant cost and has positive outcomes. Dental treatment can be expensive, so a dental contract that focuses on prevention, works with people identified as having a higher risk of dental decay and takes a more risk-based approach—patient by patient—could lead to some families spending less on their visits to the dentist each year. That would obviously be a good thing for those families. Those people who have no visible issues of tooth decay—an increasing number in the UK, thanks in part to fluoridation—do not need a service focused on drill and fill. They need a system that rewards dentists for the preventive work they do, which should lead overall to less expensive treatments.

The wider use of expert dental hygienists to monitor and advise patients as well as to carry out treatments could have a significant benefit, although there will be some dental practices—these issues have been raised—that are not currently suitable and do not have enough space to accommodate the additional clinics. Some of the proposed changes could be problematic for them. I would welcome an update from the Minister about whether he is picking up concerns from some of the pilots as to whether or not this is an issue. The result of the contract pilots will be crucial when it comes to deciding whether the patient, as well as the dentist, benefits from the change in emphasis. The wider health benefits of preventive work will also save the NHS money, if other health problems are caught early. Preventive work can save lives, which is obviously hugely important.

I urge the Minister to consider whether, as well as the pilot schemes, further public information campaigns are needed to make the general public aware of the growing number of oral cancers that are linked to smoking and alcohol consumption—particularly among young women—and the importance of brushing babies’ first teeth. It should be emphasised that dental care can be preventive, rather than something that we all have to suffer when we have toothache.

I know that companies such as Wrigley run their own campaigns linked to their products and support wider campaigns such as Keeping Britain Smiling, but, given the massive cost to the NHS of poor dental health and linked ill health, the Government also have a role to play. I hope that the Minister will not only take on board the concerns raised by me and by others, but will tell me about the steps that are currently being taken, and about those that may be planned. I invite him to come down to Plymouth, visit the dental school and look at some of the outreach work that it is doing in deprived communities, because I think that there are some very good lessons to be learnt.

We should all speak to and lobby our health commissioners to ensure that those who are involved in the new health commissioning system understand what dentists can contribute to an overall reduction in poor health and the early identification of health problems. I hope that the Minister will note that plea.

Rickets

Jim Shannon Excerpts

Tuesday 4th September 2012 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

I am very pleased to have been given the opportunity of and time for this debate and to introduce it with you in the Chair, Mr Hollobone. I start by acknowledging two Manchester GPs, Dr Hans-Christian Raabe and Dr Avril Danczak, who came to see me some months ago to draw my attention to the shocking rise in the incidence of rickets in this country over the past 15 years. A written answer that I received on 9 November 2011 contained figures showing that the number of reported cases of rickets had risen from 183 in 1995-96 to 762 in 2010-11. Earlier this year, it was reported that the chief medical officers of the UK had contacted health professionals to highlight the need for vitamin D supplements for at-risk groups. Therefore, the issue is clearly one of concern. I welcome the steps that the Government have taken so far to deal with it, but more needs to be done.

Rickets is a disease that affects the growing of bone in children and is associated with moderate vitamin D insufficiency. It is mainly characterised by deformed bones, bone pain, convulsions and delayed development, particularly in relation to height rather than weight. Current Government guidance is that most people can get all the vitamin D that they need by eating a healthy balanced diet and getting some sun. However, it is not at all clear that that advice is adequate. The national diet and nutrition survey found that 90% of people in the UK do not get enough vitamin D from their diets, and there is widespread confusion in the public mind about what constitutes an appropriate amount of exposure to sunshine.

Certain groups have particularly high levels of vitamin D deficiency. They include pregnant and breastfeeding women and their babies, young children, elderly people, those who are not exposed to much sun—perhaps because they cannot get out of the house or because they cover up their skin for cultural reasons—and people with darker skin pigmentations, such as those of African, African-Caribbean or Asian origin. Levels of air pollution may also have an impact on sunshine exposure levels, and there is certainly a gradient of rising incidence of vitamin D deficiency as we move north across the UK, so it is clearly a concern in the north-west region, where my constituency is located. When one member of a family has a vitamin D deficiency, it is also likely to be replicated among siblings and children.

It is therefore clear that steps need to be taken to deal with vitamin D deficiency in quite large sections of the population. I am pleased that the Scientific Advisory Committee on Nutrition is examining the issue, but it is not due to report until 2014, and it is likely that any recommendations made by the committee could take time to implement in any event. However, there are things that can and should be done now, not least in terms of informing and educating the public and health professionals.

A recent study by the clinical effectiveness unit at Stockport NHS Foundation Trust highlighted a quite surprising lack of awareness among health professionals about vitamin D. That study, across eight acute and six primary care trusts in the north-west, found quite poor knowledge among midwives and health visitors surveyed. Only 24% of health visitors and just 11% of midwives reported having had training in vitamin D supplementation. As a result, they felt less confident in discussing vitamin D with pregnant women and mothers, vitamin D was poorly promoted at the booking of appointments and 90% of the women were not provided with information about vitamin D. However, the study found that where trusts had good policies or expert personnel in place, staff reported greater confidence in discussing vitamin D and more women received verbal and written advice.

Last year, my hon. Friend the Member for Bolton South East (Yasmin Qureshi) hosted an event in Parliament, in conjunction with the Proprietary Association of Great Britain—the UK trade association for manufacturers of over-the-counter medicines and food supplements—at which it was suggested that doctors, nurses and pharmacists receive very little nutritional training at undergraduate level and that there is no obligation for health professionals to undertake such training once in practice. Therefore, I would like first to ask the Minister to comment on the steps that the Government are taking or planning to improve training, awareness and knowledge among health care professionals. I would also like to ask what steps are being taken to raise awareness among the wider pool of professionals working with families and children, and what discussions the Minister and colleagues in the Department may have had with Ministers in the Department for Education to ensure that staff in schools, Sure Start workers, child care professionals and so on are aware of the importance of vitamin D.

There are also concerns about financial incentives. I have looked at the quality and outcomes framework for GPs, and there is a lack of a clear financial incentive for GPs to address their patients’ nutritional needs. Will the Minister say what steps are being taken to develop the quality and outcomes framework to focus more GP attention on nutrition and vitamin D intake, and how she expects that that framework will be kept under review?

I come now to the question of vitamin supplements, which the Department of Health recommends for at-risk groups—the groups I mentioned in my opening remarks—and which are available free of charge to certain low-income families via the Healthy Start programme. However, that targeted approach has resulted in only very limited uptake, which unpublished PCT data suggest could be as low as 2% to 4%. Clearly, many at-risk families are missing out on the recommended vitamin D supplements; and although some families may obtain supplements, from over-the-counter sources, that can be expensive and the dosage may be inappropriate. I would be interested in the Government’s attitude to allowing food supplement manufacturers greater freedom to develop and market a wider range of vitamin D products, targeted at different population groups. I would also welcome the Minister’s view on how the European Food Safety Authority might make it easier for manufacturers to make legitimate claims about the role of vitamin D in good bone health.

I particularly hope that the Minister will consider a report published online, on 21 August, by the British Medical Journal that considers an initiative by the Heart of Birmingham PCT to provide universal vitamin D supplementation to all children from the age of two weeks to five years and to all pregnant and breastfeeding women. That provision of supplements was supported by a programme of continuing professional education of health staff, including GPs, health visitors, midwives, pharmacists, paediatricians and obstetricians and by a public communications campaign. In that initiative, uptake of vitamin D supplements rose year on year to reach 17% among children and pregnant women. That was still low, but considerably higher than the 2% to 4% achieved under Healthy Start. Public awareness of vitamin D also rose from just over 60% to nearly 90%, and a 59% fall was recorded in the number of cases of vitamin D deficiency.

Clearly, there are some important lessons to be learned from the Birmingham initiative. Although some problems were experienced with distribution through the NHS supply chain, limited opening hours at pharmacies and so on, and with the availability of trained staff, the initiative was very successful overall in reaching a considerable number of families who might be at particular risk of vitamin D deficiency by virtue of ethnicity, skin pigmentation or lifestyle, but would not be eligible for free supplements.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall today. I am of an age group, and others in the House may be of a similar age, that can remember that when we went out to play at school lunchtime, the milk was on the table when we came in. Is there a role for the Department of Health in the education of children to ensure that children’s health is better monitored and supervised?

[Kate Green]

I absolutely agree with the hon. Gentleman. Health professionals, and other professionals from across different disciplines, have pointed to the absence of a holistic approach that draws different practitioners and professionals together to ensure that the message is promoted and the education of children and families is pursued coherently.

The absence of trained staff was certainly seen as a factor that limited the effectiveness of the Birmingham initiative, but overall it was very successful in improving vitamin D uptake in families who would have been at risk. I am keen to invite the Minister to look carefully at the Birmingham experience. Is she willing to analyse the costs and benefits of a universal approach based on the study’s findings?

On food fortification, relatively few foods are naturally rich in vitamin D, and consumption of many of those that are, such as full-fat dairy products, eggs and oily fish, has fallen in recent years. Yet in the UK, we fortify relatively few foods, such as margarine, some processed cheeses and breakfast cereals. We do not fortify milk, which has been fortified in Canada and the US for many years. Finland, Jordan and the Irish Republic have all taken recent steps to introduce food fortification. Will the Minister indicate the Government’s attitude to statutory food fortification? There seems to be scope for a more robust approach. Can she confirm whether the work of the Scientific Advisory Committee on Nutrition will look at the experience of other countries? Will the committee’s report reflect an analysis of the effectiveness of food fortification measures in those countries?

Finally, there appears to be scope to make greater use of the public health outcomes framework, to focus attention on vitamin D. I looked at the framework, and, with the exception of some quite vague indicators on diet and hip fractures, there appears to be nothing specific to highlight the need for action to tackle vitamin D deficiency and its consequences, including the risk of rickets. I welcome the Government’s focus on public health, but we must ensure that the framework and the new health structures being put in place more widely achieve the best possible outcomes.

This is a crucial and, I have to say, challenging time of transition. We are settling into the new public health infrastructure against a backdrop of far-reaching changes in the NHS more widely. Although I appreciate that the public health outcomes framework will be kept under regular review, I would like very specific and early attention to be given to the issue in the framework and by the new health and wellbeing boards. I would welcome the Minister’s comments on that.

[Jim Shannon]

I thank the hon. Lady for giving way again. She is being very gracious. Is she aware of the statistics and figures that show a greater problem in the United Kingdom—England, Wales, Scotland and Northern Ireland—with not only rickets, but osteoporosis, from the lack of vitamin D? Is there a need not only for a pilot programme, such as the one she mentioned in Birmingham, but for a programme for the whole UK, working with all the regions?

[Kate Green]

The hon. Gentleman is quite right. The impact of vitamin D deficiency is felt in not only rickets and diseases in children, but osteoporosis and other diseases. Vitamin D deficiency inhibits the absorption of calcium, for example, which is important for bone health and growth.

Professionals have identified the lack of joined-up advice—for example, telling a woman recovering from a cancer operation and having chemotherapy that there could be an impact on her bone health and the steps that she could take to address it. It is right that professionals have expressed an interest in the development of a strategic approach, both geographically and across health conditions. Perhaps the Minister will comment on how the Government might react to that.

Rickets is a largely preventable disease that many of us thought had been left firmly in the past. Its resurgence is not in question, yet the distress and pain it causes are preventable, and we know what steps we need to take. What is more, the solutions are mainly systemic—within the control of public policy and health care practice. Although I acknowledge that some gaps in the evidence remain, the importance of vitamin D for at-risk groups—children, pregnant women and mothers—has been understood for many decades, as has the need for effective supplementation where intake is inadequate. There is therefore no need to delay working on and developing appropriate systems and a programme of public and professional education to maximise vitamin D intake. I hope that today’s debate raises public and professional awareness of the issue.

National Health Service

Jim Shannon Excerpts

Monday 16th July 2012 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am extremely grateful for the opportunity to speak in this debate. The NHS is clearly important to all of us. I have seen it personally because I have had a number of operations and through my working life in the hospice movement, where I saw how the care that is provided is so important to the families we were looking after. Clearly, the dedication of the staff is great and I pay tribute to them.

Listening to the Opposition today, it is hard to take them seriously. We can see from their actions in Wales what they would do with the NHS if they were in power. They have cut the budget, resulting in an increase of 51% in the number of patients waiting to start treatment and an increase of 156% in the number of those waiting for more than 26 weeks. All the bad news from the Opposition is therefore difficult to swallow.

I will give a couple of examples from my area. I recently met some GPs and clinicians to talk about the work they are doing to redesign musculoskeletal services. They have brought in innovative ways of ensuring that the patient knows exactly what will happen to them. Clinicians across primary care, community services and secondary care are working together to ensure that the patient has a clear understanding of the care that they will receive. They use map displays, which show a clear pathway, offer educational content for GPs to ensure that patients get the highest standard of care, and ensure that information is available for the patient.

I am proud to say that on Friday, one of the surgeries in my constituency will open a new well-being centre, which will provide a place where health care, social care and the third sector can come together to provide better ways to improve health and well-being in the town.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman share the concerns of many Members, as I believe he does, over the closure of surgical units for children in the middle counties of England? If so, what is he doing to prevent it in his constituency?

[Stuart Andrew]

The hon. Gentleman pre-empts the next part of my speech and I am grateful to him for that.

As this is a health debate, I am sure that my right hon. Friend the Secretary of State would expect me to talk about the safe and sustainable review of children’s heart units. Like other Members, I have received a number of e-mails from various organisations today. One of them said that some MPs should seek to reignite the debate and that I should think about the children because if I had children, I would move heaven and earth to ensure that the service was the very best. Frankly, throughout the campaign on children’s heart units, I have only ever thought about the children. Of course I want the very best service for them, as do the right hon. and hon. Members from all parts of the House who have worked on the campaign. I have always accepted that there is a need for change. That is why I want to discuss a few related points this evening. I know that I will have an opportunity to raise it in greater detail tomorrow, but it is important that I speak about it tonight.

Access and travel times are incredibly important to the families who use children’s heart services. Logical health planning surely dictates that services should be based according to where the population lies. The British Congenital Cardiac Association states:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

Adult Social Care

Jim Shannon Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

[Jim Shannon (Strangford) (DUP)]

The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

[Paul Burstow]

From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

Violence against Health Workers

Jim Shannon Excerpts

Tuesday 3rd July 2012 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

Our national health service employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners, 400,000 nurses and 25,000 ambulance staff, as well as an army of other health care workers. Only the Wal-Mart supermarket chain, Indian Railways and the Chinese People’s Liberation Army directly employ more people.

On average, our health service deals with 1 million patients every 36 hours. That is about 500 people a minute or eight people a second. As those figures suggest, the size and volume of the NHS means that literally millions of interactions between patients and staff occur every single day. In the vast majority of cases, these interactions are positive and result in successful outcomes for patients and staff alike, which is why, simply put, the NHS is one of the best health care models on the planet. But sadly, things sometimes go wrong for patients and badly wrong for staff. The superb staff who provide such sterling service to the public can find themselves the victims of violence while working on our behalf to provide those very services. The purpose of this debate is to highlight this wrong and seek support from the Government for righting it.

The NHS management service’s latest statistics reveal more than 150 reported physical assaults on health care staff per day—and that is before verbal assault is taken into consideration. According to the latest 2010-11 NHS survey, 7% of NHS staff had been victims of assault in the previous 12 months. The Royal College of Nursing’s research reveals further troubling statistics, with almost 11% of those surveyed having been assaulted at work in the previous two years and more than 60% of all respondents having suffered verbal abuse at work. Indeed, one respondent commented that

“verbal abuse seems to just be accepted as part of our work”.

That is totally indefensible.

In Northern Lincolnshire and Goole hospital trust, which serves the Scunthorpe area, there were 13.1 assaults per 1,000 members of staff in 2009-10. Although that figure is below the national yearly average of 16.8 per 1,000, it is still far too high. One assault against any person simply trying to do their job in any profession, never mind people who routinely save lives every day, is completely unacceptable.

Two weeks ago, I joined a local ambulance crew for five hours of their 12-hour shift, and I was hugely impressed by the professionalism of the paramedic team and the staff at Scunthorpe general’s accident and emergency department. Patients were treated with great skill, care and dignity, which is exactly as it should be, but I was shocked to learn that the fantastic paramedic I was with had gone to a house call about a year ago and was seriously assaulted by the man he had gone to help. He was chased around the house by the man, who violently and persistently assaulted him. The assault was so bad that it resulted in his being off work for six months.

I received today this e-mail from a staff nurse at Scunthorpe general hospital:

“I understand that you are taking part in an adjournment debate tonight on the above subject. I was assaulted by a patient in January this year. With colleagues I went to clean up a patient that…had attacked a nurse earlier in the day and no one felt able to approach him since. I was subjected to a violent attack which meant I was on sick leave for three months. I have had intensive physiotherapy and still attend physio regularly. I suffered a needlestick injury while trying to sedate the patient and will be tested for blood borne viruses in the next few weeks. During the time I was off work and, for some time since, I have been in constant pain, I had limited use of my right arm and restricted movement of my neck. I could not hold a pen to write or brush my teeth. Everyday tasks took hours and I became depressed and withdrawn. Even now I am unable to perform all my duties as a nurse. Yet, mine was not a serious injury. I have made considerable improvement but will always have some level of pain and restriction of movement.”

She goes on to thank us for raising this issue in Parliament.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the Chamber, and I wish to associate myself with his comments. In Northern Ireland, including in my constituency and in particular the Ulster hospital, there have been several attacks on accident and emergency personnel and ambulances. It is not specific to Scunthorpe but happens across the UK. Would better co-ordination between the hospital authorities, ambulance and emergency personnel and the police be a way of addressing some of these issues?

[Nic Dakin]

I thank the hon. Gentleman for his comments. He reminds us that, sadly, the problem affects people across the nations of the United Kingdom. I will come to the issue he raises later, but I want now to quote the final comments of the nurse who wrote to me:

“You can have no idea what it means to have this problem recognised and debated. I do not expect to be compensated in monetary terms for the pain I have suffered or the possibility that I may not be able to work to retirement age but I do want to see measures put in place to effectively protect staff who are expected to deal with difficult and violent patients.”

The costs of such assaults are multi-fold. There is the cost to the NHS of care for the victim, the cost to the NHS of the health worker’s absence from work and the possible loss of an employee if recovery is not complete. Added to that is the potentially devastating impact on the health worker’s own health and well-being, with further strain on family, friends and the wider community. I would like to pay tribute to all the fantastic people working in the NHS, including the people and organisations working hard to prevent such violence from taking place against health workers. Northern Lincolnshire and Goole Hospitals NHS Trust has launched an e-petition to heighten public awareness of the issue. The fact that the trust has recognised it in this way is to be applauded, but there is much more to be done. That is why the trust’s partnership approach, working with Unison and others to find ways of practically addressing the issue, is to be welcomed.

NHS Employers—part of the partnership for occupational safety and health in health care—is also actively involved in raising the issue of violence and aggression against staff, and is looking at how it can be managed, working hard to help create healthy and productive workplaces. Work is also under way—led by NHS Protect, with input from the Royal College of Nursing and others—to look at preventing and managing physical assaults on staff which result from a patient’s underlying medical condition, such as dementia. Many physical assaults result from a patient’s underlying clinical condition, but rather than ignoring this, steps can be taken to reduce the risks. Work to take these positive initiatives forward needs to be systematically supported and funded if it is to bring real change and reduce the risk to health workers from such patients.

All these initiatives are positive and to be welcomed. However, I want to highlight a number of concerns raised with me by the Royal College of Nursing, Unison and others. I am keen for the Minister—who I know is committed to ensuring that the Government do their best in this area—to say in his response what practical steps the Government are taking to address those concerns. The Government have funded work by the Design Council with a limited number of A and E units to reduce violence through design solutions. That is to be welcomed. How will the work be evaluated, and how will any improvements to the safety of staff and patients in such units be shared and implemented more widely? With the end of Secretary of State directions, which required NHS trusts to have measures in place to protect staff, how will it be possible to ensure that all provider services meet standards similar to those currently set under Secretary of State directions? They include access to a local security management specialist, training on conflict resolution, central reporting of physical assaults and a requirement to follow policies and guidance—for example, lone working guidance—published by NHS Protect.

Lone working nurses and health care workers absolutely need protection. They often form an invisible work force. Many health workers already work alone with limited, if any, back-up or support. The quite proper policy direction of providing more services in the community means that more health workers are likely to find themselves in potentially vulnerable situations as sole workers. How will Government ensure that there are systems in place to minimise risk and protect the work force?

Full consideration needs to be given to the possible impact of changes in health care delivery combined with efficiency savings on the likelihood of risk of violence against staff. In particular, a risk assessment of the impact of closing units, lengthening A and E waiting times and staff shortages needs to be undertaken and the effects mitigated. That needs to be recognised. In this climate of cost-cutting and austerity, how can we be certain that such measures will be put in place to reduce the risks to staff? Staff who report incidents need more support from their employers and the police. They need feedback after they have reported incidents, and they need to know what action is being taken to prevent any reoccurrence. Lack of feedback and support can lead to under-reporting of incidents and reduced morale.

I welcome the fact that pressure from Unison has resulted in a change to the code for Crown prosecutors to increase the number of prosecutions for assaults on public servants. The closer working relationship between NHS local security management specialists and trade union safety representatives has been a positive development. NHS Protect has also agreed protocols with the police and the Crown Prosecution Service. Under the memorandum of understanding with the Association of Chief Police Officers, the police are committed to progressing all cases of violence and abuse against NHS staff as a priority. The Crown Prosecution Service has also made a commitment to

“work with the police to ensure that these cases are treated with the seriousness that they deserve and encourage a robust charging policy”.

It is crucial that that should lead to a more consistent approach by police forces to following up the perpetrators of either physical or verbal abuse. RCN research suggests that police follow-ups are sometimes inconsistent around the country. Some forces follow up complaints robustly and work closely with local hospitals, but others appear reluctant to get involved in procedures, especially when the incident involves a patient with an underlying mental health condition. Such incidents in particular need more close examination, as a significant number of physical assaults on health workers are by patients with underlying mental health problems. How can the Government ensure that the memorandum of understanding between ACPO, the CPS and NHS Protect will be consistently and effectively implemented?

The reporting and investigation of assaults also need to be properly addressed. According to the RCN survey, although only about 11% had suffered physical abuse at work, 74% of the incidents they recalled were never reported to the police. Staff need to be confident that they will be supported by their employers and the police. They need to be given the confidence always to report assaults. There needs to be a culture of trust that, when reported, such assaults will be taken seriously and fully investigated, with proper support given to the victims. Proper feedback and support in the reporting process will help to keep up morale in the NHS work force and reassure staff that they should not expect to be put in danger while carrying out their duties on behalf of all of us.

In this age of austerity, budgets are being squeezed, and organisations that protect workers are being asked to do important jobs with a lot less funding. For example, the Health and Safety Executive, which plays an important role in keeping people safe at work, has had its work force reduced by a third in the last 10 years, with the number of inspections that it carries out falling from 75,000 to 23,000 a year. That could lead to the real danger of worker safety being jeopardised, which makes it even more important for NHS employers to take completely seriously the need to protect their work force and minimise the risk of attack from patients. Health and safety is not red tape; health and safety saves lives.

Worryingly, the cuts in NHS and local authority budgets and in the Health and Safety Executive are in danger of combining with the confusion caused by the NHS reforms to cause local security management specialists to become increasingly reliant on safety representatives to help them to identify those work areas in which NHS staff will be most at risk. Many local security management specialists used to work with primary care trusts. With the abolition of PCTs, there is a possible danger of confusion and uncertainty about their role in the workplaces that they cover. How will the Government ensure that the risk inherent in the changes does not lead to more health care workers finding themselves in situations in which their personal safety is put at risk?

Every single person should be able to go to work without the fear of physical harm. I strongly back Unison’s calls for a zero-tolerance approach to safeguarding NHS staff. Everyone needs to work together with a clear and persistent focus to make sure that all staff can carry out their work free from the fear and the threat of physical or verbal assault. When individuals are found guilty of attacks on health care workers, that should inform the sentencing and be treated with the utmost seriousness.

As Julian Corlett, Unison branch secretary for Scunthorpe general hospital, wrote to me:

“Violence directed at health workers is never acceptable and is not part of the contract of employment. We must dispel the myth that violence in the NHS is inevitable, or unpredictable and therefore uncontrollable. It therefore remains our key objective to see a significant and sustained reduction in the number of violent incidents directed at NHS staffs across the country, with more prosecutions and severe sanctions for those perpetrating such violence. There has to be the presumption that those committing these offences are more likely to face prosecution than not if we are to see sustained reductions in the figures anytime soon.”

Julian speaks from experience with great passion and clarity; his words will echo round this Chamber and in the world outside it. We should be vigilant and proactive in ensuring the safety of those who work within the NHS. In the words of the children’s laureate, Michael Rosen, on the 60th anniversary of the NHS, we must do all we can to protect the

“hands that touch us first...and the hands that touch us last”.

Community Hospitals (North-East)

Jim Shannon Excerpts

Wednesday 20th June 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman explain why some Members, when they are outside the House, support petitions to retain hospitals and community services, but in the House vote to stop them?

[Mr Deputy Speaker]

Order. I allowed the intervention, but I am not sure what the connection is between the north-east and Northern Ireland.

Cancer Treatments

Jim Shannon Excerpts

Tuesday 19th June 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Southport (John Pugh) on bringing this matter to Westminster Hall.

There is not one of us who has not personally been affected, or who does not have family members affected, by what is referred to as the dreaded big “C”. Last year, my sister, who lives in England, had kidney cancer. The medical services here were good in addressing that and she is on the way to recovery. My father had cancer on three occasions and, due to the skill of the surgeons, his faith and the prayers of God’s people, he got over those cancers and is still here coming up to 83 years old—or young, perhaps, which is another way of looking at it. Our health care system is good at what it does. I want to make that clear.

We have the best palliative care in the whole of Europe. That matter has been debated previously in the House. However, that does not always mean that we have the best cancer treatment in every category and sector. We must look at that.

The hon. Member for Southport spoke about pancreatic cancer. Recently, I met representatives from Pancreatic Cancer UK, who gave me some shocking figures, which are available to all hon. Members. Survival rates for pancreatic cancer have not improved for more than 40 years, making it the most deadly of all cancers diagnosed in the UK, with fewer than 3% of patients surviving beyond five years. Some 8,000 people are diagnosed with pancreatic cancer every year and it is responsible for 5% of deaths from cancer, yet it receives only 1% of research funding. There was a debate on pancreatic cancer in Westminster Hall a month or two ago. It is often regarded as a death sentence—if people get it, their chances are minimal. Perhaps the Minister can tell us what has been done to address that matter in particular.

[John Pugh]

I am glad the hon. Gentleman mentioned that, because two close friends of mine died rapidly of pancreatic cancer. One point made by the people in Liverpool to whom I spoke was that, given the almost invariably fatal outcome from this cancer, it would not be a bad idea if some of the rules regarding drugs approval were relaxed a little bit, so that people could find out what worked, because in this case there is very little to lose.

[Jim Shannon]

I thank the hon. Gentleman for that valuable contribution and agree wholeheartedly. If it comes to the stage where people’s life expectancy is minimal or reduced, I believe that they would be quite happy to take advantage of new drugs, if those were available.

All hon. Members know that finances are finite in the health budget. That being so, we are grateful for the many charities that do such magnificent work, including Cancer Research UK, Macmillan Cancer Support and Marie Curie Cancer Care. However, we must get a handle on our treatment process and outcomes, which can only come through the correct use of funding. I hope that the Minister will tell us how that will happen.

In the NHS document, “Improving outcomes: a strategy for cancer”, published in January 2011, it is clear what the Minister regarded as the way forward:

“In order to achieve these principles we must also ensure that every possible penny of money the NHS has is spent improving the quality of care and outcomes that patients experience. The Government protected the NHS in the Spending Review settlement, with cash funding growth of £10.6 billion (over 10%) by 2014/15. Compared to many other government departments, that puts us in an incredibly privileged position but this is the toughest settlement the NHS has faced in a long time.

At the same time, we need to respond to the longer term pressures the NHS faces; of an ageing population and the new demands created by new treatments and technologies. That means that, as set out in the Spending Review and the 2011/12 Operating Framework, over the next four years the NHS will need to achieve up to £20 billion of efficiency savings. These savings will be reinvested back in continuing to give patients the care that they need.”

Will the Minister say whether we are on target to make those savings? If so, when will that money go back into the system?

The document contains many examples of cost-efficient care, such as people having certain treatments as day procedures and then care at home, which makes a lot of people feel more secure as well as being cost effective. We understand the reasons and the thinking behind that: it is essential that the patient is at the heart of any decision made and any strategy must incorporate this.

I am not an argumentative person—far from it, I try to get on with most people in this world—but the hon. Member for Southport commented on the advertising campaign “Have you had a cough for three weeks or more?” We do not know how successful it was. The campaign has a role to play, and those who have had a cough for more than three weeks might well have a problem. We do not know how many people went to see their doctor and, as a result, have been made aware of problems. That is perhaps a different opinion from that expressed by the hon. Gentleman.

[John Pugh]

I said that all those things need to be reviewed in the light of evidence, that there were good campaigns and bad campaigns, and that evidence decided which category they fell into.

--- Later in debate ---

[Jim Shannon]

The facts will be the number of those who take up the campaign and see their doctors, perhaps ending up with the diagnosis of a problem.

I have read different consultation responses and have seen how different cancer organisations respond. All have been positive that, to improve patient experience outcomes, it will be important for patient experience to be measured and bettered throughout the entire patient pathway. Bowel Cancer UK points out that it is important that patient conditions are not ignored by an overarching patient experience indicator. For example, the overall patient experience reported by patients at a particular provider is likely to be less relevant than the specific experience reported by patients with the same condition. Thus, bowel cancer patients should be consulted about their treatment and given the necessary support and tools to make informed decisions about their care.

I will quickly outline seven suggestions that might lead to improvements in patient experience and care. Steps need to be taken to ensure continuity of care throughout the patient pathway. Key workers and clinical nurse specialists should play a central co-ordination role to achieve that—their involvement is critical. The meaningful data on service performance should be provided, to allow commissioners to make informed choices on the services that they commission and to inform patients about the services that they might wish to access.

Sometimes it is about knowledge and patients’ understanding of how the system can work to their advantage. Tailored patient information should be provided to guide patients through their care, in the form of information prescriptions; that should also include support to self-care, because that is sometimes the best way to deal with their problems and medical condition.

Symptom management should be offered to ensure that patients have the knowledge and tools to look after themselves when they can, but also so that they know when they need specialist support. In other words, when they need to call on the specialist support, they should have the chance to do that.

Patients should be given access to treatments in the most appropriate location for them, whether surgery, radiotherapy or chemotherapy—again, knowing the full choice.

Patients should be offered signposting and support to help them return to work, as well as ongoing support to manage continuing symptoms and the side effects of treatment. We might not always see such things directly, but they are important: trauma, the effect on the patient and their families, the financial implications and knowing about rights to benefits to get through that period, such as an application for disability living allowance.

Palliative care pathways should be considered alongside active treatment and not simply at the end of life. For many of us, palliative care is end-of-life care, but it has another role as well.

Lastly, the end-of-life care strategy should be rapidly implemented. Those seven suggestions are a method for the health system to address the care needed for those who have cancer.

I shall make a quick plug for those who do the experimentation and whose task is to find new drugs, which the hon. Member for Southport mentioned in relation to pancreatic cancer care. Queen’s university Belfast is at the forefront of experimentation in the investigation of new drugs—renowned the world over—and I commend the people there for what they do, and what many others do, because we cannot do without that experimentation to find the new drugs. Nearly every other month a new drug is announced—okay, there might yet be three or four years of experimentation and investigation, but the work of the researchers is tremendous and I commend them for it.

All the responses have been noted and the document that the Minister released is precise, yet more than a year later some feel that we have not moved forward as much as we should have done. Are we achieving better patient-focused care and outcomes? I am not so sure about whether that has been achieved, but the Minister will indicate where we are. That is why I am particularly thankful for the opportunity to debate the issue here in Westminster Hall. We do not need pretty words in a document—if I may use that terminology, and not facetiously—we need action. The Minister must turn all the words into action, and that is why I support the hon. Member for Southport and thank him for bringing the matter before the Chamber today.

Mental Health

Jim Shannon Excerpts

Thursday 14th June 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I am privileged to be in the Chamber to hear some of the speeches that have been made, including those by the hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones). It is a great privilege to hear what they said. I congratulate the hon. Member for Loughborough (Nicky Morgan) on raising the matter in the Chamber. She said that everyone has mental health issues; I suppose it is a matter of how they deal with that and control it. We all have a breaking point. I hope that I never reach that breaking point, and that others do not do so either.

As an elected representative, in my interaction with constituents in my office, I see very clearly how people deal with depression. As the hon. Member for Strangford, I wish to express views on behalf of my constituents, ever mindful of the fact that health in Northern Ireland is a devolved matter. However, the debate is on mental health generally, so the issues in Northern Ireland are every bit as relevant as those in Broxbourne, North Durham, Loughborough and anywhere else in the United Kingdom. Every day I deal with those issues, whether through employment and support allowance appeals or disability living allowance appeals, or by interacting with people and the way in which they deal with their benefits.

An issue that has been highlighted in the Chamber is the difficulties that can arise. That was an issue before the economic downturn, but it is a bigger issue today, because people find it harder to deal with the economic and financial realities that face them, which compounds their problems. In all honesty, over the past year or 18 months, I have seen greater need in people who suffer from depression, as they have had to deal with issues with which they have never had to deal before. We have debated many great issues in the Chamber in the two years in which I have been an MP, but this issue is certainly one of the most important.

I want to deal with two issues. I want to talk about mental health from the perspective of Northern Ireland, and I also want to touch on an issue the hon. Member for Loughborough mentioned when she talked about the armed forces. There are problems for our soldiers and service personnel returning from the battlefield, whether Afghanistan or Iraq, because their memories of those conflicts do not finish when they get off the plane or boat after returning home; they are still with them many years after the conflict. I feel strongly about that for those who returned from both Iraq and Afghanistan.

Good mental health should be a priority for us all, as every Member who has spoken so far has indicated. In Northern Ireland we have also made it a priority. However, Northern Ireland—I say this with respect—has been underfunded for many years, owing to direct Government reasons and others. The figures show that mental health is a greater issue in Northern Ireland than it is in other parts of the United Kingdom. People would say that that is perhaps because of the 30 years of the troubles, which I think is probably true. When someone is under pressure or stress and worried about whether they will live or die, they turn to drink, drugs or other things, and that affects their lifestyle. Ultimately, a great many people in Northern Ireland suffer from depression and mental health issues because of our country’s past. I am glad to say that we have moved on. We now have a partnership Government and we are working together to ensure that there is a future for everyone, and that in the future there is a lessened threat of terrorism.

The British Medical Association in Northern Ireland has done significant research on mental health there. When the hon. Member for Loughborough introduced the debate she mentioned a number of the points that are also in the BMA’s report, so I could not help but wonder whether she had perhaps seen the same report. It contained a number of points that she referred to and commented on. I think that the reason those points are so similar to what she said is that the same issues are just as relevant in Northern Ireland as they are in Loughborough and the rest of the United Kingdom.

I would like to touch on how we can improve the situation. I know that the Minister will have a detailed and helpful response to the debate. To start with, it is a taboo subject. I think that the Government and policy makers must strive to ensure that the stigma, which Members have talked about, and the clear discrimination and fear that surround mental health are eliminated or addressed by focusing on promotion, education, prevention and early intervention. Those are the four headlines the BMA puts forward in its suggestions. There is clearly a work force planning problem that, in some occasions, occurs simply because of reductions in staffing levels. There are a number of things we need to do, and perhaps the Minister, when he responds, can tell us how the issue of mental health will work within the staffing restrictions and assure us that that concern will be taken on board.

The Northern Ireland Executive’s programme for government made a commitment to work for a healthier people and identified mental health as a priority. It also set out targets to try to address the issues. The person who suffers from mental health problems is only part of the problem. When a constituent with mental health problems comes to my office, as they do to the offices of other Members, there is not just one person sitting in a chair in front of me, because they are usually accompanied by someone else; there is a family circle, children, mums and dads and everyone involved. While one person might suffer from mental health problems, half a dozen people could be affected by the ripples.

I am also concerned about teenagers who suffer from depression. Between 10% and 20% of our teenagers will suffer from depression at some point in that short period of their life. I believe that there has to be recognition of mental illnesses, notably depression, and it means that we need to look beyond good mental health and at preventing mental health problems and ensuring early intervention. Many personal issues affect mental health, including drink, drugs, working conditions, homelessness, poverty, unemployment and risk-taking behaviour, whether smoking or unsafe sex, and those issues affect many of the people who come to my office with these problems.

Let us address these problems first by strengthening individuals, by addressing emotional resilience and by promoting self-esteem, life skills, coping skills and communication skills. We also have to strengthen communities. Those are the issues I feel are important. That means addressing the issue of social inclusion, improving neighbourhood environments, which make a difference. In relation to teenagers, we also have to try to address the anti-bullying strategies in schools. Those are important because bullying is one of the things that lead to young people having these depression issues.

We also have to reduce the structural barriers to mental health, which means access to education and meaningful employment. I know that that everyone will agree with that, but at the end of the day we need to have a strategy in place to address mental health issues, and that is what we are seeking to do through this debate. We all agree that there is absolutely no doubt that we all support the issue and the vulnerable people affected, people who we meet every day and who need real help.

Suicide in the community is a great worry for us all as elected representatives. Every one of us will have dealt with families, with people whom we know personally or with people from families that we know personally who have lost loved ones—who took their own lives because they felt that there was no way forward. They were coming off the back of terrible depression or terrible pressure, and did not know where they could go next.

[Mr Kevan Jones]

We have been talking about the voluntary sector, and in my constituency there is a very good organisation, which also came about as a result of a personal tragedy for the individual—a woman called Shirley Smith, who runs If U Care Share. Her 19-year-old son died, and it is about young people and talking about those issues. She goes into schools, youth groups and football clubs to do so. Does the hon. Gentleman think we should have a national strategy on that to ensure that it is part of the curriculum as well?

[Jim Shannon]

Yes, I do. When a constituent of mine died in a car accident on a Sunday night, I went to her house on the Monday night, and her father just wanted to speak and to talk about his daughter. That is the issue. On many occasions, it is just a matter of having someone to talk to, someone who can lend a sympathetic ear when it is needed most, so I wholeheartedly agree with the hon. Gentleman on that matter.

Back in 2005, the then Secretary of State for Northern Ireland, who had some responsibility for health, the right hon. Member for St Helens South and Whiston (Mr Woodward), set up a task force to develop a suicide prevention strategy for Northern Ireland. It is paying some dividends in relation to a decrease in the number of suicides, but the number is still at a very high level.

Other Members have touched on dementia and Alzheimer’s, and after wearing my hat as a councillor for 26 years and as an Assembly Member for 12 years, before being privileged to enter this House, I must note that the number of people with Alzheimer’s and dementia is greater today than ever before. I do not know the reasons why, but they are real, the statistics prove it and we have an issue there as well.

On employment support allowance appeals, the hon. Gentleman made an interesting point about those who have mental health issues, because when they go to an ESA appeal the issue is clearly not a physical one, because physically they can walk about, move their hands, brush their hair—if they have any, unlike me—or put a hat on their head. They are asked whether they can do those things, but those are not the questions that a person with mental illness needs to answer. They need to answer the questions, “Are you moody?”, “Do you fall out with people?”, “Are you aggressive?”, “How do you cope with difficult situations?”, “Do you start a task that you cannot finish?” Those are the questions for a person who is depressed, and I agree with the hon. Gentleman, because the appeals panel—the chair and those who deal with such tribunals—need to understand those issues better, so that an appeal can be presented in a way that people understand.

It has been stated that everyone has mental health issues. No one is immune, and although stress is greater among the poor and the unemployed it applies throughout society. Good mental health is crucial to the overall well-being of an individual, of societies and of countries.

In Northern Ireland there are about 150 suicides each year: 41% are single males, and 22% are males between 25 and 34-years old. Some 50% of suicides in the UK involve psychiatric patients, and one reason is a loss of contact; in that context I want to talk about soldiers, about a loss of contact by the health service and about treatment non-compliance, whereby people do not take the medication that doctors give them.

Figures for the United Kingdom as a whole indicate that depression accounts for about 60% of the country’s main health problems, alcoholism about 10%, Alzheimer’s about 8% and severe stress about 6%. That leads me on to that second issue, which is to do with our soldiers.

The week before last I had the opportunity to go to Cyprus with the armed forces parliamentary scheme. Some MPs in the Chamber will be members of that great scheme, some will be aware of it and some will have been members in the past. We have an opportunity to meet soldiers and to hear about strategic issues so that we can present them to the House in an informed and knowledgeable way.

When we were in Cyprus two weeks ago, we noted its importance from an Army and a strategic point of view, but we had not realised that it is halfway to Camp Bastion in Afghanistan. There is a new scheme in Cyprus whereby soldiers returning home from Afghanistan come through a so-called decompression centre in Akrotiri; last year 30,000 did so. They call it decompression because it helps them to unwind after what they have experienced in Afghanistan over the previous few months. The sun is usually shining, which makes a big difference. They have a chance to shower, to have their kit completely dry-cleaned, and to have a good meal. They have access to mobile phones, and they are able to speak to their doctor, padre or commanding officer. They have a chance to get back into normal life—to step down and get themselves ready to go back home to their family. The work done for our soldiers in the Akrotiri centre, which cost £4.5 million to build, gets them ready for life back home.

Those soldiers have seen in Afghanistan the most horrific things that we cannot begin to visualise. They have seen friends and colleagues killed or injured, some with life-changing injuries. We know of those people because we have met some of them, and we are humbled when we do so. The bullets and the bombs are intermingled with the stress, the trauma, the bad memories and the nightmares—those are all part of the things they have to face long after they leave the Army. While the Army, the Royal Navy and the Royal Air Force look after their personnel, the forces associations do likewise. We recognised from our time in Akrotiri, as we have in our constituencies, that once soldiers are out of the Army they are often distanced from those associations too. The Royal British Legion might not always be at hand for them. They might have no friends or their marriage might have split up. They might turn to drink and drugs, but that will give only temporary relief and they are still on their own. I am mindful that defence is not the Minister’s portfolio, but I hope that when he replies he will consider the welfare of our soldiers who have returned from Afghanistan, who are not in the forces any more because they have left or retired, and are now apart from the ritual and discipline that they were once very much part of.

Every one of us will be aware of constituents who have lost control because of the memories and nightmares of what they have seen. Whenever the memories flood back and the flashbacks reappear, they relive what they have come through, and then they face their demons alone. We need to face up to this issue confronting those who have served, and are serving, in the Army, the Navy and the Air Force. The health service needs to address it UK-wide, in England, Wales, Scotland and Northern Ireland. The plight of our soldiers should be a priority for this Government, as I know that it will be. I commend the motion to the House and hope that Members will support it.

Pancreatic Cancer

Jim Shannon Excerpts

Wednesday 23rd May 2012 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Scott, for calling me to speak; it is a pleasure to serve under your chairmanship. I am pleased to have secured this debate, as it is on a subject of huge importance to thousands of families across the UK. It is also a subject that is close to my heart.

This debate was originally scheduled for the last week of the previous parliamentary Session. However, the cause of Prorogation it was cancelled, so I am particularly lucky to have been drawn again so quickly. Whether that was because of pure luck or the Speaker’s Panel taking pity on me, I do not know, but I am grateful none the less.

As it happens, the timing for this rescheduled debate could not have been better, because last week we established the all-party group on pancreatic cancer. It is chaired by Lord Patel, the Cross-Bench peer, who has huge experience of the medical profession, and it has a most fantastic treasurer in the hon. Member for Scunthorpe (Nic Dakin), who is here in Westminster Hall today. The all-party group aims to work with Pancreatic Cancer UK, Cancer Research UK and others to increase awareness of pancreatic cancer, and to help campaign for better care and treatments, which will lead to improved outcomes.

The simple fact is that we need better care and treatment. The number of people diagnosed with pancreatic cancer is rising. In 2008, around 8,100 cases were diagnosed—about 22 cases a day. Compared with other types of cancer, those numbers are quite low. However, there is a very poor prognosis in pancreatic cancer cases, with only 3% of patients surviving for five years or more. In my own particular case, my partner survived for only seven weeks after being diagnosed.

Despite advances in technology and improvements in survival rates for other forms of cancer, that figure of 3% has remained unchanged for 40 years, which is quite incredible. There are also wide regional variations in UK survival rates, the so-called and much cited problem of “the postcode lottery”. On a national level, that survival rate—only 3% of pancreatic cancer patients in the UK survive for five years or more—is the worst in the developed world. To put it into context, it is half the survival rate of the US, Australia or Canada. Those countries’ survival rates are obviously still low, but they are much better than the British survival rate.

There have also been reports from people with pancreatic cancer that the care provided in the UK has fallen below expectations. The 2010 NHS national cancer patient experience survey found that pancreatic cancer patients fared significantly worse than patients diagnosed with other cancers. That needs to change. Some things will be easier to rectify than others. For instance, improving the patient experience seems an obvious and relatively easy thing. However, we can and should work on improving awareness, diagnosis, treatment, care and—ultimately and most importantly—the survival rate across the board.

One can look at the impact of the advertising to increase awareness of bowel cancer, which is a difficult cancer to deal with. We are looking to achieve a similar impact in terms of increasing awareness of pancreatic cancer. Increasing awareness is vital, because too often pancreatic cancer is diagnosed at far too late a stage. Although symptoms may have manifested themselves for several months, many people do not visit their doctor until it is too late and the disease is quite advanced. In fact, 50% of pancreatic cancer patients are diagnosed only as a result of an emergency hospital admission and more than 80% of pancreatic cancer patients are diagnosed only once the tumour is inoperable. Those are startling, sobering and depressing statistics.

Let me refer again to my personal situation, in which the pancreatic cancer was diagnosed only after a series of what were just stomach aches, and tests were carried out only after those stomach aches and after a number of visits to the GP.

For the record, the symptoms of pancreatic cancer can be quite vague and varied. They can include weight loss and pain in the stomach, which both appeared in my particular experience of the disease, as well as back pain and jaundice. But if someone does not have any knowledge of the disease—neither I nor my partner had any such knowledge at the time—how would they realise that, because one is feeling tired every day there is something particularly wrong, until the stomach aches develop? Even then, in my personal experience the stomach aches were not significant in terms of pain. We had no awareness that that feeling of tiredness was anything to do with cancer.

We need to ensure that doctors are making the right diagnosis. Nearly 30% of pancreatic cancer patients will have visited their GP five times or more before being properly diagnosed; that was true in my situation. So we need to make sure that GPs are provided with the proper tools and training to recognise the symptoms of pancreatic cancer. Moreover, we need to ensure that GPs are able to refer their patients swiftly to hospitals for further tests when they suspect a case of pancreatic cancer.

As part of that process, Pancreatic Cancer UK is holding an early diagnosis workshop next month. Hopefully, that workshop will help to come up with more concrete actions that could be taken. I understand that the Minister’s colleague, the hon. Member for Sutton and Cheam (Paul Burstow), has agreed to support that workshop, which is an encouraging sign.

Put simply, late diagnosis means that the few treatments available might not be an option, so it is absolutely imperative that we improve awareness and diagnosis.

Let me turn to treatments. The uncomfortable fact is that few options for curative treatments exist. One of the reasons why survival rates for pancreatic cancer are so low, compared with those for other types of cancer, is that pancreatic tumours are relatively highly resistant to chemotherapy. Having said that, I note that Cancer Research UK has said that it believes there is some kind of breakthrough in terms of a new class of drugs, details of which it announced in April; that new class of drugs looks quite promising in terms of being able to improve treatment.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate on a very important issue; every one of us will have constituents who will be affected by it. Does he share my concern—and, I suspect, the concern of many people—that pancreatic cancer is the fifth most deadly cancer in the whole of the UK and yet only about 1% of cancer research is on pancreatic cancer? Also, does he feel that it is now time for the Minister to work with all the regional bodies across the UK—the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly—to introduce a UK-wide strategy to reduce deaths from pancreatic cancer?

[Eric Ollerenshaw]

The hon. Gentleman can obviously read minds, because that point about research is in my next paragraph. His other suggestion about a UK-wide strategy is a really interesting and positive one, because pancreatic cancer obviously does not respect any boundaries, or any devolved Government or national Government. So he makes an interesting point, which the all-party group can perhaps consider.

Effective cures for pancreatic cancer remain stubbornly elusive, but we need to try to find ways to prolong patients’ lives and to ease their pain and suffering, while always remembering that, with cancer, it is not only the patient who is affected but the people around them, including their family. Cancer affects not just one person; its effect spreads to other people. I had not entered the cancer world before my own personal experience—I call it a separate world, because it is like entering a separate universe that has never been experienced before. Patients’ loved ones also experience suffering.

NHS (Foreign Nationals)

Jim Shannon Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Kingswood (Chris Skidmore) on securing this debate. He tried hard to keep a balance—it is important for us to do so—as did the hon. Member for Ealing, Southall (Mr Sharma) during his interventions. However, whenever I read the background information, I cannot but feel shocked. On 3 May, an article in The Daily Telegraph on the foreign national debt stated that official figures suggest that

“more than £40 million is owed to NHS hospitals by foreign patients who were not eligible for free care”

and that freedom of information requests showed that

“the average unpaid debt for the provision of care to foreign nationals was £230,000 in the 35 trusts which responded.”

The article went on to note the doctors’ trade magazine Pulse’s claim:

“If this figure was the same across all 168 English acute trusts, the total debt would be almost £40 million”.

Those are worrying figures. The article continued:

“The FoI requests showed St George’s Healthcare Trust in South London had the largest outstanding debts, totalling £2 million from £3.55 million invoiced to foreign nationals for health treatment from April 2009.”

Everyone present is proud of our NHS and of the high esteem in which it is held, not only in this country, but throughout the world. I do not want to be a scaremonger. I want to keep my comments balanced. It is not in my nature to stir up angst or discontent. As the hon. Member for Kingswood has mentioned, we do not want xenophobia or discrimination, but the figures are unsettling and there are concerns that our health system is being taken advantage of by some people, which is to the detriment of British people who are waiting to be seen and receive treatment.

Anyone who knows me either inside or outside this Chamber will know that I often put my hand in my pocket to help those in Africa, India and other parts of the world. The same is true of other Members and of our great nation, because we are a nation of givers. Our charity contributions in a time of economic restraint are still above the norm—we are holding our own. In Northern Ireland in particular, our charity giving per head of population is second to none. I am all for international development and believe that we as a nation have a role to play in helping others who need it. The UK makes a significant contribution to third world aid, and we continue to do so—our commitment is to give—while other countries are cutting back. We as a nation are making a significant contribution and will continue to do so. I and other Members support the Government entirely on that issue.

I am also a constituency man and know that people are becoming discouraged. I am conscious that I am speaking as a Northern Ireland MP and that health is a devolved matter. Cancer patients talk to me about new treatments that cannot be paid for on the NHS because of lack of funding. I have asked questions on the Floor of the House about whether new treatment will be made available for those constituents of mine who clearly need it. In the past few days, we have heard on the news about the postcode lottery—that terminology is often used—whereby the treatment depends on the funds available where someone lives and the demands on the system. That is not necessarily a criticism—it is a fact of life. My constituents deserve to have the best treatment in the world and I will work as hard as I can to ensure that that happens.

The fact that £40 million is owed by some foreign nationals needs to be addressed. The Minister and the Home Office have indicated that they intend to introduce a £1,000 threshold to

“capture 94 per cent of outstanding charges owed to the NHS.”

I hope that that will be the case.

I hear that people now believe that we have a lax system. Again, we need to keep a balance. We cannot provide a world health service—it just cannot be done; the moneys are not there. We need to draw the line, and I believe that we should draw it in this place and that it should be a straight, firm line. Will the Minister indicate whether there will be a review or a reassessment of the six-month visa that allows GP registration and access to NHS care? That needs to be clarified, so that we can see where we are going.

There is a clear difference, as the hon. Member for Ealing, Southall has mentioned, between those who are taken ill on holiday and those who come here directly to take advantage of our health system. Again, it is about balance.

I have been encouraged to hear the Government’s proposals, but as a Northern Ireland MP I am concerned about whether they will make their way over to Northern Ireland. I will chat with my colleagues at home to ensure that we implement like-for-like proposals. Health is a devolved matter in Northern Ireland and the Health Minister is a member of my party. I will certainly have some discussions with him. The hon. Member for Kingswood has touched on this issue, but will the Minister explain what interaction there will be with the regional Assemblies—the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly—so that we have a UK-wide policy? It is important that all of the devolved Administrations have a similar policy to that on the mainland in England.

There are so many people in need of our health system at home that if we were to take in every sick person who was able to travel to the UK, it would not take a week until we imploded because of the demands on our system. We have to be realistic about what is expected of us and how we can help others. It about getting the balance right. The NHS is our national health service and one into which we have paid over many years through our tax system.

I had the privilege—some would say that it was not a privilege—of serving on the Health and Social Care Bill Committee, on which both Government and Opposition Members discussed the figures and tried to devise a reorganisation that would save money and still provide a good service. As well as delivering what is best for our citizens in the United Kingdom, it is important that we are able to help those who need it and who come here not with any specific intention to take advantage of the NHS, but who find themselves in need of it due to ill health. Any of us can be taken ill on holiday, so we take out insurance, which covers us for so much. It does not cover for circumstances in which ill health might result in a longer stay than anticipated, but it does help part of the way.

Some have taken advantage of the system. The Government are right to tighten the system and to ensure that there is a good NHS for the whole of the United Kingdom. The hon. Member for Kingswood referred to the term “health tourism”, which others have used and which sends out signals. Whether that term is correct or not, some people are doing it. We need to make sure that we have a system that can help those when they need it. We are a caring nation—we do not want to turn people away—but our system needs to ensure that that is done correctly. As I have said, this is all about balance. It is about ensuring that we, as a caring nation, can offer help to those who need it. No one who needs help should be turned away—that is clearly where I am coming from—but at the same time we need to tighten the criteria, close loopholes and at least ensure that the £40 million drain on NHS care is restricted or comes to an end.

--- Later in debate ---

[Anne Milton]

It will bring the focus closer to home. I would expect the shadow Minister to welcome this change, because GPs will now be much more acutely aware that registration with them should not automatically entitle people to NHS acute trust care. We are undertaking a review that I will mention in my concluding remarks. It is early days in respect of the UK Border Agency and the change in the immigration rules, so we do not have sufficient information adequately to evaluate how effective they are, but I think that we will see a significant impact. The shadow Minister asked specifically about the Olympics.

[Jim Shannon]

The Minister said that £14 million in debts was written off by the Government. Do the Government contact the countries that people have come from to try to recover some of those debts, or is it too costly administratively to do that? Is it cheaper to write off debts than to chase them up?

[Anne Milton]

That is true of all debts. Trusts are not always aware of the rules and the obligations placed on them. Sometimes, they do not have the infrastructure in place to chase such debts and sometimes the costs of chasing debts are greater than the debts themselves, so they write them off. Either way, it is clearly not fair on the taxpayer. West Middlesex is an exemplar. We in the NHS are not good at sharing best practice, but practice at West Middlesex should be spread more widely.

Back in 2005, when the Labour Government were in power, as part of the UK’s successful bid for the 2012 Olympics they committed to provide games family members with free medical care. The games family is a tightly defined group of people—athletes and their support teams, officials, accredited media and IOC members—who are directly involved in taking part in or supporting the games. We have introduced a specific exemption for those people in respect of hospital treatment that might otherwise be chargeable, which will last for only nine weeks around the time of the Games and will be limited to treatment, the need for which arises here, so pre-planned or routine ongoing treatment that can wait will not be free. Normal charging rules will apply to all other visitors, including those coming to see the games.

The NHS has been briefed to be particularly vigilant in screening visitors who seek treatment and in applying the charging rules, given the large influx of visitors to the country. Let me reassure the residents of Hackney—the shadow Minister rightly said that Homerton is one of the designated hospitals—that treatment will be given on the basis of need. Local people should not suffer at all as a result of these rules which, as the shadow Minister will be aware, were an important part of the previous Government’s bid.

My hon. Friend has mentioned some of the details of our review. It is important that there should be qualifying criteria, a full range of other criteria exempting services or visitors from charges, and criteria for charging for services outside hospital, as we move towards more care being delivered outside hospitals. We need to be mindful of costs that could be incurred, thereby ensuring that we have more efficient and effective processes throughout the NHS, including the ability to screen eligibility. Let me reassure the hon. Member for Strangford (Jim Shannon) that it is important that we work closely with the devolved Administrations, and have close discussions with them, to ensure that there are not unforeseen and unintended consequences.

Once again I thank my hon. Friend the Member for Kingswood for introducing the debate, and I thank hon. Members for the balanced, moderate nature of the discussion. It is important that we set an example—all parties desire to do so—and demonstrate to the public that such difficult issues, which can involve distinct communities, can be discussed and considered in a fair and balanced way and are matters of cross-party concern, with all political parties working together. It is not becoming for any politician to score party political points on an issue of such fundamental importance to the taxpayers of this country.