Artificial Intelligence in Healthcare

Ian Paisley Excerpts

Thursday 5th September 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is a great pleasure to serve under your chairmanship, Mr Paisley. The debate has been really interesting, particularly in the light of the number of Members who stood up and admitted that, although they could not send emails, only recently learned how to text and do not use contactless payment cards, they were very much in support of the potential of AI technology and what it can offer patients, healthcare settings and the public at large.

AI is exciting and innovative. I have been in my Department only a few days and I have learned some more from this debate. I hope to have some answers for hon. Members, every one of whom gave an example of the exciting breakthroughs and areas of application of AI, as well as of what it can deliver for patients. That is incredibly exciting.

I thank my hon. Friend the Member for Crawley (Henry Smith) for securing this debate. He made the point about misinformation and fake news. We need more of these debates because Westminster Hall, and this place as a whole, is a good forum to knock down those myths, get rid of fake news and stop fearmongering about the use of AI, because journalists who are interested in AI will follow these debates and quote what hon. Members say. We should have more debates on this subject in future.

Artificial intelligence has the potential to make a massive difference to health and care. There are significant opportunities to save money, improve care and save lives. AI technology could help personalise NHS screening and treatments for cancer, eye diseases and a range of other conditions, as well as free up staff time.

Almost all health and care services can benefit from AI in some way, but realising its potential for our health and care system depends on the involvement of patients. We are committed to working with patients to ensure that they understand and are involved in the decision making about how we use AI to deliver the impact that we both want and need.

I will give a few examples of how AI is working. Some patients have already benefited from it, as hon. Members have highlighted. John Radcliffe Hospital in Oxford has developed a system that uses AI to improve detection of heart disease and lung cancer, as the shadow Minister mentioned. Currently, 20% of heart scans result in a false positive diagnosis, and the subsequent 12,000 unnecessary operations cost the NHS about £600 million a year. The potential financial savings are huge.

Another fantastic example of the use of AI is that of Moorfields Eye Hospital’s implementation of the DeepMind AI algorithm for retina scans. The AI can correctly recommend patient treatment referrals, to the same or better standard as world-leading doctors, for more than 50 sight-threatening eye diseases. Tens of thousands of scans were taken of people with both healthy and diseased retinas, and DeepMind developed software that could detect—long before a doctor could—sight-threatening diseases and the patterns that lead to them. That is just one example.

The use of AI goes further than just diagnostics. NHS 111 online, once fully implemented, will automatically triage patients by using AI technology. The system sends patients to the most appropriate care setting and reduces unnecessary A&E visits, meaning that patients can access the care that they need faster.

We must make best use of the available resources within the NHS to harness the full potential of AI, which relies heavily on enormous amounts of data to learn and become effective at its task. That data must be shared safely, however. Health data that is shared fairly, ethically and transparently has the potential to improve outcomes for patients, improve the efficiency and efficacy of the NHS, and underpin the next wave of innovative research taking place in the UK.

To help the NHS and researchers share health data in a safe, secure and lawful way, the Government have committed to developing a policy framework that sets out our expectations for how the NHS should engage with researchers and innovators when entering data-sharing partnerships. That builds on the work of the code of conduct for data-driven health and care technology. We are committed to involving patients and the public in the development of that policy. That is key and comes back to the point made by the hon. Member for Cambridge (Daniel Zeichner). Patients must be at the heart of and engaged in projects, understanding how their data will be used in future and reassured of its safety.

To support the NHS in embedding the framework in practice, we will also set up a national centre of expertise. The centre will sit in NHSX and provide hands-on commercial and legal expertise to NHS organisations to support them in reaching fair, ethical and transparent agreements for data. Although AI has been the subject of much speculative reporting, on both benefits and risks, we know that it will bring big changes to the way in which care is developed and experienced.

While we promote the latest data-driven scientific advances in healthcare, we must always ensure that patient data is respected and properly protected. Data is vital to the delivery of safe and high-quality care, but we need to ensure that an understandable and trusted system is in place, which patients can be confident will protect their data. The Government are clear that patient data will only ever be used and/or shared when anonymised, or with the consent of the individual, unless for direct patient care. That is an important point and one that almost everyone made.

We have therefore put in place several safeguards, including legislation such as the Data Protection Act 2018, enacting GDPR; data and cyber-security standards applicable across the health and care system; and legislation that is under way to put the National Data Guardian on a statutory footing to provide an independent and authoritative voice on how data is used across the health and care system. We have also launched the national data opt-out, which gives individuals choice of how their data is used beyond their individual care. That gives patients choice, which is important.

In some instances, it will be appropriate for patient data to be shared for secondary purposes, such as when consent has been given on behalf of the patient, or there is an overwhelming public interest in sharing. The National Data Guardian is supporting work with NHSX to clarify and update guidance on the lawful use of patient data to support the understanding of the public, clinicians and industry. We do not want to hinder the progression of innovations, but all patient data should be handled with the respect and care that the public rightly expect.

We are also very aware of the ethical issues that can be raised by artificial intelligence at a personal, group and system level. Bias is a current common issue with the use of AI, and we must curtail any bias within algorithms by ensuring that the data feeding them reflects our diverse population and range of health economies. Initiatives such as DeepMind’s ethics and society research group and the Partnership on AI, which counts IBM, Microsoft, Facebook and Amazon among its members, show that industry is alive to the issues. We are already taking steps to ensure the safe development, deployment and use of AI, and the published code of conduct for data-driven health and care technology that I mentioned earlier encourages technology companies to meet a gold-standard set of principles to protect patient data to the highest standards.

NHSX announced that it would set up an “AI lab” to bring together the industry’s best academics, specialists and technology companies to build groundbreaking diagnostic tools and treatments in line with the NHS’s priorities. NHSX is delivering the Prime Minister’s grand challenge mission to use data, artificial intelligence and innovation to transform the prevention, early diagnosis and treatment of chronic diseases by 2030.

The NHS AI lab will harness the power of data science and AI to continue the UK’s great tradition of using evidence-based decisions in health, public health and social care, and to position the NHS as a world leader in artificial intelligence and machine learning. It will collaborate widely to identify impactful ways to improve the NHS through more sophisticated use of its data. Once identified, the lab will develop, test and deploy early-stage software solutions to be handed over to the NHS to implement at scale.

The operations of the AI lab will align to the core values of the NHS. Most relevant to this debate, the AI lab will protect patient privacy—to go back to the substantive concern expressed by the hon. Member for Cambridge in his speech. The AI lab will sit within the NHS and will protect patient data. It will also guarantee that the value of the healthcare data is retained by the UK public.

As well as ensuring that the technology meets the highest standards and sufficiently stringent regulation, we must ensure that the public are aware of that technology. The public must understand the principles well enough to be confident in a particular technology’s capabilities, irrespective of the statistical evidence supporting it. For the NHS to maintain the confidence that the UK public place in its brand, it must ensure that the apps and data-driven technologies that it recommends are examples of the best practice, not simply in transparency but in what they do and where the personal data goes.

There is now an opportunity for the UK to do that well, making the UK’s standards for MedTech an international benchmark, strengthening the position of digital health in the UK and enabling it to make great leaps forward. As I mentioned, the National Data Guardian and NHSX will work together to produce clarifications on the circumstances in which it is appropriate to share data. We recognise the findings of the “Putting patients at the heart of Artificial Intelligence” report produced by the all-party parliamentary group on heart and circulatory diseases and its calls for greater public engagement to avoid a souring of opinion on AI. We will continue to engage patients in the design and development of AI, where appropriate, and to raise the profile of the effectiveness and efficacy of using AI to provide health and care.

I will now go on to the points made by Members and their requests for reassurance. My hon. Friend the Member for Crawley asked how an NHS organisation investing in the new technologies would be rewarded. We are investigating how best to do that by engaging with commissioners, clinicians, business and academics. We will announce more detail in due course.

The hon. Member for Cambridge asked for an assurance that the additional NHS funding that has been announced will go ahead. Yes, the additional funding will go ahead, but we are still investigating how best to distribute it. My assurance to him is that, yes, the funding will be distributed. He himself highlighted the complexity of ensuring the fair distribution of such funding.

My hon. Friend the Member for North East Derbyshire (Lee Rowley) mentioned mitigating the risks. I hope that I covered that in my speech. A huge amount is going into mitigating such risks. For example, the Information Commissioner provides anonymisation guidance. I also refer to the points I have already made about NHSX.

The Scottish National party spokesman, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about mental health and patients. This morning, I heard about a great example of AI helping a patient suffering with dementia. It is being used to track normal movement and behaviours. When something different or unusual happens in the home to cause concern, an alert is sent out to a first carer who can be on the scene immediately. That is another great use.

The hon. Lady also asked what we were doing about 5G. I will not try to wing this one, but will simply repeat the answer that my officials gave me word for word: we are working closely with the Department for Digital, Culture, Media and Sport, which is leading test beds—is that right?—for 5G in Liverpool and Birmingham, showing how it can improve access to services and exchange of information between patients and clinicians.

The hon. Lady also asked about international collaboration. NHSX will engage with the World Health Organisation through the Global Digital Health Partnership, and the Medicines and Healthcare Products Regulatory Agency has a strong tradition of international engagement with both the US’s Food and Drug Administration and the European Union, which is key to solving difficult regulatory questions.

In conclusion, I reiterate that AI’s potential to transform the way in which we deliver health and care in the UK is huge. Advancements in diagnosis, treatments and prevention facilitated by AI will provide frontline NHS staff with more time to spend providing care to those who need it most. Through our involvement in the Prime Minister’s grand challenge, the AI lab and our work with the National Data Guardian, we will raise the profile of AI as a health and care project, and ensure that the public are fully aware of both its benefits and the expectations they should place on the NHS.

In the last few seconds, would my hon. Friend the Member for Crawley like to wind up?

[Ian Paisley (in the Chair)]

Order. I decide who is called to wind up.

[Ms Dorries]

Sorry, Mr Paisley.

[Ian Paisley (in the Chair)]

You have about 30 seconds to wind up, Mr Smith.

Living with Dementia

Ian Paisley Excerpts

Tuesday 25th June 2019 Westminster Hall

[Ian Paisley (in the Chair)]

It is very warm in the Chamber today. Hon. Members may want to remove their jackets: please feel free to do so—I would not want anyone parboiled. Before I call Debbie Abrahams, who will move the motion in her own time, I ask Members to prepare, because of the interest in the debate, to make speeches of about five minutes. We shall keep that informal, but hopefully we will be able to get everyone in.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is lovely to see you in the Chair, Mr Paisley. I thank the Backbench Business Committee, which granted the debate, and I want to recognise my hon. Friend the Member for Cambridge (Daniel Zeichner) as its co-sponsor. I also thank the Alzheimer’s Society, which provides superb support to the all-party parliamentary group on dementia, and the parliamentary digital team for promoting the debate. We hope to hear the views of many people from across the country on the recommendations in the report we shall discuss.

The subject of dementia and people living with dementia is particularly close to my heart. As many Members will know, my mum was diagnosed with Alzheimer’s disease at 64 and I was one of her principal carers. Having had that caring experience and seen some of the issues my mum faced, I wanted to raise awareness about dementia and the many different brain diseases that cause it. As many will know, dementia is now the leading cause of death in the UK, having overtaken heart disease and cancer. It is estimated that 850,000 people in the UK have a dementia, and Alzheimer’s disease is the most common. That is expected to increase to 2 million by 2050. Globally, there will be 152 million people living with dementia by 2050—a 204% increase. If there is anyone who does not now know someone with dementia, they soon will.

There is already much work under way at the UK Dementia Research Institute, where there is a search for programmes to identify people at risk of different dementia types and prevent them from contracting the disease, as well as for treatments and cures. In spite of the commitment by the former Prime Minister, David Cameron, to invest in dementia research, it still receives only one tenth of the research funding that cancer receives. However, there is also a need to invest in dementia research that could improve the lives of people affected by dementia today. I have campaigned with many others to raise the issues affecting people living with dementia, including becoming the first MP to be a Dementia Friends champion, working with Oldham Dementia Action Alliance to develop a dementia-friendly Oldham and Saddleworth, and undertaking various all-party group inquiries on how to improve the quality of life of people living with dementia.

The report from our latest inquiry, on dementia and disability, was launched last week. More than 2,500 people affected by dementia responded to our call for evidence—one of the largest responses to any all-party group inquiry. What the respondents had to say is very important. According to the Equality Act 2010 and the United Nations convention on the rights of persons with disabilities, dementia is a disability. As one family carer put it:

“If this isn’t a disability then I don’t know what is.”

However, the all-party group was told that society is lagging behind in that understanding and failing to uphold the legal rights of people with dementia. Evidence presented to the inquiry revealed that, across the country, the disability rights of people with dementia are not being upheld. Shockingly, 98% of the survey respondents thought that people living with dementia are treated differently from people with other health conditions or disabilities. They believe that that is due to the hidden nature of dementia, and the stigma that surrounds the condition. That is simply not good enough, and we need to do more.

--- Later in debate ---

[Holly Lynch (Halifax) (Lab)]

As always, Mr Paisley, it is a pleasure to serve under your chairmanship. I join colleagues in paying tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for her leadership and for the compassion she shows in everything she does. I am a Dementia Friend because of her, having attended one of her workshops here in Westminster in 2016. I have since become a dementia champion and was asked by the Alzheimer’s Society to run its workshop for Dementia Friends at the 2016 Labour party conference to 80 colleagues and members, which was quite a challenge for my first workshop. I am incredibly proud to have played a very small role in training some of the UK’s 2.8 million Dementia Friends and sending them out into their communities to make them that bit more dementia-friendly. Once again, I pay tribute to my hon. Friend for her role in that.

This debate gives us an opportunity to evaluate where we are against the aspirations set out in the Government’s Challenge on Dementia 2020, but also to shine a spotlight on some of the good work that is being done at a grassroots level—not least in Halifax, thanks to some truly inspirational and passionate volunteers. As we have heard time and again, 850,000 people are living with dementia in the UK, a figure that is expected to double by 2040. One in 14 over-65s is living with dementia. If that is not an incentive to us all to do everything we can while we are able and empowered to do so, I do not know what is.

I recently wrote to older people in the Sowerby Bridge area of Halifax on behalf of the campaign to make Sowerby Bridge a dementia-friendly town, and invited them to a day of action to learn more and see the support available in their area. That campaign is driven by Shabir Hussain of Bluebird Care in Calderdale, who is a thoroughly committed community activist, along with Chris and June Harvey, who are truly dementia champions, and who run the wonderful Memory Lane Café for people with dementia and their carers. With their trustees and volunteers, Chris and June run pop-up cafés in churches and community centres in Sowerby Bridge and Halifax, with a dementia-friendly programme of games and crafts, information and support, cakes, music and conversation. Some 540,000 people in England alone care for those with dementia, and estimates suggest that one in three of us will be involved in caring for someone with dementia at some time in our lives, so a dementia-friendly environment that offers a thoroughly positive experience for all those involved in living well with dementia makes a massive difference to the regular attenders.

We also have a young onset dementia and Alzheimer’s group, or YODA for short, which was set up by Julie Hayden and provides support for younger people with dementia and for their carers and families. As we have heard, it is often overlooked that 42,000 people of working age live with dementia. Their requirements can be quite different. People diagnosed with dementia at that time of life usually present between the ages of 30 and 65 and are most likely in work, potentially with dependent children, older parents to care for or financial commitments such as a mortgage to consider. For that group, as other hon. Members have said, living well requires a different support package from that required for over-65s.

I would be remiss not to highlight the work of Inspector Neil Taylor of West Yorkshire police, who is a dementia champion and the chair of Dementia Friendly Todmorden. He has gone over and above in promoting best practice within West Yorkshire police and his local community—all credit to him. West Yorkshire police have introduced the Herbert protocol, named after George Herbert, a veteran of the Normandy landings who lived with dementia. The police and other agencies encourage family and carers to complete a form with useful information that could be used in the event of a vulnerable person going missing. The form includes vital details such as medication required, mobile numbers and places previously located, along with a recent photograph. In the event of a loved one going missing, the form can be handed quickly to the police to speed up the search and assist in supporting that person, who may be lost and confused when they are located. I recommend that all forces adopt such a protocol as soon as possible.

We are blessed with dedicated volunteers who have made Calderdale a better place to live with dementia, but what if Shabir, Chris and June, Julie, Neil and others like them were not there? The environment might be quite different without their leadership. How can we ensure that such work is supported and replicated elsewhere?

I give credit where it is due. David Cameron’s Government launched the dementia challenge in 2012, which sought to create dementia-friendly communities, with work led by the Alzheimer’s Society; drive improvements in health and care; and improve research, with a commitment that funding for dementia research be doubled to more than £66 million by 2015. Under Dementia Challenge 2020, as the programme was called when it relaunched in 2015, the Government committed to investing more than £300 million in dementia research and medical innovation.

It has been estimated that dementia costs the UK economy £23 billion a year, which is more than the costs of cancer, heart disease or stroke. With the numbers of people living with dementia expected to double by 2040, predicted costs are expected to treble alongside that increase. For anyone not yet won over by the human arguments for committing to research for dementia, the economic arguments speak for themselves.

To be fair to David Cameron, I believe that he understood the issue. I hope the Minister can assure us that she will seek to make it a continuing priority for the incoming Prime Minister. However, there are still areas in which I would like to see things standardised across the UK to support people, particularly younger people, who live with dementia, as well as their families and carers. To have a dementia diagnosis in the workplace, with dependants or financial commitments, must be incredibly daunting, but with a renewed focus on that group, and with changes to our understanding of the support that those demographics need to live well, we can make a positive difference. I thank the APPG on dementia for its report “Hidden No More: Dementia and disability”, which calls, quite simply, for

“equality, non-discrimination, participation and inclusion.”

I wholeheartedly endorse those aims.

[Ian Paisley (in the Chair)]

I thank colleagues for their immensely good self-imposed discipline, which will allow the Opposition spokespersons and the Minister 10 minutes each to speak.

--- Later in debate ---

[Caroline Dinenage]

I thank the hon. Lady for that intervention. I am sure the slight disturbance caused by her mobile created a welcome distraction for everybody from my speech. I took note of what she said in her speech and she makes an excellent point about protections.

To go back to research funding, the incredible dementia discovery fund, which other Members have mentioned, was launched by David Cameron in 2015. It is the world’s largest venture fund aimed at a single disease area that looks to develop novel pre-clinical therapies. Our continued commitment to support research has also seen increasing numbers of people involved in the joint dementia research programme, with 20,000 people taking part in dementia research studies. To answer the question asked by the hon. Member for Vale of Clwyd (Chris Ruane), I am happy to meet and discuss any other research that comes forward.

Ahead of developing new treatments, we need to be able to support people to live well with dementia in their communities. The Dementia Friends programme, which a lot of people have mentioned—I am also a Dementia Friends champion—is a great example of increasing public awareness. Through the dementia-friendly communities programme—365 so far this year in England— we are making society more inclusive. We are supporting the National Dementia Action Alliance’s work to promote dementia-friendly hospitals across England through its charter to improve the care that people receive.

My hon. Friend the Member for Witney asked me about writing to the Department for Work and Pensions about improving its guidance to employers, which I will commit to do. We know that careful reforms are required to ensure that the social care system is prepared for the challenges of an ageing society, including for those with dementia. Many Members, including the hon. Member for Cambridge, mentioned adult social care funding. Many Members also talked about cuts to local authorities, but over the past year we have given councils access to an additional £10 billion: an 8% real-terms increase.

However, the fact that we are still talking about the social care system being on the point of crisis, at a tipping point or under huge pressure, shows the scale of the problem. That is why we have committed to publishing the adult social care Green Paper at the earliest opportunity. I share everybody’s frustration about the delays, but it will set out ideas for an element of risk pooling to save individuals from catastrophic costs, which some have spoken about today. We are committed to ensuring that everybody has access to the care and support they need. More short-term social care funding will be agreed alongside the rest of the local government settlement in the forthcoming spending review.

The NHS long-term plan sets out a 10-year strategy, outlining how the NHS will spend the £33.9 billion cash terms annual increase that will go into the NHS budget. We now know that around a third of dementia cases are preventable. Since 2018, every person attending an NHS health check in England—the hon. Member for Burnley (Julie Cooper) mentioned prevention—receives information about how to reduce the risk of developing dementia. It includes advice on smoking, safe levels of alcohol and being physically active. Between 2013 and 2018, nearly 7 million people attended health checks.

My hon. Friend the Member for Chichester (Gillian Keegan) mentioned Careline in her constituency. There are lots of innovative ways that technology can improve the lives of people with dementia. Jelly Drops are an ingenious way to tackle dehydration using sweet-like capsules. My local county council in Hampshire uses existing technology such as Amazon and wearable technology to help people maintain their independence, stay safe and combat isolation. All those achievements, brought together in the dementia challenge 2020, help to improve the lives of people with dementia, but we know that more needs to be done. We are committed to continuing to improve the lives of people with dementia, and of their families and carers.

[Ian Paisley (in the Chair)]

I call Debbie Abrahams to wind up.

Cystic Fibrosis Drugs: Orkambi

Ian Paisley Excerpts

Monday 10th June 2019 Westminster Hall

[Paul Scully]

My hon. Friend is absolutely right. Vertex has a pipeline that should help its shares—their value has doubled over the past few years, and I am sure they will do very well in future—but we must have a balance with shareholder value, so that the company can continue to invest and continue its research. As he says, this is about human beings, their quality of life and their lives.

[Ian Paisley (North Antrim) (DUP)]

The hon. Gentleman has struck a chord with the points that he has raised, which have been heard by Members of different parties. We must also make this cross-channel, and Northern Ireland cannot be left out of this arrangement. I know the chief medical officer has been in discussions with NICE and the Department to ensure that no postcode in the whole of the United Kingdom is left out of a settlement in this matter.

[Paul Scully]

The hon. Gentleman is absolutely right. Northern Ireland must surely be in there too.

Austerity: Life Expectancy

Ian Paisley Excerpts

Wednesday 18th April 2018 Westminster Hall

[Louise Haigh]

My right hon. Friend is absolutely right: these are long-term issues, which need addressing. They are all the more heartbreaking because we have seen decades of progress, and we all assumed that that would only go in one direction; little did any of us imagine that we would see a rise in infant mortality in the sixth-richest country in the world. These figures are, quite frankly, inexcusable.

On social care, care homes in deprived communities often no longer receive enough to cover the costs of care, which inevitably compromises the quality that they are able to provide. For those in such communities who cannot afford private care homes, that reduction of quality, and in some cases the lack of any available residential care at all, has had a punishing effect.

All Members present will have received casework regarding those still in their homes in the community who rely on care packages. Their care is simply unacceptable, relying on care workers who are paid far too little and who often do upward of 25 care visits every single day. There is not a chance, even by unsustainably drawing on the boundless good will of those care workers, that visits could last for 30 minutes, as defined by official guidance. It is beyond the realms of possibility. Those millions of hours of lost contact time for the 470,000 vulnerable—predominantly elderly—people who use home care will have undoubtedly compromised their long-term care and support needs and the management of multiple conditions.

It perhaps should not be a surprise that the rise in mortality and the fall in life expectancy came from precisely that cohort—older women living alone in poorer areas. In many senses, they were the early-warning sign of the deeply troubling trend in increasing mortality. This cohort, more reliant than any other on a functioning, effective, compassionate state providing quality support, have been badly let down in recent years. It should be a source of national shame that elderly women in some of the most deprived areas of our country are living in isolation, not properly cared for, and are losing their lives because the state has not supported them. However, it is not just that cohort of women. Some 7% of the extra deaths in 2016-17 were of people aged between 20 and 60. Almost 2,000 more younger men and 1,000 more younger women have died than would have if progress had not stalled.

I am sure that the Minister cannot look at the evidence presented here today, or at the research undertaken over the past two years, and not want to take steps to tackle those shocking statistics and to prevent those lives from being cut short. It is therefore critical that Ministers and the Government take seriously the fall in life expectancy and the evidence behind the growth in mortality. Up to now, Public Health England has regrettably tried to attribute it to the greater prevalence of flu. However, as Loopstra noted in her report:

“If Public Health England’s attribution of rising mortality to cold weather and flu is correct, then it should lead to an elevation of mortality in regional swathes across the nation. However…trends have varied considerably across local authorities, with no apparent geographic patterning consistent with regional outbreaks.”

The rise in unexpected mortality and the concurrent fall in life expectancy represents a significant moment in the history of public health in this country, yet the Department of Health has so far rejected the call from public health professionals for an inquiry into the sharp rise in deaths. I repeat that call today, and ask the Minister to look very seriously at the evidence presented on the link between life expectancy and austerity.

I will end on the words of Danny Dorling and Stuart Gietel-Basten, who have undertaken so much of the research in this area:

“demography is not destiny. Projections are not predictions. There is no preordained inevitability that a million years of life need be lost…but only through politics comes the power to make the changes that are now so urgently needed.”

The Minister has that power in her hands, and there can be no more pressing question for her than to ask why the citizens of our country are dying sooner than they should. I hope she leaves no stone unturned in pursuit of that answer.

[Ian Paisley (in the Chair)]

I do not intend to put a formal time limit on speeches. However, there are two Opposition spokespersons as well as the Minister, and I would like to start calling the Opposition spokespersons just after the hour, so if Members could speak for about five minutes each, that would be helpful.

--- Later in debate ---

[Chris Ruane]

I am afraid that I must move on, because I have been getting eyes from the Chair and I do not want to upset Mr Paisley.

The Government have said that the situation is a blip because of flu or the cold weather. The Department of Health has seemed to downplay fears about life expectancy, pointing out that smoking rates have gone down and cancer rates have gone down, but that is all the more reason to be worried. If those indicators are going down and life expectancy is going down, what is causing that? Those are good indicators, but there are some bad outcomes for certain people in certain areas.

A report by Professor Martin McKee, whom I had the pleasure of meeting yesterday, notes that the most recent period

“has seen one of the greatest slowdowns in the rate of improvement”

in life expectancy

“for both sexes since the 1890s”.

The relative data on life expectancy today is comparable to a time before workers’ rights, advancements in medicine and technology, and the welfare state. That slowdown, as reported by the Office for National Statistics last July, shows that the increases in the previous period, before 2010, meant that for every five years that a woman was living, she could expect to live one year extra. Now it is the case that for every 10 years that a woman is living, she can expect to live one year extra. The rate has been halved.

Let me add to those figures some of my own, which I received through parliamentary questions that I tabled in January. Between 2009-11 and 2014-16, 19.8% and 20.3% of local authorities reported a decline for females at birth and at 65-plus respectively. There are certain areas of the country, certain demographics and certain genders—women—who are feeling this the most. That is no surprise, because 80% of the austerity cuts made since 2010 have fallen on the shoulders of women. The link between life expectancy and cuts to social care budgets has already been highlighted.

The hon. Member for South West Bedfordshire mentioned Scotland. I do not want to stick up for the Scots: they can do a good job themselves, especially the hon. Member for Central Ayrshire (Dr Whitford), with her medical background. However, there are national and regional variations within the United Kingdom. If we look at local authorities in England, we see that 22% of them have seen a decrease in life expectancy.

[Ian Paisley (in the Chair)]

Order. Could the hon. Gentleman draw his remarks to a conclusion?

[Chris Ruane]

In Wales and Northern Ireland the figure is 18%. In Scotland it is only 6.2%. In the north-east of England, 27% of local authorities have seen a decrease in life expectancy. There are regional differences. What we can draw from that is that where there has been devolution and kinder, gentler Administrations, there has been a less sharp decline.

Hope is a powerful motivator in the way we make decisions. Messages of hope won historic victories for my party in 1945 and 1997 and denied the current Government their majority last year. What the Conservatives proposed at the last election, after seven years of austerity, was another 10 years of austerity. There is learned helplessness out there. People are sick and tired, and they are dying because there is no hope. They have lost income—£2,000 for most people and £5,000 for teachers. Austerity is biting, not just in medicine but in social care, and affecting mental health and physical health. In the short time I have left, Mr Paisley, it is worth noting—

[Ian Paisley (in the Chair)]

Very little time.

[Chris Ruane]

There is very little time, so I will draw my comments to a close by saying that Professor Martin McKee and other academics, from Oxford and other universities, want the Health Committee to have an inquiry on this issue. It is complex. I have mentioned some of the causes, and other MPs, from both sides of the Chamber, have mentioned some of the other causes of the decline in life expectancy. It is a complex mix of issues and deserves an inquiry by the Health Committee.

--- Later in debate ---

[Mrs Hodgson]

It is not rubbish. Professor Sir Michael Marmot warned:

“If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too”.

Sadly, we have seen this across the board. Despite the growing pressure on our health and social care service, the Government are responsible for spending cuts across our NHS, social care and public health services. While demand continues to increase, the Government have taken away vital funding, which could close the life expectancy gap.

Since local authorities became responsible for public health budgets in 2015, it is estimated by the King’s Fund that, on a like-for-like basis, public health spending will have fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16. Further real-term cuts are to come, averaging between 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse among adults of more than £22 million compared with last year and smoking cessation services cut by almost £16 million. Spending to tackle obesity, which the hon. Member for South West Bedfordshire mentioned as a cause of shorter life expectancy, has also fallen by 18.5% between 2015-16 and 2016-17 and further cuts are in the pipeline. These are vital services for local communities and could benefit their health and lifestyle, but sadly they continue to be cut due to lack of funding.

How does the Minister expect to close the life expectancy gap without investing properly in vital public health services? An ounce of prevention is better than a pound of cure. The Government must invest in public health and prevention services, as that could play a significant role in closing the life expectancy gap that we are discussing.

When the Prime Minister made her first speech on the steps of Downing Street—the Minister is nodding, because she knows the quote—she said:

“if you are born poor, you will die on average nine years earlier than others.”

We were all pleased that the Prime Minister highlighted that issue, but I have been left disappointed with her Government’s lack of response to tackle it. We on this side of the House are committed to ensuring that our health and care system is properly funded, so that all children are given the best possible start in life and older people are treated with the respect and dignity that they deserve. I hope that the Minister will clearly outline what the Government will do to close the life expectancy gap.

[Ian Paisley (in the Chair)]

Before I call the Minister, I thank all hon. Members for complying so obediently with the timing that I requested.

 Orkambi and Cystic Fibrosis

Ian Paisley Excerpts

Monday 19th March 2018 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

I beg to move,

That this House has considered e-petition 209455 relating to access to the drug Orkambi for people with Cystic Fibrosis.

I will first read the petition into the record, if I may. It is entitled “Make Orkambi available on the NHS for people with Cystic Fibrosis”, and states:

“Conventional CF treatments target the symptoms of CF, precision medicines like Orkambi tackle the cause of the condition. Though Orkambi is not a cure, it has been found to slow decline in lung function, the most common cause of death for people with CF, by 42%.

In July 2016, the National Institute of Clinical Excellence (NICE) recognised Orkambi as an ‘important treatment.’ They were, however, unable to recommend the drug for use within the NHS on grounds of cost effectiveness and a lack of long-term data.

We are calling on the British Government to call for a resolution to ongoing negotiations between Vertex Pharmaceuticals, NHS England and NICE as a matter of the utmost urgency. It is essential that a fair and sustainable agreement is found.”

To date, there are 115,419 signatories to the petition.

It is a pleasure to serve under your chairmanship, Mr Evans. This is my first debate here—hon. Members have not come to see me, but to support this important cause. It is incredible to see so many people, and to see these Benches and the Public Gallery full. I thank my hon. Friends and colleagues for supporting this noble cause.

[Ian Paisley (North Antrim) (DUP)]

Does the hon. Gentleman agree that the reason why there is such public and political interest in this matter is that the Government have acted in a prehistoric way when it comes to treating patients? This drug should be purchased and made available as widely as possible and as soon as possible, so that patients who suffer from this disease can have a better quality of life.

[Paul Scully]

I understand the hon. Gentleman’s position and concern, especially so when many people in Ireland in particular are cystic fibrosis sufferers, but I remind him that NHS England is the procurer, not the Government—it is done through that independent process.

NHS Pay

Ian Paisley Excerpts

Wednesday 13th September 2017 Commons Chamber

[Jonathan Ashworth]

I hope the hon. Lady made those points at the rally last week, when she was talking to nurses. But I would say to her that the Government have found an extra £1 billion or so for Northern Ireland. We do not begrudge Northern Ireland that, but the Government have found more money for Northern Ireland. Also, the Government are giving away billions and billions in corporation tax cuts. They have given away £1 billion in inheritance tax cuts. Government is indeed about making choices. We would make a different set of choices, but if the hon. Lady is genuine, as I believe she is, and sincere, as I believe she is, in wanting to get rid of this cap, she needs to send a message to the Chancellor, not the Tory Whips, and vote for our motion.

[Ian Paisley (North Antrim) (DUP)]

I thank the hon. Gentleman for giving way on this very important issue, and I must say that I and my colleagues are minded to support the motion that he has put before the House. But it would be appropriate if true sincerity was shown by all Members of this House—if they stopped attacking the Government for giving Northern Ireland that £1 billion, so that we can alleviate the costs that would allow us to make that pay gap narrow.

[Jonathan Ashworth]

I did say I did not begrudge Northern Ireland the money; I was just making the point that the Government have found the money, when they keep telling us that there is no money for anything else. But we are grateful that the Democratic Unionist party has signed the early-day motion in the name of my hon. Friend the Member for St Helens North (Conor McGinn), and we are aware that the DUP has said consistently that it supports getting rid of the pay cap for public sector workers. We would be very happy for the party to join us in the Division Lobby this evening.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We have had many debates on the NHS in the House, and as I have said previously, the workforce is one of our biggest challenges, which is why it is so important to get this right. The debate is focused on NHS staff, but we are discussing all public sector workers. We are talking about all workers within the NHS: we must not only consider those at different grades, but not allow a separation between frontline and back-of-house staff. As a surgeon, if I turn up at a clinic and there are no case sheets and the patient has not been informed of their appointment, it is a totally pointless exercise. We need to realise that the NHS is a team, and if we do not look after the team, it will not work.

Obviously this all started with the crash. I will defend Members further along the Opposition Benches, because I get really bored with the Labour party being given responsibility for the crash. Labour did not have that degree of world domination. It was a world crash. At the time of the crash, it was right to look at public sector pay, because it is a big outlay. The reason given at the time was to avoid redundancies and keep people in their jobs. However, although in Scotland we have had no compulsory redundancies, there have been 20,000 NHS redundancies over the past seven years and more than 40,000 compulsory redundancies among public sector workers. That means that people in England had a pay freeze for three years and then a pay cap, but they still lost colleagues.

I still work in the NHS and, until the recent campaign, I would have heard comments from nursing colleagues about not money but staffing—people being on shifts and feeling thinly spread, unable to care, anxious about the danger to their patients. I would say that that is the No. 1 concern, but people in England have had a double whammy: they have had the pay freeze and the pay cap, yet they have still had redundancies. From what we read, there could be a lot more to come from the sustainability and transformation plans, and that is just plain wrong.

In Scotland, we focused what money we had in a different way. The people on less than £21,000 got 3% rises every year, with an absolute minimum in 2010 of £250, which has now risen to £400. If we focused only on percentages, a consultant like me would be sitting on a great pay rise, while the person who is cleaning the bedpans and making the beds would get a pitiful rise, so it is important that more of the money is pushed lower down. In Scotland, we pay the real living wage, not what we Scottish National party Members call the pretendy living wage—the national living wage. A living wage should be a wage on which someone can live. It is as simple as that. Our public sector workers demand no less than that.

[Ian Paisley]

I appreciate the points the hon. Lady makes. She has creatively reflected on how the Scottish Government have directed resources differently, which is exactly what we and the Northern Ireland Executive want to do with the £1 billion resource. It will allow us to direct resources differently so that we can then address the other critical issues. Does she agree that people who begrudge Northern Ireland’s getting that money are actually begrudging public sector workers their rights?

[Dr Whitford]

I do not begrudge people in Northern Ireland the money that they have gained from that deal. All that the rest of us are asking for is to have something similar elsewhere. Nurses in Scotland, Wales and England are struggling as much as those in Northern Ireland. To be honest, it is a distraction to keep focusing on that deal. I disapprove of it, but not because people in Northern Ireland are getting a bit more of the help that the rest of us would be glad to receive.

We had the pay freeze and then the pay cap, but there have even been times when the pay review bodies’ recommendations have not been carried through. That has resulted in a band 5 nurse in England being paid £300 less a year than a band 5 nurse in Scotland. We have pushed the money down the way, so for a healthcare assistant or nursing auxiliary, the difference is more than £1,100 a year. However, it is not just a matter of the people at the bottom. In a way, the people who have experienced the freeze the most are those at the top of their grade who are not getting any more increments and are not changing grades. In actual fact, their pay has not moved for several years, and then it has moved by only 1%. Other people’s pay has gone up by increments, so at least they have seen a change in their pay. Earlier, a Labour Back Bencher was talking about a senior nurse. Such senior staff, who are within 10 years of retiring and who carry the experience of the NHS, are looking at other jobs in which that kind of life experience would be much more highly rewarded, and they are thinking, “Can I even afford to stay in this job if I am to look after my family?” In Scotland and elsewhere, we have tried to tackle this appalling issue of low-paid staff in a caring public service such as the NHS, but now we must realise that, for people higher up the grades, the time is over.

--- Later in debate ---

[Ian Paisley (North Antrim) (DUP)]

I have already alluded to the fact that I am delighted that the Labour party secured this afternoon’s debate. We will support the motion if this matter goes to a vote tonight, but it will be interesting to see whether we actually reach that point. Maybe the House will agree that the points that have been raised today are such that we should send out a clarion call from this House that we agree with what has been said on both sides of the Chamber today, despite some of the party political divisions that might have informed some of the debate.

I too declare that, like many Members, I have members of the family in the health service. My wife was a nurse in the Royal Victoria Hospital in Belfast, my daughter is a nurse in the Craigavon Area Hospital, my niece is a junior doctor in a hospital in Belfast, and my nephew is a trainee doctor. Many of us therefore see at first hand and hear about the needs of our health service from our relatives. From time to time we hear churlish points made to the effect that people do not care. I think all Members throughout the House know that at any moment they will know someone who works for or is being cared for in the NHS, and it is important to state that it is a brilliant service and that that service needs to be supported.

I want to raise two points. The first relates to the number of nursing staff vacancies that currently pertain in the NHS. I quote from a letter from Janice Smyth, a director of the Royal College of Nursing in Northern Ireland, in which she has indicated to me:

“The use of agency staff in Northern Ireland and associated agency costs have almost doubled”

over the past few years, and that of course puts significant pressure on budgets. Also, it is unfair on regular staff in the service when they see the difference in pay that sometimes accrues. That is not to deny bank staff their right to that pay, but it does have an impact on people’s morale.

We have 1,300 vacant posts for nurses in Northern Ireland, and about the same again in the private sector. That needs to be addressed, and Northern Ireland has tried to address it by way of ensuring that the bursary remains in place. I believe that has been beneficial, but that is not the only answer. I also believe that the pay difference in Northern Ireland is dramatic and significant. It is important that I put this on the record. A care assistant in Northern Ireland earns about £17,500. Without the pay cap, they would be earning almost £20,000. A newly qualified nurse earns about £21,000. Without the pay cap, they would be earning about £25,000—a shortfall of £3,500 per year. For an experienced staff nurse, there is a significant difference: whereas they currently earn about £28,500, without the pay cap they would be earning £32,000—a shortfall of over £4,000 per annum. A highly qualified, experienced specialist nurse in Northern Ireland earns about £41,000; without the pay cap they should be earning £47,500—a shortfall of a staggering £6,500. That gap must be addressed, and addressed radically if we are to change things.

I would say to those members of the Labour party who chide us about the £1 billion deal: your party would have quite happily covered a deal that would probably have been better for us—those are the discussions we had in advance of the last election. In chiding us, you only hurt the public servants in Northern Ireland who are benefiting from that £1 billion deal that will allow us to allocate this money to relieve these costs.

[Several hon. Members rose—]