Social Care Funding

Bambos Charalambous Excerpts

Tuesday 1st October 2019 Westminster Hall

[Caroline Dinenage]

That is an excellent intervention, and the hon. Gentleman is right to say that we must do more to recognise and support young carers. The hon. Member for Plymouth, Sutton and Devonport said that we must do more to help schools to identify young carers, and that was a key part of the carers action plan that was announced last summer. A young carers’ takeover day of Parliament is planned in the months ahead: every MP across the country will be encouraged to invite a young carer from their constituency, which will give us a real in-depth understanding of what an amazing job young carers do.

We all recognise the challenges that the social care system faces. As a population, we are getting older: by 2040, one in four people in the UK will be 65 or over, as the right hon. Member for Twickenham pointed out. It is also important to understand that social care is not just a service for older people; the number of people under 65 who have carers is growing and accounts for more than half of social care spending. That can have quite a disastrous impact on local authority budgets, as the hon. Member for Plymouth, Sutton and Devonport pointed out. I will certainly take forward the points that he made.

These long-standing trends put increasing financial pressure on local authorities. In response, we have taken steps to ensure that the social care system has the funding to meet urgent challenges in the short term. In 2017, we announced an additional £2 billion in grant funding for social care, which we supplemented with a further £650 million in the 2018 Budget. Councils have responded by increasing their spending on social care, which has risen in real terms in each of the past three years.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Will the Minister give way?

[Caroline Dinenage]

I will make some progress, if the hon. Gentleman does not mind.

As a result of our investment in social care, 65% of local authorities were able to increase home care provision in 2017-18. Local authorities have increased the average fee paid for older people’s home care by 4.7% in 2018-19, bringing some much-needed stability to the provider market. I am very pleased that the Care Quality Commission has rated 84.1% of social care settings as good or outstanding.

I am delighted to say that in our most recent spending round we announced further investment in adult social care. We will provide councils with access to an additional £1.5 billion for adult and children’s social care next year, including £1 billion in new grant funding over and above the £2.5 billion of existing social care grants. In the spending round, we confirmed that all the existing funding streams would be maintained next year—hard-wired into the Budget, if you like. The Government will also consult on a 2% adult social care precept that will enable councils to access a further £500 million. This increase in funding is part of the biggest increase since 2015 in overall core spending power for local government: it will increase by 4.3% in real terms next year.

The new funding from the spending round will support local authorities in meeting the rising demands that they face, while helping them to continue to stabilise the wider social care market. This additional funding is the first step towards putting adult social care on a fairer and more sustainable footing. We have already started preparing for the multi-year spending round due next year.

The challenges facing social care are not purely financial, as hon. Members across the parties, including my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter) and for Newton Abbot (Anne Marie Morris), have said. It is important to point that out, because stakeholders across the sector tell MPs: “Even if money were no object, we would not necessarily continue to provide this service in the current system.” The current system is not working in so many respects, and it is not working properly for some of our most vulnerable citizens, which is why we are continuing to support the system through a programme of sector-led improvements to help councils to make better use of funding to deliver high-quality personalised service, with more than £9.2 million committed by the Department in 2019-20.

We are also breaking down barriers to encourage much better integration of health and care, and we are looking at what more we can do to support the workforce and carers, as I have mentioned. In terms of integration, the better care fund has helped to enable much better co-operation between health and social care partners at a local level. It has also been instrumental in reducing delayed transfers of care, which has been mentioned: they have decreased by 2,147 since February 2017. We are looking at how we can use the fund to drive better integration.

My hon. Friend the Member for St Ives (Derek Thomas) spoke about bed vacancies and people stuck in hospitals. There is a lot more integration going on between care providers and health settings that are using those beds to provide the step-down care and discharge to assess that we want to see.

Body Image and Mental Health

Bambos Charalambous Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Lady for raising that point—I have heard of that campaign. It is disturbing that so many people alter their images. None of us is perfect—God help us if we all were—but for people to think that they need to alter their appearance because they are unhappy with it, and for that to become normalised, is quite a sinister development in society. At the risk of being trite, perhaps we should be telling everyone to learn to love themselves.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the Minister aware of the Good Childhood report, which states that girls who share pictures or videos of themselves are less happy with their appearance than those who do not? Is she aware that the Children’s Society is campaigning for a greater understanding of what makes children unhappy, and does she agree that we need to focus on that?

[Jackie Doyle-Price]

Yes. The Children’s Society is doing some excellent work in this space and it always has a lot of expertise to share. We have to address this issue collectively as a society, because if we do not start equipping children with the tools to look after themselves and the right attitudes, that damage is set up for life. The hon. Gentleman is absolutely right to raise that point and I encourage the Children’s Society to engage with us more on what we can do to support it.

The Government recognise that poor body image is a common problem. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body weight or shape. We also recognise the impact that idealised body image can have on lesbian, gay, bisexual, and transgender people particularly, on ethnic minorities, and on those with disabilities or serious illnesses.

The Mental Health Foundation recently published a very informative report on body image. Some of its findings are shocking: 20% of adults feel shame, 19% feel disgusted, and 37% of teenagers feel shame in relation to their body image. This should make us all stop and think. When it comes to teenagers, we all recognise that going through adolescence is a difficult time, when we are at our most vulnerable, including to the outside influences that tell us that our body shape is not as it should be and that we are not as perfect as we could be. I welcome the recommendations made in the foundation’s report, which is aimed at public and commercial organisations and gives us things that we can do to help ourselves.

Having a negative body image affects the way that we feel about ourselves and it can affect people’s aspirations and confidence. In the most extreme cases, it can lead to eating disorders, depression and even feeling suicidal. I know that the hon. Member for Dewsbury (Paula Sherriff) is as concerned as I am about this issue, and I commend the work that she has been doing specifically on eating disorders. The increases that we are seeing in suicide and self-harm among young people are incredibly worrying. Much of this is being driven by young women and girls, but we must not forget the boys either. It is important that we work to raise awareness of the problems of body image that many people face and hopefully prevent them from developing issues in future.

Clearly, social and digital media companies are key players in this debate, because they contribute to the volume of material that encourages people to think negatively about themselves. Young people are put under such pressure to have the perfect image, the perfect body, the perfect relationship and the perfect clothes—the perfect everything—and that places unrealistic expectations on them. As hon. Members will know, we are in close dialogue with social media companies to encourage them to act more responsibly over the content on their platforms. We have held three summits so far; the most recent was only last week. We have said that, ultimately, we will consider legislation if they do not clean up their act. That said, Governments can always be three steps behind the development of technology, so I would much rather that we worked collaboratively and co-operatively to address this content.

So far, I have been encouraged that the companies have committed to increasing their efforts to protect users from harmful suicide and self-harm content online by coming together to establish and fund a strategic partnership with the Samaritans. That work is commencing. They will look not only at self-harm and suicide, but at pro-eating disorder content. We will continue our meetings with social media companies.

I was particularly concerned to see that a number of sites and materials are available that contain harmful content such as pro-anorexia messages. It is completely unacceptable that this sort of content is easily accessible to vulnerable young people. We are having talks with Amazon about removing books from its retail sites, but we need to ensure that social media companies are vigilant about taking down content published on their sites as well.

In the face of these modern challenges, central to tackling the problems in future is empowering our young people to improve their emotional resilience and wellbeing, so that they feel confident in themselves and in seeking support if they feel they need it. We are investing in massive improvements in mental health provision in schools. We have a new workforce that we are rolling out. We also need to make sure that children can access mental health support and we are investing in more provision in child and adolescent mental health services. As part of making health education compulsory in schools from September next year, it will be absolutely essential that we teach children how to protect their mental wellbeing. That will cover unrealistic expectations about body image. I hope that that will allow young people to recognise what is normal—what is normal, and is there any such thing as normal?—and what is an issue for them and others, as well as to know how to seek the right support when issues arise and to know that it is accessible to them.

Another issue I would like to talk about is gender identity, which has been the subject of quite a number of negative reports in our newspapers in recent months and, indeed, on Radio 4 this week. This is about people’s sense of self and physical appearance and about them wanting to change their gender identity. We have been aware of the issue of gender dysphoria, but there has been quite a lot of comment, and the House and the public need reassurance that the treatments available on the NHS, particularly for children, are appropriate.

To put the issue in context, gender dysphoria is where a person experiences discomfort or distress because there is a mismatch between their biological sex and their gender identity. That is incredibly difficult for anyone to deal with, but young people, in particular, will find it difficult. Many Members will have had representations from constituents about access to services to cope with gender dysphoria—I know that because I have signed many letters on the issue. It is essential that someone suffering with gender dysphoria receives the right support—support that really considers their holistic needs—because gender dysphoria often exists alongside other morbidities, and we must make sure we treat the whole person. Where appropriate, people should receive specialist treatment.

The Gender Identity Development Service for children and young people is provided by the Tavistock and Portman NHS Foundation Trust. There has been lots of concern in the press about that trust, but having discussed the service with NHS England and visited it, I would like to try to give Members some reassurance and to address some of the points that have been made about the service.

The first thing I think the service would like to get across is that gender should be seen as a spectrum. The whole treatment pathway is based on allowing children to explore their feelings in a safe environment. Not all children referred to the service will go on to transition. That is an important point to recognise, because if children have the time and space to work through their feelings, that will perhaps lead to a different treatment pathway.

I know there has been lots of concern that too many children are being referred to the service, but I would like to reassure the House that the service takes children through treatment in a very exploratory way around gender, and more than half of the children referred do not go on to transition. The service will treat each case as individual and complex and will address some of the co-morbidities that come along with gender dysphoria—lots of concern has been raised about the fact that some of these children are also on the autism spectrum.

It is important to recognise that, compared with services internationally, the service is very much at the conservative end of provision, which has led to it being criticised as far too conservative by some aspects of the lobby in favour of more services. However, where we are dealing with children who have not reached the age of majority, and where some of the treatments they may go through may be irreversible, the whole issue of consent is clearly important.

It is important to note that this aspect of service has grown quickly, and it has done so in an absence of public scrutiny. I can understand why there will be some public concern about it, so I would like to reassure the House that I am working with NHS England to do a proper review of the research around this service and the ethics of it to establish a proper framework for consent, recognising that we are looking at treatments that may have long-term consequences.

I can assure the House that the service works hard to ensure that consent is robust and that young people who might receive hormone therapy receive adequate information about the nature and consequences of that treatment. Such consent is not a one-off decision; it requires ongoing dialogue with the service. It will also require some assessment of the capacity and competence of the individuals consenting.

It is important to assure the House that this issue is very much under review. My starting point is that nothing should be undertaken in this space that would be irreversible for anyone under the age of 18. With that in mind, NHS England is putting in place a new policy and a new service specification for children’s services, and will thoroughly consider the issues that have come up in the press recently. Clearly, those issues will be a matter for debate, and many Members will have an interest in them. It is important for public confidence, as well as to enable access to services, that we have a proper, ethical debate around consent and the clinical evidence behind prescribing long-term hormone treatments.

Finally, I want to say a little about cosmetic procedures and regulation. I am pleased to see the right hon. Member for North Durham in his place—he is my conscience on these issues. It is fair to say that they are becoming increasingly common, and as they do so, they are becoming increasingly risky. Increasingly, it is becoming normalised for young women, in particular, but not just young women, to seek cosmetic procedures to alter their appearance.

I was pleased to launch an awareness campaign around cosmetic procedures earlier this year, which I have driven forward to make sure not only that we encourage people to properly consider the risks of any procedure they might undertake, but that they do not just wander down to the hairdressers and book a Botox appointment or a filler but really take steps to make sure they are going to a reputable provider. It is important that people fully understand the risks and where to look for a safe procedure. We have made sure that there is good material on the NHS website, and we are encouraging people to access that information when they are considering having any kind of procedure.

However, there is a really important message that we must give, which is that anyone considering having anything done to their appearance should not seek an operation overseas. There are some very disreputable operators advertising—for example, there are holidays in Turkey with a procedure. That is hugely dangerous, and I am afraid that the NHS is picking up the costs of those procedures. That is obviously something we need to address properly.

We will look at stronger regulation of the sector. Again, I would say that no one under the age of 18 should seek a cosmetic procedure. We have come to think that having some kind of lip filler is just like going to have a haircut, but when it goes wrong the results are much worse than having to let our hair grow back. Therefore, no one under the age of 18 should be seeking such procedures, and we need to do a lot more to make people realise exactly what the risks are.

[Bambos Charalambous]

Obviously, the harm is done with young people early on, and they are very impressionable—we have mentioned reality TV, and the Digital, Culture, Media and Sport Committee is looking at its impact. Does the Minister not think that we should try to teach positive body image at school and provide support at school for people who have concerns about their body image? That would be a wise investment of Government funds and would actually help young people to address their concerns and anxieties at every stage.

[Jackie Doyle-Price]

I agree with that. Through the new personal education that will be rolled out next year, we will have the ability to address that issue. I would just say that we need to be careful about this and to give some scrutiny to what the content of that might be. We have to really make sure that people respect the fact that we are all different and we all come in odd shapes and sizes, but everyone is beautiful. That is a really important message to convey. It will be incredibly challenging to get that content right, and we do need to bring some scrutiny to that.

Body image is clearly a strong contributory factor in many cases of mental ill health. I am pleased that we are starting to tackle some of these issues, but there is a long way to go. We have reached a stage at which the herd has gone so far down the road that the idealised view that everyone is a size zero model, whose perfectly coiffed, long, naturally blonde or brunette hair has no shades of grey and no curls, has taken hold. It will take a long time to turn that juggernaut around, but in the interests of a healthy society we all need to get a grip.

Public Health Funding: Enfield

Bambos Charalambous Excerpts

Tuesday 16th July 2019 Westminster Hall

[Joan Ryan (Enfield North) (IGC)]

I beg to move,

That this House has considered public health spending in Enfield.

It is a pleasure to serve under your chairmanship, Mr Betts.

I requested this debate to highlight some of the harsh realities stemming from the Government’s decision to slash the public health grant to our community, and to draw attention to the fact that the ongoing uncertainty around long-term funding is prompting a crisis in public health. Our council’s ability to deliver a range of public health services aimed at preventing disease, prolonging life and promoting good health is being seriously affected.

The Government’s national health service long-term plan may have put prevention at the heart of its policy but, to quote David Finch, senior fellow at the Health Foundation:

“The sustained cuts to the public health grant clearly run counter to these aims. The public health grant is not a nice-to-have. Without urgent reinvestment, we will continue to see a direct impact on people’s long-term health”.

Last month, the Health and Social Care Committee said that cuts to public health services were a “false economy”. Cancer Research UK and more than 80 other organisations have come together to call on the Government to provide a sustainable solution for public health. Ministers must take immediate and positive action to increase investment in public health, to reduce health inequalities and to support our health and social care system.

I will take this opportunity to pay tribute to the work of the Enfield Over 50s Forum and its president, Monty Meth, who is sitting in the Public Gallery today with many of the forum’s members. Their typically dogged campaign to highlight the cuts to Enfield’s public health grant and the disparity in per-person funding between our borough and other councils in London has forced this issue to the top of our community’s agenda.

The Minister should be well aware of the forum’s work on this matter, given the number of letters that its members have written to her and her Department in recent weeks and months—although, sadly, their letters have not received a considerate ministerial response. Instead, they have received a reply from the Department’s correspondence unit that, to put it mildly, leaves a lot to be desired.

One constituent with impeccable manners, who forwarded me a copy of the letter he received, described the response as “baloney.” Another resident labelled the reply “meaningless” and “full of Whitehall gobbledygook”, and it is hard to disagree with that analysis when they are treated to phrases such as:

“The formula is designed to generate target allocation shares of a funding envelope”.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Does my right hon. Friend agree that, because the baseline funding has been set from 2013, it takes no account of changes in the population of Enfield to do with age, poverty and other factors that might hugely affect the funding that Enfield actually deserves right now?

--- Later in debate ---

[Seema Kennedy]

I will move on to the specific issue of the funding formula, how it came into being and how it might change. Of course public health is a question of the investment that national Government put in and how local authorities spend it, but there is a lot of innovation. I applaud Enfield Council and all local authorities for what they have done, because different authorities have used it in different ways. They are adopting innovative approaches. They are renegotiating contracts that perhaps had been untouched for years before the 2013 transfer. I will address funding later in my remarks. Councils are adopting new service models that have the potential to reach communities that have often been left out by traditional service delivery models.

I recognise that in the last spending review, there were difficult decisions to be made to ensure the sustainability of public finances, but over the five-year period, £16 billion has been available to local government for use on public health, including £3 billion for the current financial year.

The right hon. Lady raised a very important issue about the distribution of funding for local authority public health activity. I recognise the pressures that she has referred to specifically in relation to Enfield. When responsibility for local health functions moved from the NHS to local government in 2013, funding for relevant services was transferred to individual local authorities. That was based on historical local spend for the NHS, and the process revealed huge variation across the country. The funding for Enfield is based on what the NHS had been spending there up until 2013.

The Government are now carefully considering how to allocate public health funding in a more needs-based way, rather than continuing to allocate funding based on NHS historical spend. We recognise that Enfield’s per capita funding breakdown is different from that of other London boroughs, but a per capita basis is not actually a meaningful way of comparing allocations or the best way of determining funding. That is precisely because it takes no account of different levels of need and it disregards significant variables that have a major influence on the need for public health interventions. An example is the age profile of a local authority’s population. We will look carefully during the next spending review at future funding arrangements and the best way to allocate funding to each local authority.

On the letters from the Enfield Borough Over 50s Forum, if the right hon. Lady would like to distil those messages into a letter to me, I will happily respond to her and she can make that response available to her constituents.

[Bambos Charalambous]

A future funding formula needs to take account of need. There should not be the current differentiation. Kensington and Chelsea receives £82 per person more in funding than Enfield. It cannot be right that two boroughs that are about 8 miles apart have such a variance in funding. Will a future funding formula take more account of local needs?

[Seema Kennedy]

As I have said, the Department is looking at the funding formula. The hon. Gentleman says that the boroughs are only 8 miles apart, but we know that in areas that are very close together, life expectancy and, importantly, the length of time a person lives in good health can vary hugely. That is why we need to look very carefully at all the factors before the new formula is created. That will be assessed in the next spending review in the light of all the available evidence.

I am committed to working closely with local government, and with other partners and colleagues, to build on the achievements of the last six years. We need to act on a local, national and global level to meet the public health needs of the present and to rise to the public health challenges of the future.

Question put and agreed to.

Medical Cannabis under Prescription

Bambos Charalambous Excerpts

Monday 20th May 2019 Commons Chamber

[Tonia Antoniazzi]

I entirely agree, and I am very concerned about it. We have heard in the House this evening that people are growing their own cannabis, and there is a growing trade. There is an online family of people who are helping each other to obtain the most THC possible from different combinations of different plants. It is a complete industry. Why are the Government not getting a grip, and providing a proper, GMP-standard, pharmaceutical product for people?

I also want to talk about the cost, which is extraordinary. Has the Minister or anybody in her office done a cost-analysis? Alfie Dingley’s case provides a classic example: how much has he saved the NHS by not having emergency medication and not using the ambulance service to go into hospital? It seems nonsensical that we are not going down this road.

I want to talk about a couple of my constituents. Only a few weeks ago I had a visit from the parents of a 14-year-old son. My son is 14 too, so their situation struck a chord with me. Their son has intractable epilepsy. Mum has given up her job to look after him—he has a very efficient system around him. He benefits from a ketogenic diet and the next available medicine is Epidiolex. Epidiolex does not contain THC but she wants her child to be on a trial, and the trial is limited. A mum should not come to me begging for her son to be on a trial, but when I spoke to her about medical cannabis with THC she was reluctant to engage because of a fear of breaking the law and of not following the system properly. All our families are following a system. They are at the end of the road in terms of what medicine they can be given, so I want them to be given medical cannabis with THC as soon as we can.

NHS England is drafting terms of reference, and as co-chair of the APPG I appreciate its efforts. These children must have access, however; they must not be waiting three or four years. I urge NHS England to work collaboratively with the devolved nations because we need our children in Scotland, Wales and Northern Ireland to have the same benefits.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I congratulate my hon. Friend on her excellent speech and the excellent work she has been doing with the APPG. I also congratulate the End Our Pain campaign, which has done so much to raise this issue. Does my hon. Friend agree that NHS England needs to improve its guidance on intractable epilepsy and fast-track it so that children can get the THC they need?

[Tonia Antoniazzi]

I totally agree that a completely different approach is needed if we are to get the medicine to our families now.

It is very upsetting that families are risking getting criminal records by bringing in medical cannabis and are having to fundraise for prescriptions. I pay tribute to families that are fundraising in the public domain—to the parents and the friends, such as Craig who has cycled many, many miles up Pen y Fan recently to raise money for Bailey. I say to all those families that are raising money, “Don’t give up; there is hope, and hopefully we will be able to get you the medicine you need on prescription from the NHS.”

It would be very remiss of me to stand here and not pay tribute to the late Paul Flynn, former Member for Newport West. Paul was an absolute inspiration. I was a patron of an organisation with him and he was inspirational when I went to Birmingham to speak with him. His knowledge of and passion for medical cannabis was second to none, and I know that, as Madam Deputy Speaker mentioned, he is watching over us now and hoping we will get the breakthrough he was working so hard towards.

My hon. Friend the Member for Manchester, Withington (Jeff Smith) spoke of a bespoke medical response and creative thinking, and I ask the Minister to work with us: pull groups of families out of local trusts and set up an immediate observational trial with the 18 families that we have at End Our Pain; get the NHS to pay for the costs of the medicine when a private prescription has been issued until NHS prescribing is more routinely accepted; and allow the guidance from medical cannabis experts to be used. Some excellent UK experts have come together to form the UK Medical Cannabis Clinicians Society, and they have issued prescribing guidance, too. I say, “Please, work with the NHS to give clear central guidance that medical cannabis is legal and that there is an expectation that it will be prescribed as a normal unlicensed medicine when appropriate.”

Oral Answers to Questions

Bambos Charalambous Excerpts

Tuesday 7th May 2019 Commons Chamber

[Mr Speaker]

Order. We have a lot to get through. I shall take one more question, and then we must move on.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Today I met representatives of the Teenage Cancer Trust. As we await the publication of the workforce implementation plan following the publication of the NHS long-term plan, what plans does the Minister have to ensure sustainable funding for the teenage and young adult cancer specialist workforce?

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

I thank the hon. Gentleman for his question; I had the pleasure of meeting representatives of the Teenage Cancer Trust recently as well. Cancer is an absolute priority for the Government. Our aim is for 75% of all cancers to be detected at an early stage by 2028. As my right hon. Friend the Secretary of State has said, the workforce plan will be reporting imminently.

Age-related Macular Degeneration: NHS Funding

Bambos Charalambous Excerpts

Tuesday 9th April 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I beg to move,

That this House has considered NHS funding for age-related macular degeneration.

I begin by welcoming the Minister to her place. I am very pleased that she is now a Minister and I look forward to having many more interactions with her.

Sight is a wonderful gift. Sight allows us to witness and experience the world we live in. It is not surprising that, in survey after survey, the fear of losing one’s sight comes top in comparison with other conditions. It is remarkable that we do not hear more about the leading cause of blindness in adults, which is age-related macular degeneration or AMD for short.

AMD is the breaking down of the macula, which is the sensitive and small tissue at the centre of the retina. It is responsible for processing central vision and allows us to see colour, detail and sharpness in objects. There are two types of AMD: dry and wet. Dry AMD, which affects 90% of people with the condition, is caused by thinning of the under-layer of the macula, which can lead to blurred vision. Thinning of the under-layer of the macula is caused by small white or yellow deposits called drusen. They may at first not affect vision all that much, but as they build up over time, they can lead to blind spots in someone’s central vision and can later become wet AMD.

Wet AMD is usually caused by new blood vessels growing underneath the macula that bleed and leak into the macula, which can cause blindness and distort vision in that eye. The onset of wet AMD is more rapid and can be more damaging, leading to irreversible vision loss. According to the charity Fight for Sight, AMD is the leading cause of sight loss in the UK, predominantly affecting people aged over 65. It accounts for 50% of severe sight impairment and 52% of all Certificate of Vision Impairment registrations in England and Wales.

AMD progressively damages a person’s central vision, which in some cases can leave them unable to read, drive or recognise faces, although they may retain their peripheral vision. It is estimated that 600,000 people in the United Kingdom are living with late-stage AMD. Industry data suggest that by 2026 there will be 9.7 million people in the UK affected by all stages of AMD and 800,000 of them will have late-stage disease that affects their vision. Projections suggest that by 2050 the figure for people with late-stage AMD could rise to 1.3 million unless measures are taken now to address this issue.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my hon. Friend on securing this very important debate and I, too, welcome the Minister to her place. Significant numbers of people will potentially lose their sight. My hon. Friend has cited some of the figures. By 2050, the number of people living with sight loss will be in excess of 4 million. Does my hon. Friend agree that, given the numbers, it is time that we had a UK-wide vision strategy on eye health and sight loss?

--- Later in debate ---

[Bambos Charalambous]

My hon. Friend makes an excellent point; I will come to that matter later in my speech.

AMD is an ever increasing public health issue, presenting as one of the number of long-term conditions that can lead to an increased risk of morbidity in patients. AMD costs the economy an estimated £1.6 billion a year and hits the productivity of society. There is a strong correlation between AMD and decreased quality of life outcomes, including an increase in depression, impaired ability to do everyday tasks, feeling more socially isolated and being 1.7 times more likely to suffer falls. Twenty-one per cent. of the annual medical cost of falls, which is £56.5 million, is attributed to those with visual impairments. The loss of independence resulting from sight loss can also be incredibly debilitating because systems are not set up to deal with it.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate, and I offer the Minister all best wishes in her new position. It is well deserved, and we look forward to working with her regularly in Westminster Hall and elsewhere.

My father suffered from AMD, although he did not know he had it until it had reached a late stage. Does the hon. Gentleman agree that early diagnosis is important for all matters of eye care that affect us, as is visiting an optician at least once if not twice a year? That is one positive thing we can do.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. Early diagnosis is so important, especially for wet AMD. The target requires people to be seen within 18 weeks of diagnosis, but that is unacceptable for people with wet AMD who should be seen within two weeks. Otherwise, their vision could suffer serious damage.

One concern is that the NHS has insufficient eye clinic capacity, due to delays and cancelled appointments that the British Ophthalmic Surveillance Unit has identified could lead to up to 22 patients a month losing their vision. The all-party group on eye health and visual impairment—I am pleased to see two members of the group here today—is supported by the Royal National Institute of Blind People, and in its inquiry, “See the Light”, published in June 2018, it identified 16 recommendations on which the Government should take action.

Three recommendations on which the APPG is still waiting to see progress include: the urgent need to increase the number of trainee ophthalmologists to keep pace with increasing demand; the need to ensure that sustainability and transformation partnerships—STPs—address current and future need; and the need to establish a national target to ensure that patients who require follow-up appointments are seen within a clinically appropriate time to prevent delayed and cancelled appointments.

According to statistics from the Industry Vision Group, last year three out of 44 STPs identified ophthalmology as a priority service, and only seven out of 44 met the 18-week referral target every month between January 2017 and January 2018. Early intervention for wet AMD is crucial to avoid blindness, and even the 18-week target that I mentioned to the hon. Member for Strangford (Jim Shannon) is not suitable for people with wet AMD, which requires treatment within two weeks. There is still a need to collect robust data on ophthalmology at clinical commissioning group level in order to assess performance and learn from best practice. Some of the issues relating to delay or the cancellation of appointments may be due to systems and processes, and not necessarily to funding.

Ophthalmology has the second highest outpatient attendance of any speciality, with 7.6 million appointments in England in 2017-18 accounting for 10% of all outpatient appointments. As we are all living longer, that figure is projected to increase by up to 40% over the next 20 years. The Government could do a number of things to help improve the situation for people with AMD and other sight-threatening conditions. First, we need a national eye health strategy—that point was raised by my hon. Friend the Member for Battersea (Marsha De Cordova). Unlike Scotland and Wales, England does not have a national eye health strategy, but one is needed to address workforce capacity issues and health inequalities, and to enable better care and improvements to the quality of life for those with AMD.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

The hon. Gentleman is making a good point. In my community the Kent Association for the Blind has done a lot of work on this issue, and I was proud to visit it recently. I also congratulate my hon. Friend the Minister on her new appointment, and on her liberation in finding her voice again and being able to express her own views, albeit of course measured through those of the Government.

[Bambos Charalambous]

I am pleased to hear of the excellent work taking place in the hon. Gentleman’s constituency.

Contained within the strategy should be a minimum commitment to research similar to that given in the Government’s dementia 2020 challenge, which committed £60 million a year to dementia research, resulting in significant advances for those suffering with dementia. It is unclear how much funding has been set aside for ophthalmology from the £20 billion announced in the Government’s NHS long-term plan. I would be curious to hear from the Minister whether it is part of the plan or not.

There is also a need for the establishment of a national ophthalmology database to collect and analyse data for the purpose of improving outcomes, better decision making, and allocating resources. At present, there is fragmented data collection, such as that by the health quality improvement partnership, administered by the Royal College of Ophthalmologists, which covers only cataract surgery. A database that routinely collects information on AMD would greatly assist research and the planning of clinical care for those with AMD.

All STPs and integrated care schemes should be held accountable for developing and implanting integrated ophthalmology plans. Three years ago, the Department of Health commissioned a number of “Getting It Right First Time” reports into a series of areas, including ophthalmology. Unfortunately, that report is yet to be published, but hopefully when that happens it could inform the integrated ophthalmology plan, along with other sources such as the Royal College of Ophthalmologists’ “Way Forward” reports.

[Jim Shannon]

The hon. Gentleman is very gracious. As I should have said earlier, I declare an interest as the chair of the APPG for eye health and visual impairment. He is right that it is important to visit an optician to have a test for AMD, but such a visit can have other benefits. Through a person’s eyes, an optician can get an idea of what that person’s body is like, and can diagnose other things that are wrong. There are other benefits to visiting an optician for an early AMD test, in terms of everything that goes with it.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. We should all visit opticians on a regular basis, because they can detect a whole series of other eye conditions.

My second ask is for the publication of a workforce development plan for ophthalmology. That should also be a priority. There is already a shortage of eye care specialists who can diagnose and treat AMD. The number of ophthalmologists in the UK is the second lowest in Europe. The numbers are expected to reduce further, while the patient population is likely to increase significantly. The Department of Health and Social Care should commit to producing a workforce development plan that addresses the current situation and assesses future demand and provision need.

NHS RightCare should also develop guidance and a workstream for AMD, and data packs that can be shared as a resource and inform improvement in treatment for AMD. An IT platform that allows better integration of services is needed—for example, from primary care to hospital-based ophthalmology—so that a more joined-up approach can lead to better outcomes for patients with AMD.

Finally, it should be remembered that there is a link between sight loss and mental health, depression and frailty. The secondary effects of sight loss should also be considered when making both national and local policies on commissioning services.

[Marsha De Cordova]

My hon. Friend is being very generous. On that point about the impact of sight loss and the link to mental health, does he agree that a clear strategy would enable all services to be more joined up, so that when somebody is diagnosed with losing their sight all the relevant support would fall into place because there is a clear pathway?

[Bambos Charalambous]

My hon. Friend makes an excellent point. The impact of sight loss can lead to depression and other mental health issues, so they should form part of any strategy related to sight loss. I agree with her 100%.

I ask the Minister to recognise the need for more attention to the needs of people with AMD, and to set about taking on board and implementing the suggestions that I have raised.

Services for People with Autism

Bambos Charalambous Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

The hon. Gentleman has referred to adults, but I remember going on a trip with the APPG to a young offenders institution that had tried to establish a wing that was autistic-friendly, and hoped to roll it out across the estate. He is right: a big cohort of the prison population are on the spectrum, and face particular challenges that need to be looked at.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Will the hon. Gentleman give way?

[Huw Merriman]

I will give way one more time, but I really should make some progress.

[Bambos Charalambous]

The hon. Gentleman mentioned the issue of employment, which is vastly overlooked. Many employers do not know what adjustments they should make to become more autism-friendly, and people with autism are deprived of work as a result. Will the inquiry be looking at that issue?

[Huw Merriman]

A few years ago, Ambitious about Autism produced a big report looking looked at that specifically. I am fortunate to have in my constituency an organisation called Little Gate Farm, which takes people who have finished their education and makes them work-ready. However, it requires employers to give them a chance, and I am always writing to employers urging them to do so.

Let me give some examples. One young lad was obsessed with washing cars. We matched him up with a garage, and that is exactly what he does. Someone else was given a job in a bookkeeping firm. The big challenge there is ensuring that that young person takes time off, because they have become so used to the routine. The initiative has become so successful that people are throwing themselves into work. We must do all that we can, as Members of Parliament, to pair and support people.

My right hon. Friend the Member for Chesham and Amersham says that we in the APPG

“will hold the Government’s feet to the fire to see those recommendations reflected in the new strategy.

Our need to act is clear. Too many people”—

as we have just discussed—

“still have to wait too long for a diagnosis—more than three years in some parts of the country. Getting a diagnosis can be a crucial milestone, helping to unlock vital support. Delays in being diagnosed can result in people developing more significant needs, or mental health problems.

National guidance from the health watchdog NICE state clearly that children or adults suspected of being on the autism spectrum should start their diagnostic assessment within three months of being referred to their local autism team. But we know there is a postcode lottery in waiting times for appointments, with many parts of the country falling far short of the three-month target. Alongside the National Autistic Society, we have been pushing progress on this issue in this very chamber for several years. Valuable research”—

carried out by the right hon. Member for North Norfolk (Norman Lamb)—

“on behalf of the APPGA shone a further spotlight on these long waits and called for a mandatory minimum waiting time standard. I am pleased to have him on board again leading our inquiry on health and mental health, which heard evidence last week.

We also know that autistic people too often don’t get the physical and mental health care they need. They face high levels of health inequality, and evidence suggests that people may die early as a result, which has been highlighted by Autistica. It’s vital that all health and care staff receive autism training to ensure that our health service meets their needs and makes the changes and adjustments that it needs to—a key part of the Autism Act. I welcome the Government’s current proposals on mandatory training in autism and learning disability to all health and care staff following the dogged campaigning of Paula McGowan, a mother who tragically lost her son Oliver. It’s vital that this proposal is taken forward and that its impact is monitored. I hope the Minister will devote some time to make sure that this programme makes a difference.

I also welcome the inclusion of autism, alongside learning disability, as one of the four clinical priorities in the NHS 10-year plan to improve health services. This is a great step towards ensuring that the NHS supports autistic people as well as it supports everyone else. It sets out actions to reduce children’s diagnosis waiting times, reduce the number of autistic people inappropriately under section in mental health hospitals, and making sure that reasonable adjustments are put in place. But we need more details on how these, and other commitments in the Plan will be delivered (and how they will be funded). I would appreciate if the Minister could update the House on when we can expect to see this much-needed detail.

I am pleased to see the Government already thinking ambitiously about the future of the strategy. I warmly welcome the Government’s commitment to extending the autism strategy to include children and young people, as well as adults, for the first time.”

NHS 10-Year Plan

Bambos Charalambous Excerpts

Tuesday 19th February 2019 Commons Chamber

[Bambos Charalambous (Enfield, Southgate) (Lab)]

In May 2018, I introduced my private Member’s Bill on palliative care. Investment in palliative care will help save the NHS billions. While the long-term plan deals with some aspects of end-of- life care, it does not go far enough. There is still a postcode lottery when it comes to hospice funding, with some areas getting up to 50% of their funding from clinical commissioning groups, while other areas get as little as 1%.

We will all be living longer, so it is vital that we put in place proper funding for hospices and end-of-life care. I am very lucky to have North London Hospice’s health and wellbeing centre in my constituency. It provides excellent services for users, but I am still staggered that it has to constantly fundraise to keep them going. These services are vital and should not be dependent on people’s charity. I ask the Minister to commit to making all clinical commissioning groups assess the need for palliative care in their area and provide funds accordingly to meet that need.

Another area where we need additional investment is the NHS workforce. To address the anticipated rise in cancer, with the rise in life expectancy, the Government need to ensure that measures are in place to deal with training, recruitment and retention of staff. Macmillan Cancer Support states that currently 2.5 million people in the UK are living with cancer. That figure is expected to reach 4 million by 2030. That will put huge pressure on the NHS cancer workforce in the foreseeable future.

There is a particular concern about breast cancer specialists. For every three breast radiographers who retire over the next five years, only two are expected to replace them. Breast Cancer Now has called on the Government to invest £39 million in recruitment for the breast imaging and diagnostic workforce, as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall of radiographers. The problem is being compounded by the delay in the production of phase 2 of the cancer workforce plan, which should be an integral part of the long-term plan. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand. That can then be set out in the 10-year cancer workforce strategy.

Unless the Government get workforce planning right, I have serious concerns that patients will suffer. I urge the Minister to take action to deal with these matters urgently.

Orkambi

Bambos Charalambous Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin (North Herefordshire) (Con)]

Last week, one of my constituents, whose daughter suffers from cystic fibrosis, came to see me. He explained that every year that access to Orkambi or other such similar drugs is delayed takes 10 years off the life of his daughter.

My constituent explained how the long hours in hospital and in treatment mean that cystic fibrosis defines his daughter’s life. However, clinical trials by Vertex seven years ago marked the start of a new hope. Vertex’s amazing progress suggested that he might not outlive his daughter, that she could have the fullest life now possible, and that he would not have to tell her that she was likely to die when barely into adulthood. The whole House will understand that never in his worst nightmares did he consider the fact that these drugs would succeed yet be unavailable to his daughter.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the hon. Gentleman aware that Orkambi, which is manufactured by Vertex, is licensed and available in Ireland and the Netherlands where there are only 1,000 cystic fibrosis sufferers, but not available in the UK where there are more than 10,000 sufferers? Does he agree that that is a terrible shame?

[Bill Wiggin]

I suggest that the hon. Gentleman hears the rest of the speech before he expects to draw any conclusions.

Cystic fibrosis is a life-limiting genetic disorder. Patients with cystic fibrosis experience a build-up of thick mucus in their lungs. This can have a wide range of effects on their respiratory, digestive and reproductive systems. The disease is widespread in the UK. One person in 25 carries the faulty cystic fibrosis gene. Statistically, that is 26 Members of this House whose future generations could be affected by this cruel disease.

Cancer Workforce and Early Diagnosis

Bambos Charalambous Excerpts

Tuesday 8th January 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.

Lives are saved when cancer is diagnosed early. I know we all are united in wanting all cancers to be caught early so that survival rates can be drastically increased. However, to diagnose and detect cancer early, we need a sufficiently skilled workforce and full staffing. NHS staff do amazing work, but they are under extreme pressures. We are one of the richest countries in the world, but lives are being lost because of under-investment in our NHS workforce. If we are to come anywhere near to achieving the Prime Minister’s target of diagnosing three in four cancers at their early stages by 2028, we will need to have a long-term plan that will deal with the staffing shortages, which will no doubt get worse post Brexit.

Cancer Research UK estimates that by 2035 a person will be diagnosed with cancer every minute. At present nine out of 10 people will survive bowel cancer if it is diagnosed at an early stage, but that figure reduces to only one in 10 if it is not diagnosed until stage 4. Currently between 46% and 61% of cancer sufferers are diagnosed at stage 1 or 2, which means that people are slipping through the net and dying needlessly owing to a lack of resources. With 40% more people being referred for diagnostic cancer tests than four years ago, cancer diagnostic services are struggling to keep up with demand. They have already missed their cancer waiting time targets over the past three years.

I am the co-chair of the all-party parliamentary group on breast cancer. The rest of my comments will focus on breast cancer, for which the situation is even worse than I have been outlining. The breast imaging and diagnostic workforce are critical for the early diagnosis of breast cancer, but Breast Cancer Now has discovered that only 18% of breast screening units are adequately resourced with radiography staff to meet demand. Taking into account the ageing workforce of breast imaging radiographers and the increase in demand, we have an exacerbation of pressures that will only get worse. For every three breast radiographers who retire over the next five years, only two are expected to replace them, which means that imaging and diagnostic services will be unable to keep up with demand. That will cause delays, which in turn will cause greater anguish for those waiting to be tested.

Fifty-five thousand people are diagnosed with breast cancer in the UK every year, yet the survival rates lag behind those of Sweden, Portugal, Germany and France. We have a declining workforce and an increase in demand. Unless the Government invest in a fully funded workforce plan, patients will suffer. We need a new approach to workforce planning based on best practice and clinical need. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand, and set out a 10-year cancer workforce strategy. The plan must be backed with appropriate funding. Breast Cancer Now has called for the Government to invest £39 million in recruitment to the breast imaging and diagnostic workforce as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall in radiographer numbers.

The Government’s decision to scrap bursaries for allied health professionals and nurses is a factor in making it harder to recruit. Someone who wants to become a mammographer must self-fund an MSc following a three-year radiography degree. Prior to the 2017 bursary cuts to allied health professionals courses, including for diagnostic radiographers, the undergraduate degree was covered by a bursary. Following that disastrous cut, there was a 20% decrease in the number of applications to allied health professionals courses and a further 9% cut in 2018. That under-resourcing, directly linked to the Government’s bursary cuts, has undoubtedly cost lives. I urge the Minister to reverse the cut to bursaries to ensure that the financial barriers to becoming a mammographer are removed and that more applicants are encouraged to apply for allied health professionals courses.

Funding for early diagnosis is not just about staffing levels and recruitment. It is also about new technology. There are new improved ways of detecting breast cancer, such as via tomosynthesis, which is far more effective in detecting breast cancer in some women. Artificial intelligence could also be used to assist in analysing the vast data capture involved in screening, but that would require the commitment by the Government of investment in new technologies and training. Risk-stratified breast screening is another way of making better use of technology to assess a woman’s individual level of risk by using algorithms to assess various risk factors. Once an assessment has been done, a more personalised service can be given for women at higher risk, which could again help to save lives.

I will finish by asking the Minister whether he will commit to getting Health Education England to produce phase 2 of the cancer workforce plan, which will be based on need, and confirm that it will be properly funded. Will he reverse the cuts to bursaries for courses for allied health professionals and nurses, and make sure that recruitment levels are up to the levels that are required, especially with Brexit looming? Finally, will he commit to exploring and funding new technologies and training that will help to detect cancer earlier, target those who are at higher risk, and alleviate the pressures on the workforce? If the Government do not get things right in relation to the shortfall in funding for early diagnosis and the cancer workforce, some people will inevitably die an avoidable death from cancer.