Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Jim Shannon Excerpts

Tuesday 28th November 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

Earlier this year it was announced that Wales was set to become the first UK nation to introduce mandatory national licensing for what we call special procedures: tattoo artists and those working in body piercing, semi-permanent makeup, acupuncture and electrolysis. The licensing regime in Wales is being introduced under part 4 of the Public Health (Wales) Act 2017. Happily, section 180 of the Health and Care Act 2022, passed by this place, gave the Secretary of State the power to introduce a licensing regime in England. I am really glad that we are now doing that and that our Government are taking the issue seriously.

In this very short debate, I am keen to hear from the Minister what the Government are doing to speed up the introduction of that regime in England, something that the Health and Social Care Committee, which I chair, called for when it published a report on body image back in 2022. I want to mention my hon. Friends the Members for Bosworth (Dr Evans) and for Sevenoaks (Laura Trott), who did good work on that regard when they were on that Committee.

As we are all well aware, non-surgical cosmetic procedures such as Botox, dermal fillers, chemical peels and aesthetic procedures such as tattooing and body piercing are soaring in popularity. The beauty industry is valued at an estimated £3.6 billion in the UK. That boom has been fuelled by sales on social media and in beauty shops on the high street. However, while these procedures are popular, they carry risks that must be managed to protect both those who undergo the procedures and those who provide them.

At present, healthcare professionals such as doctors, nurses and dentists who carry out non-surgical cosmetic procedures must be trained and insured as part of the requirements laid down by their own regulatory bodies or Royal Colleges. However, there is no set training for beauty therapists and other non-professionals, something that is a cause for concern and an issue that many respected practitioners have campaigned on for some time. It is, after all, in their interests; as the sector has boomed, there has been a rise in people being physically and mentally harmed by poorly performed procedures. The aesthetics sector has been described to us by some, in part, as the “wild west”, which clearly is not ideal for anyone, patient or practitioner.

Further to that, a survey carried out by the British Association of Aesthetic Plastic Surgeons found that 69% of its surgeons have seen patients with complications following temporary fillers. Again, that outlines the need for the licensing scheme to be introduced and enforced. An estimated 900,000 Botox injections are carried out in the UK each year, with 3,000 complaints registered in 2022. The public need to be educated on the risks; they cannot assume that someone who is carrying out an aesthetic treatment is trained. It goes without saying that people should take the time to find a reputable, insured and qualified practitioner, if they decide that such treatments are for them.

To my mind, the licensing scheme is an important step towards better outcomes for the industry and consumers and, I hope, towards removing rogue practitioners from the industry. Practitioners must have adequate training to deal with complications and to minimise them in the first place. For instance, if a blood vessel is blocked while a patient is undergoing a procedure, it could easily block the blood supply to their eye. I was contacted with the horror story of one woman who was unable to open her eyes for 16 weeks following botox treatment.

Wales opened its 12-week consultation on its licensing scheme in January of this year. The scheme aims to reduce infections, eliminate poor working practices and create a central public register for licensed practitioners and approved business premises. That is important as the industry continues to increase in popularity. The Welsh chief medical officer said at the time that he was

“very pleased that these impending changes have been widely welcomed by practitioners in Wales, with many already volunteering to meet the new standards.”

One tattoo shop owner who has been working with the Welsh Government on the new qualifications said—this was widely reported—that:

“The increase in quality of tattoos in the last decade has been exponential so the hygiene needs to be raised. This is all positive for the industry and helps shake the image of it being dark and shady. It’s reassuring for those getting tattooed as well.”

I obviously very much agree with that statement, which shows why we need further legislation—or regulation off the back of legislation—in England to protect both clients and practitioners. In answer to a written question earlier this month, the Welsh Government confirmed that the aim is for their statutory licensing scheme to come into force in the summer of 2024, when it will initially apply to the four special procedures specified in their 2017 Act: electrolysis, body piercing, tattooing and acupuncture.

As I say, I was pleased when the Health and Care Act 2022 introduced powers for the Secretary of State to establish a mandatory licensing scheme in England, following calls for greater regulation of non-surgical cosmetic treatments—not least from my Select Committee. It is important that the scheme is introduced sooner rather than later, which we emphasised in our report on body image.

It was positive when the consultation in England finally opened at the beginning of September this year with pretty much the same intentions as the Welsh piece of work. However, concerns have been raised with me by those in the industry that the consultation in England has been far too heavily biased towards medical input rather than input from those in the cosmetics industry, which makes up a large part of the sector. As part of our body image inquiry in 2022, the Health and Social Care Committee recommended that the introduction of licensing for non-surgical cosmetic procedures be made a priority and introduced by July this year. The Committee also suggested that a safety taskforce be set up to bring stakeholders together, but I understand that the Government decided not to follow that route. The National Hair and Beauty Federation says that it is concerned that the Government have not reached out to an adequately broad range of stakeholders. Why have the Government not pursued the route recommended by the Select Committee?

In the pre-consultation phase, it was felt that more medical organisations than beauty organisations were consulted, which the NHBF has suggested caused a bias towards the medical sector. That is creating concern that routes into aesthetics via the beauty sector will therefore be restricted, which will have obvious consequences for many legitimate and reputable businesses. It also creates the risk that the new regulatory regime may drive some practices into the underground market rather than increase quality and standards across the industry, which is what we are aiming to see. The NHBF also said in September that it had written to the Government twice this year regarding the new licensing scheme but was yet to receive a response. Maybe that has been updated since.

When implementing mandatory licensing, we need to ensure that we establish a framework that demands a higher standard of care and proficiency from all practitioners. Further to that, another issue that needs to be addressed by the national scheme is procedures carried out in tattoo and piercing studios in England, which are currently subject to regulation by local councils. As there is no national scheme, we currently lack the reassurance needed. Practitioners need to contact the local council where their premises are based to get a tattoo, piercing or electrolysis licence. They must then register both themselves and the premises with the local council. However, registration is a fairly simple process, there is no requirement for the provision of proof of qualifications, and local authorities have few powers to refuse a registration. The current licence with local authorities covers tattooing, semi-permanent skin colouring, cosmetic piercing, electrolysis and acupuncture.

Local councils do, it must be said, conduct regular inspections of premises to ensure that they are compliant with health and safety laws, and there is a requirement for every tattoo artist to be licensed by their local council. To remind the House, tattooing without a licence or tattoo certificate is illegal. However, the fact that licensing is determined by local councils in England means it differs on what standards must be met across the country by those who apply. For example, some councils demand that all practitioners have access to their own sink, while others are happy for shared sinks, which risks cross contamination—posing a health risk. A new compulsory licensing scheme would ensure that both clients and practitioners are adequately protected, and practitioners would have to abide by the same rules across England.

The purpose of registration with councils is to protect the public from the transmission of blood-borne viruses such as HIV, hepatitis B, hep C and other infections, and to ensure that the health and safety regulations are followed. I think a national licensing scheme would increase this protection. As I have already set out, although section 180 of the Health and Care Act enables the Secretary of State to establish a licensing scheme, it is yet to be fully enacted. The consultation process closed a month ago today, and the advances to implement this hugely important scheme have been slow in England. When does the Minister think the Government will respond to the consultation?

There are four key priorities that must be addressed in the new licensing scheme to make sure that there is adequate protection for practitioners and clients. The first is the design and implementation of the national licensing scheme for all premises, as well as practitioners of non-surgical cosmetic procedures, to ensure that those who practise invasive procedures are competent and safe for members of the public—our constituents. Secondly, all practitioners must hold the correct insurance to provide these procedures. Thirdly, there needs to be official guidance on the training and qualification expectation of all practitioners, such as the knowledge and application of infection controls and first aid training should things go wrong. Fourthly and finally, we need a system that effectively records adverse incidents and public awareness raising so that all cases that go wrong can be tracked. I think such a system would dramatically improve safety standards. It would also ensure that members of the public are better equipped, as they would have better tools and knowledge surrounding the procedures and the practitioner that they were using.

The Government did assure the Joint Council for Cosmetic Practitioners, the British Beauty Council and the Chartered Institute of Environmental Health that they were committed to the licensing of the non-surgical aesthetics sector in England, so I ask the Minister when we can expect to see further action, following the consultation that I have mentioned.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this debate forward. My council, Ards and North Down Borough Council, has a policy in relation to piercings specifically. It has initiated a piercing guidelines policy to make both piercers and those who get piercings aware of the guidelines and policies that, in its word, “must” be followed. Does he agree that there could be more discussion of providing this information—in local schools, for example—because many people who get piercings are under 18 years of age, and are often naive to the guidelines and hygiene policies that piercers must follow? Educate them early: does the hon. Gentleman agree?

[Steve Brine]

We have enough debates in this House about some of the things that we teach in schools, and I can but imagine some of the responses we would get to this, but in my view education can never be a bad thing. There is nothing wrong with tattooing and piercings. It is not my personal choice—I do not know about the hon. Member for Strangford (Jim Shannon)—but if people are going to do it, I think they should go with their eyes, or any other part of themselves, wide open; and that is why the hon. Gentleman’s point on education is well made. [Interruption.] Did that amuse you, Mr Deputy Speaker?

In closing, would it be possible for the Minister to outline the timeline, even in rough terms, for the introduction of the licensing scheme? Finally, I understand that it is complicated and a bit like peeling an onion—the more you take, the more you find—could the Government outline which procedures will fall under the new licensing scheme? On that, I will close; I look forward to hearing from the Minister.

Post Office Services: Edinburgh West

Jim Shannon Excerpts

Monday 27th November 2023 Commons Chamber

[Christine Jardine (Edinburgh West) (LD)]

The subject of the debate is post office services in Edinburgh West. Although it is about my constituency, the problem could just as easily apply to many constituencies throughout the country. Indeed, I have not spoken to a single Member who has not said that their constituency faces the same problem with post office closures as we face in Edinburgh West.

When I was thinking about the debate, I wondered what the answer might be if I asked any of the children in my constituency what a post office was and what they used it for. I also thought they might look at me with astonishment if I told them that what they now regard as part of the local shop was once the organisation that provided everything from our telephone services at home, our mail and all sorts of Government forms, to pensions and stamps.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this matter forward. Last week, the parliamentary group of the Democratic Unionist party met the Northern Ireland sub-postmasters association. Every one of those issues that she mentions were discussed with us. We were told that those opportunities were no longer available in the post office, by which I mean MOTs, car tax renewals, and passport renewals. The post office was also used as a community hub. All of those things highlight how important post offices were. I know that the hon. Lady has said all of that, so I hope that, in his response, the Minister can give us some succour and respite in relation to what the post offices can and should do.

[Christine Jardine]

The hon. Member makes a very good point. These were all vital services. Not so very long ago, post offices were central to communities up and down the country. They also provided some of the most spectacular examples of architecture, and they dominated our town centres. The local post office was where I applied for my first driving licence. I opened my first savings account there and queued for what seemed like hours every Christmas to make sure that the family’s cards and presents went off safely to various parts of Australia and Canada—but not any more. The Post Office I grew up with in the 1960s had 25,000 branches. In 2021, that figure had more than halved to 11,415, with more than half of those listed as vulnerable. The organisation itself lost £597 million in the same year.

In Scotland we have the biggest problem in the UK, having lost more than 6% of our post offices in the past two years alone. In Edinburgh West, two have closed and one has been relocated to a different area in the past year. As I said earlier, this problem is not isolated to Scotland or to Edinburgh West. One third of rural post offices are now offered as part-time outreach services.

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[The Parliamentary Under-Secretary of State for Business and Trade (Kevin Hollinrake)]

It is a pleasure to serve under your chairmanship, Madam Deputy Speaker. I congratulate the hon. Member for Edinburgh West (Christine Jardine) on securing this debate. She is right to say how highly valued post offices are to our communities, and to speak up for them in this debate. I promise her that I fully support her perspective, representing a rural constituency myself.

The network of roughly 11,500 branches around the UK that the hon. Member refers to is the largest retail network in the country. As she points out, a recent London Economics report pointed out how post offices not only have economic value in terms of the use of the post office itself—she referred to a gentleman with an envelope looking for a post office for a stamp—but benefit other local shops, cafés and other businesses on our high streets. The knock-on effect adds up to around £3.1 billion a year, according to that report, so we are fully aware of the importance of post offices to communities and to the economy.

I am very keen, and I have been since I took over as Minister for postal affairs about a year ago, among other duties relating to my brief, to challenge the Post Office to make sure that it is doing the right thing by postmasters. The hon. Lady quite rightly points to the level of remuneration that postmasters get. We have to get that right to make the whole network sustainable. I gently point out to her that the Post Office is a commercial business, so it is not something that I direct on a day-to-day basis, but I am keen to take forward challenges on behalf of Members on both sides of the House.

The hon. Lady is aware of the network criteria that 99% of the population must live within three miles of their nearest branch and that—this is relevant to her constituency—95% of the total urban population must live within one mile of their nearest outlet. The network actually is not in decline—more post offices opened than closed over the course of the past year—but we see fluctuations, and it is regrettable that Edinburgh West has seen closures in recent months. I know that is very disappointing for her and her constituents; we know how important the post office is for those communities.

Of course many postmasters are running franchise businesses in their own right, and many of the challenges that postmasters face are faced by many high street businesses. Consumer habits are changing the dynamic and the viability of some postmasters’ businesses, and we need to find ways to make sure that they can run viable businesses that pay them fair remuneration for their work.

The hon. Lady and other hon. Members mentioned relationships such as that with the DVLA. That has been extended until the end of March next year. We want to see a longer-term deal than that, but that is a negotiation between relevant Government agencies and Post Office Ltd.

It is the case that consumer habits are driving down remuneration, and I do not think it is for us to dictate to our citizens how they should access services. Increasingly—I am sure the hon. Lady and other Members have done this—we access services such as passport or driving licence renewal online. That is much more convenient for many people, and it is driving down remuneration significantly. Only a few years ago, some of those Government services were contributing about £500 million annually to the post office network. That is down to a few tens of millions of pounds now, again because of consumer habits, but we are keen to try to make sure that there are other opportunities for postmasters.

[Jim Shannon]

The hon. Member for Edinburgh West (Christine Jardine) referred to elderly people and those who are isolated in the community and do not have access to online services. Those are the people who tell me they need their post office. There are many of them. I think the Minister would probably agree that there is a duty on the Government to try to encourage the renewal of those contracts come next March, and to ensure that the people we represent are looked after.

[Kevin Hollinrake]

The hon. Gentleman is absolutely right. I say that both as a Member of Parliament serving a rural area and as postal affairs Minister. We want to make sure that every citizen of this entire nation is served properly. Post offices do an important job in that. We need to make sure that post offices are there, not just due to Government support, but because people use them. There are some things that we are working hard on to try to make sure that the level of remuneration, which lies at the heart of this debate, is improved.

As the hon. Member for Edinburgh West is aware, Duart Crescent and Blackhall post offices have both unfortunately closed in recent months, due to their respective postmasters choosing to resign; they were not closed by the Post Office. The Post Office is advertising those opportunities to local retailers to try to reinstate services.

Autumn Statement Resolutions

Jim Shannon Excerpts

Thursday 23rd November 2023 Commons Chamber

[Kevin Hollinrake]

As I said, there is no doubt that we have been through difficult times, but the hon. Lady should look forward optimistically to the rise in the national living wage and the probability that inflation will be halved again by this time next year, having already been halved. She needs to take a more optimistic view about will happen in the economy next year. I am very optimistic that people will see better times ahead, which is what we all want to see, but the Government are realistic. We have spent £500 billion providing support, saving jobs and businesses, and helping people during covid and the cost of living crisis, but that money has to be paid back. The Opposition need to explain how they are going to do that, if they were ever given charge of the economy.

Small businesses also need protection from late payers, so that they can safeguard their precious time and resources. The measures in the autumn statement seek to achieve all that and more, transforming the fortunes of businesses up and down the country. The statement contains a multitude of measures that will give businesses easier access to investments.

The UK has been something of a start-up miracle—we are second out of the 39 countries in the OECD for start-ups and seventh for scale-ups, which is still a good performance in relative terms but one that we need to improve. Capital holds the key. This Government could not be clearer about that fact and have introduced measures in that regard.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his positive attitude in response to the measures that have been put forward, but I have a request on behalf of my constituents who work in the hospitality sector. Rates and alcohol duties have been frozen for another year, including those on spirits, meaning it will not cost people any more to go out to pubs and other venues in the hospitality sector, but Colin Neill from Hospitality Ulster has expressed concerns about energy prices. Do the Government intend to do anything about them?

[Kevin Hollinrake]

The hon. Gentleman raises a good point. I chair the Hospitality Sector Council and meet large and small hospitality businesses regularly, so I understand the pressure they are under. The hon. Gentleman has some such businesses in his constituency and I do too, so we know that is a problem. We have put a huge amount into supporting businesses with their energy costs, halving the cost of energy for most businesses. Energy is much more affordable than it was this time last year, which was an incredibly difficult time, but some businesses are locked into expensive energy contracts from the backend of last year, when prices were very high. If the hon. Gentleman has any examples of such businesses, he should bring them to me, as we have commitments from the energy suppliers, so we can challenge them and try to smooth the contracts over a longer period to ease the pain. I am happy to help him with any individual cases in his constituency.

On capital investment, the Prime Minister and the Secretary of State for Business and Trade will host 200 of the world’s leading investors at the Global Investment Summit this weekend and on Monday, which I hope to attend. It will showcase the UK as one of the world’s best places to do business, and drive billions of pounds of new and strategic investment into every corner of the economy.

The autumn statement has a host of innovative measures that will unlock investment and fuel growth. For example, our pension reforms will help unlock an extra £75 billion of financing for high-growth companies, while providing an even better deal for savers. Plans include a new growth fund within the British Business Bank to crowd in pension fund capital to the UK’s most promising businesses.

Another example is our plan for further funding for two British Business Bank programmes, including the long-term investment for technology and science competition. That will make £250 million available to successful bidders to increase investment in key science and technology sectors, with the private sector contributing at least as much again. Not only that—we have made £50 million available to extend the future fund breakthrough scheme, which backs businesses focusing heavily on research and development.

Although the Chancellor did not mention it yesterday, we have also introduced important measures for equity investments, including a 10-year extension to the enterprise investment scheme and the venture capital trust scheme, giving investors and businesses the confidence, certainty and stability to invest, which underpins the system.

Secondly, this autumn statement contains a series of measures that will provide smaller businesses with practical help. As we prepare to mark Small Business Saturday next weekend—I am sure that Members across the House will visit their small businesses on 2 December—it could not be a more timely moment to announce our business rates support package. It will help high streets and protect smaller firms, which are the life blood of our local communities, saving the average independent pub more than £12,000 a year, and the average independent shop over £20,000.

In addition, the autumn statement will include measures to toughen our regulations to tackle late payments. I have seen at first hand how this scourge can crush even the most determined of business owners’ dreams, so it is right that we act.

The Procurement Act 2023 means that the 30-day payment terms, which are already set for public sector contracts, will automatically apply through the subcontract supply chain. From April next year, any company bidding for large Government contracts will have to be able to demonstrate that they pay their own invoices within an average of 55 days and that will reduce progressively to 30 days.

International Men's Day

Jim Shannon Excerpts

Tuesday 21st November 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is not often I get called first; I appreciate the opportunity. It threw me, but I have read my notes and know what I am going to say. I congratulate the hon. Member for Don Valley (Nick Fletcher) on setting the scene so well. He touched on some of the things I wish to speak about: suicide rates, prostate cancer and loneliness. I live on a farm on the Ards peninsula, so appreciate and understand how isolation and loneliness can play a big part in farming communities, simply because of what the job entails. Very often there is the farmer and his dog or his animals; interaction with other people does not happen.

In setting the scene, the hon. Gentleman used the illustration of young Tommy. I know that young Tommy does not exist, but there are young Tommies out there across the community who do. He illustrated that very well with that example and I commend him. It is great to be able to speak in this debate. November is an important month because we can raise awareness of men’s health and wellbeing, particularly mental health and testicular and prostate cancer.

The occasion also gives an opportunity to lead by example, as World Children’s Day is celebrated on 20 November. Having the two sit so close together is a fantastic way to encourage good moral values and responsibility. It is good to talk about these issues in a constructive and positive way. I look forward to hearing the Minister’s response, as she understands the subject well, and I hope she will give a positive reply to our questions. I also look forward to hearing from the two shadow Ministers. I know their contributions will enhance and enliven the debate, as will others. I am conscious not to leave anybody out.

I want to comment on important statistics related to men’s health. Figures from AWARE NI state that suicide is the leading killer of men under 50 in Northern Ireland. That is a sad reality that nobody wants to think about. Not long ago we had a spate of suicides in my immediate town of Newtownards. They tended to be young men in their early twenties, which is discouraging and worrying. I remember when one young fellow committed suicide, a number of his circle of friends did likewise.

There is the key issue, which is not the Minister’s responsibility, but adds to the debate. I am sure the examples and evidence I give from Northern Ireland will be replicated across the United Kingdom. One in three men in the UK have had suicidal thoughts due to stress. It is no secret that many men view depression as a sign of weakness, choosing to ignore the symptoms. I hope that would not be the case, but recognise that it is. Perhaps the Minister could give us some thoughts on how we can better reach out to those men, to ensure that the stigma they worry about does not drag them down.

Many see the stigma attached to opening up and asking for help. The phrase “man up” is not meant in a derogatory fashion, but as a prompt to strengthen oneself. The fact is that it talks people down, and I think it is wrong to say that when it is taken too literally. Men then suppress their anxieties and try to deal with them inwardly, even when they are not able to. I see no shame in asking for help and I encourage men everywhere to do that. International Men’s Day is the time to reinforce that point.

I referred to life in the rural communities, simply because we are a country of small farms. Some of them are run as one-person businesses, and at others the wife looks after the house and also helps on the farm. Lots of the interaction is very isolated. Funnily enough, yesterday morning someone came to my office—I will not mention her by name—to talk about the problems she is experiencing as a result of rural isolation. The issue applies to both men and women, but I wanted to dwell on it in this debate about International Men’s Day.

I have known a few people over the years who, if we met them today in any company, we would think that they were the life and soul of the party. But the thing is that, when they leave that party and that group of social friends, when they get home and close the door, they are a different person. We should not always think that the person who is jovial, funny, talkative and laughing all the time has no problems, because it is possible that they do.

Samaritans has found that men who live in rural areas are less likely to seek mental health support, and due to the nature of their community they are more likely to feel isolated. At half-past 11 there will be a Samaritans event on suicide prevention in, I think, Speaker’s House. If Members are available, I suggest that they try to get along to that. As someone who represents a partly rural community and who lives in a rural area, I know that this is an incredibly important issue, and I encourage anyone who is feeling confined or isolated not to be ashamed of seeking help.

The same point can be made for veterans too. I wish to underline the issue for veterans separately, because I deal with veterans in my offices every day. The veterans charity Beyond the Battlefield is based in my constituency and its incredible work reminds me of what has been done for former service personnel suffering from PTSD and poor mental health due to the nature of their service. I work with many charities, but I want to mention two in particular in my constituency. I have been involved with Beyond the Battlefield since its inception. It provides accommodation and has applied for another grant through the Ministry of Defence’s veterans scheme. If successful, it will be able to provide more beds to people.

The second charity is SSAFA—the Soldiers’, Sailors’ and Airmen’s Families Association. Every one of us of a certain generation, and perhaps more, will know about SSAFA. I hold a coffee morning for it every year, and this year I think we left with £5,800. That is for coffee, tea and sticky buns, so it really is quite an achievement. People are very generous, and it is quite clear that they give more than what they would usually give for a bun and a cup of coffee.

[Karl MᶜCartney]

One of the reasons I am standing here is that the hon. Member for Northern Ireland, as many of us think of him, has made some very valid points, including about Samaritans, which has a direct link to my constituency of Lincoln. I do hope to see some Members at Mr Speaker’s event later this morning. We are commending International Men’s Day, and the hon. Gentleman has made some very good points regarding suicide and other issues, but I wanted to stand up so that he did not feel alone. We all know that he intervenes on many of us when we make speeches, and I wanted to return the favour.

[Jim Shannon]

I thank the hon. Gentleman for that intervention. Yes, we all share many things in common, and we are here to contribute to the debate in a positive fashion. This House can shine and reach out in a way that is necessary in the society we live in.

I am very conscious of time and that others also want to speak, so I will not go on much longer. Queen’s University Belfast has a prostate cancer centre of excellence, and I mention that because it recognises that prostate cancer is a killer. The hon. Member for Don Valley referred to that in his introduction, because he recognises, like I do, that there is not a full understanding of what it means to men. If someone has a wee problem, they might not do anything about it and say, “Well, sure, I’ll get better by the end of the week,” or, “I’ll get better in a fortnight’s time.” But they do not. I commend Queen’s University, and I look forward to visiting that centre of excellence shortly.

On International Men’s Day, the Government have joined Prostate Cancer UK to unveil a £42 million screening trial to find ways of detecting earlier the UK’s most common cancer in men. When we see that somebody does something good, I commend saying something good about it. There are many times when certain things will happen that we are perhaps concerned about, and we will not register them. The Government have made £42 million available for that purpose—well done. They have recognised the issue. The Minister might comment on that when she speaks later.

That will allow hundreds of thousands of men across the country to participate and remind other men that they are not alone. It is really good that the Government have put their hand in their pocket—on behalf of us all—and made this happen. Thousands of lives could be saved. May I seek clarity from the Minister and ask whether the money will be extended to the devolved nations as well, and whether this issue is devolved? We cannot leave the men of Northern Ireland, Scotland and Wales behind.

To conclude, let us use this day to duly celebrate the men in our community and the contributions they make. Hon. Members here will know that when it comes to men’s issues, I am here in this House to speak for them, and I do it every time. Today the debate is about International Men’s Day, so I want to make a plea for them. I thank the hon. Member for Don Valley for raising this issue today, and for reminding us that we should always encourage and support emotional stability for everyone out there who is suffering.

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[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to participate in this debate to mark International Men’s Day 2023. I thank the hon. Member for Don Valley (Nick Fletcher) not just for securing the debate, but for the sensitive way that he drew out some very important issues that too often get buried under other matters that we discuss in this place. It is important that we continue to talk about gender equality, equal pay and the pension gender gap, but that does not mean that we cannot be cognisant of and exercised about the very important public health and social challenges that face men and boys. There is no doubt that those challenges and issues exist.

The theme of International Men’s Day 2023 is “Zero Male Suicide”, and that is where I want to focus my attention. The need to help men and boys cope with and understand mental health issues is beyond urgent. As we have heard, the overall suicide rate is 13.9 per 100,000 people—a similar figure to previous years—but male suicide rates are still three times as high as female rates, and in Scotland, 556 men died by suicide last year. Behind every statistic lies a family torn apart and a life that ought not to have been lost.

Suicide is the No. 1 killer of men under the age of 45 in the UK. It kills more men under 45 than car accidents, cancer, drug or alcohol addiction, or any other issue that can end lives. The fact that men take their lives by their own hands in such numbers is truly heartbreaking. We can wring our hands, but there must be something more we can do to reduce those awful statistics. Key to that is seeking to understand why so many men resort to suicide, which is a terrible last act of despair.

One explanation that many point to is the fact that males have traditionally not been expected to admit when they are finding life difficult. A number of Members have talked about the awful expressions that are often used, including “toughing it out” and “manning up”, which the hon. Member for Strangford (Jim Shannon) first mentioned. As a result, men and boys often find it hard to admit when they are struggling and need support, and that can only undermine their mental health and increase their sense of isolation. Problems mount up, but they feel it is weak if they admit it, ask for help or simply need a chat to share their concerns and process their feelings. Instead, they are much more likely to internalise their feelings, which often detrimentally impacts their relationships with their family members and friends—their children, their wives and their extended social relationships.

How we as a society adjust our expectations of men is important. It is okay for someone to admit that they are struggling; it is not a sign of weakness. As boys grow up and develop in their homes, families, schools, workplaces and universities, we need them to learn that they will sometimes need support and that there is no stigma attached to talking to someone if they are suffering. In fact, it is perfectly normal, and actually it could be seen as a sign of strength. If we cannot get men and boys to open up and share their worries, concerns and problems with those closest to them, or a support organisation if that is easier for them, we are unlikely to make a meaningful dent in those awful statistics. Each number is a family torn apart—a life lost that could have been saved.

Although we know that suicide is the biggest cause of death in males under the age of 45, we also know that when it happens, the loved ones left behind are often bewildered. They often did not see it coming. For the rest of their lives, they are left with questions—“What did I miss?”, “Could I have done something to prevent this?”, “Why did they not talk to me?” That is why suicide does not just take lives but tears families apart and leaves wounds that truly never heal.

I pay tribute to the wonderful UK Men’s Sheds Association. In my constituency, I have seen at first hand the fantastic work undertaken by the Three Towns Men’s Shed, which serves Ardrossan, Saltcoats and Stevenston, and the Garnock Valley Men’s Shed, which serves the towns of Kilbirnie, Beith and Dalry. In these sheds, men get together to offer each other friendship, camaraderie and a sympathetic ear. They share practical skills, experiences and problems, and provide a shoulder for each other when times are tough. Men helping each other in their communities is what a men’s shed does at its best, and it is not overstating the case to say that men’s sheds have the potential to transform and save the lives of the men who join them.

[Jim Shannon]

The hon. Lady is right to underline the issue of men’s sheds. I can think of four men’s sheds in my constituency: in Saintfield—I see them on the third Saturday of every month—Portaferry, Newtownards and Ballybeen. Those four men’s sheds have saved lives, which is what she is referring to.

[Patricia Gibson]

I thank the hon. Gentleman for his intervention. I am delighted with the men’s sheds in my constituency, because the three towns in the Garnock valley are post-industrial areas with great socioeconomic challenges. Sadly, we know that people who are socially and economically disadvantaged are also those at higher risk of suicide and at higher risk of developing mental illness. Middle-aged men living in the most deprived areas face an even higher risk of suicide, with rates of up to 36.6 per 100,000, compared with 13.5 per 100,000 in the least deprived areas.

The changing nature of the labour market over the last 60 years has particularly affected working-class men. With the decline of traditional male industries, they have lost not only their jobs, but a source of masculine pride and identity. We also know that men in midlife tend to remain overwhelmingly dependent on a female partner for emotional support, but today, men are less likely to have one lifelong partner and more likely to live alone, without the social or emotional skills to fall back on. Undoubtedly, loneliness is a significant factor in many male suicides; it puts men’s suicide risk at a higher level. Men’s sheds can truly mitigate that and help men to strengthen their social relationships.

I will briefly mention the impact of allotments. In my constituency, we have the Elm Park allotment in Ardrossan and the Kilbirnie allotment on Sersley Drive, which allow men to get out into the open air and forge friendships. Otherwise, they may be sitting at home, watching the telly and becoming catatonic with loneliness. At the allotments, they develop relationships with other volunteers in a very healthy outdoor environment. In my view, things that build the social fabric of our community, and which help men get together, save lives.

Menopause

Jim Shannon Excerpts

Thursday 26th October 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for raising this issue. It is a massive issue for my constituents and the personal experience through my own wife is very clear. Given that 10% of women leave work during the menopause, saying that they feel and have felt unsupported and unable to continue—which really should not be the case—does he agree that there should be a greater obligation on businesses to help women?

[Peter Dowd]

That is another point that I will touch on later, but the hon. Gentleman is spot on.

Anyone who happened to be in Westminster Hall on Wednesday last week will be able to testify to the work that the APPG has done. More than 100 Members and others gathered for a photograph to mark and celebrate World Menopause Day. My hon. Friend the Member for Swansea East said she was not sure that visitors to Westminster Hall were ready to see so many women parliamentarians and others doing impromptu exercise squats. However, she also said that, if it was a good enough location for Henry VIII to play real tennis, it was certainly good enough for a group of menopausal women to highlight the benefits of exercise to their physical health and mental wellbeing.

The fact that those influential women, grassroots campaigners and clinical experts were brought together in Parliament showed the world that Westminster was listening; but listening alone is not enough while women continue to suffer. Listening will not help them get a diagnosis or access to treatment, or find the support they need. That requires action, and on World Menopause Day the APPG, which is chaired by my hon. Friend the Member for Swansea East, launched the menopause manifesto. Based on evidence that the group gathered by speaking to those affected by the menopause and experts in the field, the manifesto sets out seven recommendations, which we are urging all parties to adopt in their own manifestos ahead of the next general election.

I cannot stress enough how important it is to the 13 million women in the UK who are currently perimenopausal or menopausal, and to all around them who are indirectly affected—the hon. Member for Strangford (Jim Shannon) raised that point—to know that those in power will support them. The first recommendation in the manifesto is for health checks. Every time that is mentioned in conversation, people are genuinely surprised that it does not already happen. Many will remember receiving, on turning 40—along with the cards, gifts and the good wishes—an invitation to a 40+ NHS health check. Those “MOTs” monitor our weight and blood pressure, and are used to assess the risk of developing conditions such as diabetes, heart disease and strokes. What they do not include for women, at present, are any questions about, advice on or reference to the menopause, which is at best a surprise and at worst quite shocking.

There is strong evidence showing that many women are accessing primary care and being treated for individual symptoms because neither they nor their clinicians are recognising the root cause of those symptoms—a point raised earlier by my hon. Friend the Member for Blaenau Gwent (Nick Smith).

By raising awareness among medical professionals, who can, in turn, help to educate women at their 40-plus health checks, we can reduce the number of extra visits that women make to surgeries and prevent further misdiagnosis and inaccurate prescribing. We can also dramatically increase the number of women who get prompt and correct diagnoses and access to treatment pathways. We know that this would save the NHS money in the long run.

Many healthcare providers are now starting to include menopause in their standard packages, having identified the fact that patients are being sent for appointments in secondary care for an array of symptoms that have not been correctly diagnosed as menopause. By including menopause treatment as standard, they are reducing the cost to the NHS of these unnecessary appointments.

The second recommendation of the APPG’s manifesto is a national formulary for hormone replacement therapy. Although HRT is not the answer for all women, millions across the country rely on this treatment to manage their symptoms. We know that, in a 10-minute consultation, prescribers do not have the capacity to go searching for alternative treatments if a patient’s usual product is out of stock, and we have seen a supply shortage for many of these products. A national formulary would resolve this issue, as all eligible products would be easily accessible on surgery systems, thus eliminating the postcode lottery and regional variations that women are currently experiencing.

[Jim Shannon]

The hon. Gentleman is most gracious in giving way. He mentioned that there are sometimes disparities from, say, county to county. There are also regional disparities. I know he accepts that, and the Minister has taken note too. When it comes to providing better treatment, a recommendation has to be that every part of the United Kingdom—England, Scotland, Wales and Northern Ireland—should have an agreed strategy for helping women. Does he agree that there should be the same policy, the same strategy and the same response everywhere?

[Peter Dowd]

I agree with the hon. Gentleman. It is crucial that women are able to go to any surgery and, although there may be marginal differences in treatment or access to treatment, the substance is that they should ultimately get more or less the same access and the same treatment, depending on their needs.

The third recommendation also relates to prescribers. The manifesto calls for the inclusion of menopause as an indicator within the GP quality and outcomes framework. This change would help to balance the deficit in knowledge and understanding among GPs by incentivising improvement in diagnosis levels and treatment provision within primary care. If clinicians were better informed, they would be more confident in discussing menopause with patients at their health checks and in prescribing appropriate treatment, which would greatly benefit patients who visit their GP to seek support.

Moving away from healthcare, I am proud to say that, earlier this year, Labour committed to the fourth recommendation: mandating that all companies with more than 250 employees introduce menopause action plans to support those experiencing symptoms. That goes some way to addressing the points raised by hon. Members.

Alongside this, the APPG would like to see the provision of specific guidance for small and medium-sized enterprises and the introduction of tax incentives to encourage companies to integrate menopause in their occupational health plans. There are great examples of companies embracing the issue, and there are some excellent tools available to help, such as the British Standards Institute’s menstruation, menstrual health and menopause in the workplace standard. With research showing that one in 10 women are leaving the workforce and thousands more are reducing their hours or avoiding promotion, it is vital that more is done to address the impact of menopause on women’s economic participation.

The APPG is not asking for women to be given special treatment; we are asking merely for an understanding that working arrangements and environments may need to be flexible. This willingness to incorporate flexibility will benefit businesses, boost the economy and give women the confidence to progress in their career.

The manifesto’s fifth requirement is about the licensing of testosterone for women. It has always struck me as odd that when women reach menopausal age, which is different for everyone, they become deficient in three hormones—oestrogen, progesterone and testosterone—yet only the first two are available to women when they are prescribed hormone replacement therapy on the NHS. As my hon. Friend the Member for Swansea East has noted previously, if a woman wants the third hormone, they have to pay for a private prescription. The all-party group is calling for an evaluation of female-specific testosterone treatments, with a view to their being licensed by the Medicines and Healthcare products Regulatory Agency.

In the sixth recommendation, we are calling for better funding for research into the potential links between menopause and other health conditions, as well as the varying experiences of women from different backgrounds and ethnicities—that is very important. We know from the evidence that the APPG has received that those with conditions such as autism and attention deficit hyperactivity disorder can struggle more with their menopausal symptoms, and that those who have been treated for cancer often experience early menopause. So it is vital that much more is done to better understand the different journeys that women from different backgrounds are experiencing. In the past week, my hon. Friend told me said that she had been lucky enough to visit two universities, one in London and the other in her own home city of Swansea. Both are keen to do more to support their staff and to bridge the significant gaps in understanding around more complex menopause experiences.

[Jim Shannon]

I thank the hon. Gentleman very much for the scene he is setting. Small and micro-businesses are predominantly male-owned, so the issue for them is understanding how to put over the requests on behalf of ladies who are going through the menopause. Does he feel that the Government and the Minister should take that on board as well, to ensure that those businesses have the relevant information and guidance to do that within the small workforce that they look after?

[Peter Dowd]

The hon. Gentleman makes a good point and sets out an excellent idea. I am sure that the Minister, as part of the expansion or integration of the manifesto, can take it on board.

As I was saying, my hon. Friend was delighted that Swansea University announced last Friday that it would be introducing menopause into the curriculum for all of its medical students, as well as launching a menopause clinic for staff and students. I truly hope that it will be the first of many universities to do this. Future policy in this area, and an improved women’s health strategy, will be possible only if more funding is dedicated to this vital research.

The seventh and final part of the manifesto calls for a review of the demand for specialist menopause care. We need to look at existing provision, evaluate where increased secondary care is needed and assess other ways in which women could seek help. That might, for example, include access to specialist nurses in primary care and pharmacists, to ease the demand on GPs. That is another simple recommendation that would be easy to achieve, while having a significant impact on the care and support that women are able to access.

Nothing in the all-party group’s manifesto is difficult to achieve; no big contracts or big budgets are needed to make the changes that will significantly improve women’s experiences. The only thing that is needed is a commitment to prioritise this area of women’s health. We need a commitment to improve support, diagnosis and access to treatment for all those who need it. Who would not want that? I know that every Member of this House would want it. We need a commitment to show the 51% of the population who will directly experience menopause that they matter—that they really matter.

[Eddie Hughes (Walsall North) (Con)]

It is an absolute pleasure to follow my good friend the hon. Member for Bootle (Peter Dowd). I was originally excited to see that the hon. Member for Swansea East (Carolyn Harris) was going to be opening the debate, simply because her enthusiasm for this subject is contagious and draws people in, but he has done incredible justice to the opening of the debate.

It is marvellous to see a number of male colleagues in the Chamber. I grew up in a house with five brothers and an Irish Catholic mother, and the word “menopause” would in no circumstances ever have crossed her lips. I then went to an all-boys school and went on to do civil engineering at university. There were no girls at my school and just two women on my civil engineering course, in the whole of the department, so my exposure to women was somewhat limited until I finally got off the building site and into a traditional workplace. There I found that men whose experience was not as sheltered as mine had no greater knowledge or understanding of this topic, although I felt they had far less excuse.

So when my wife began to experience the symptoms of the menopause, originally neither she nor I, nor her GP, fully understood what was going on—certainly, menopause was not the initial diagnosis. That highlighted for me how difficult and challenging it must be for some women: they present to their GP, the GP misdiagnoses or misunderstands their symptoms, and then the problem is protracted because the appropriate treatment is not identified quickly enough.

With an understanding of that and as an MP representing the good people of Willenhall, Bloxwich and Walsall North, it was important to me to engage as much as possible with people who could help. We found a place for a menopause café—somewhere where women and men could come and sit down and talk about this topic, over a cup of tea and a slice of cake, in a relaxed environment. I think it is beholden on us, particularly male colleagues, in our role as MPs, to do everything we can to ensure that everybody is as well informed as possible. As I said in my intervention, in our male roles as family members, friends and relatives, it is incredibly important for us to first understand the symptoms and the range of appropriate treatments available, so that we can fully provide the necessary support.

[Jim Shannon]

The hon. Gentleman has mentioned families, groups and work colleagues. Does he agree that women who go through early menopause may find it difficult to discuss the subject with their employers? Those conversations need to be had, to ensure that women of any age are supported and enabled to engage fully in all aspects of their workplace instead of being excluded, perhaps unintentionally.

[Eddie Hughes]

I thank the hon. Gentleman for that intervention. Given that my wife, myself and her GP did not fully understand what the symptoms were and at what age they could arise, it is completely understandable that an employer might be challenged in terms of providing such support. That is why it is vital that we do our best to ensure that everybody is as well informed as possible, because, exactly as the hon. Gentleman says, such symptoms might start to appear at any age, so it is important that their root cause is identified quickly and people can provide that support.

I am delighted to say that, now that my wife has a very senior role in her company, it is easier for her to drive that ethos throughout the company. I pay credit to phs Group for its work countrywide. I have invited the hon. Member for Swansea East to come and speak at one of its offices in the south of Wales—I hope we can arrange that soon.

I pay tribute to all colleagues in the Chamber today, particularly the men in our role as champions, fighting side by side with the women to ensure that this topic is completely understood by as many people as possible, so that we can all provide the support that is so well deserved.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Bootle (Peter Dowd) for setting the scene so well. I have made a few interventions, but I will add a few words to put on record my support for the motion, as I am here on behalf of my party.

The hon. Member for Walsall North (Eddie Hughes) made an interesting point to which I subscribe from a personal point of view. My wife Sandra went through this, and it was quite difficult for her, not just physically but emotionally. The hon. Gentleman put forward some incredibly helpful ideas: better understanding in the home, better understanding in the family and better understanding in the workplace. I employ seven girls and one fella in full-time and part-time roles, and although I am not better or more knowledgeable than anyone else, I do understand some of the issues that are apparent in the office. That understanding has to start with me and end with everyone in the staff to ensure that the right things happen.

Over the last period, we have had a menopause support group in Northern Ireland. It was created for one reason. The hon. Member for Walsall North referred to a private place. Sometimes people need a private place where they can discuss their experiences and talk about what is happening with others, sharing information on the perimenopause, the menopause and any hormone-related issues. I know the knowledge that women will be able to give each other in those private circumstances and discussions. That is so very important.

The hon. Member for Bradford South (Judith Cummins), who has the Adjournment debate on osteoporosis, reminded us all of the increased risk of osteoporosis, fractures and brittle bones through menopause. She clearly and helpfully reminded us that when it comes to understanding those things better, the health sector needs to be a bigger part of the picture.

[Wera Hobhouse]

It is important that everybody understands that osteoporosis leads to many premature deaths. That is why we need to talk more about it. I am glad that we have all been talking about osteoporosis in connection with the menopause. Does the hon. Gentleman agree that we need to raise awareness of it, because it leads to many premature deaths?

[Jim Shannon]

I thank the hon. Lady for her intervention. I referred to the groups in Northern Ireland because, in many cases, we find that it is the women themselves who are initiating the private support groups and ensuring that things are happening. I ask the Minister, is there any help from Government to ensure that these advice groups are available?

To go back to the subject of osteoporosis, the hon. Member for Bradford South is right. In my office, I have a staff member specifically tasked with looking after benefit issues, and the work for that lady is enormous; she is probably working the equivalent of a five or six-day week. She tells me that, in many cases, the issue is access to personal independence payments. I know that this does not come under the Minister’s Department, but is there a process in place to help ladies understand and apply for that benefit, which is there for a purpose? Government have created the benefits system, and people should never feel that they should not apply for a benefit if it is there for them, which I believe it is.

When people are drained and emotionally raw, which many are, and when the sweats mean they have to shower several times a day and they need prompting to eat and take care of themselves, we need a system, and we need someone there to help along the way. I am my party’s health spokesperson, and I want to add my support to all those who have spoken.

The Government need to be proactive and ensure that guidance is given to businesses, so that they can do things the right way. Some 45% of women felt that menopausal symptoms had a negative impact on their work, and 47% said they needed to take a day off work due to the menopause. That underlines the need for support.

With that, I will conclude, ever mindful that we are fortunate to have a shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), who will add her support to the debate—I look forward to hearing from her—and a Minister who well understands our requests. I am very confident that we will have the help we need, not for us, but for our constituents, for the women who contact me, for my wife and for all the other women who find it very hard to deal with these issues.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the shadow Minister.

Economic Crime and Corporate Transparency Bill

Jim Shannon Excerpts

Consideration of Lords message
Wednesday 25th October 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

The Minister said clearly that there has been consultation with Scotland and Northern Ireland. Will he indicate who those discussions have taken place with? Was it banks, or the Departments looking after matters in the absence of a functioning Northern Ireland Assembly? I am keen to know who does the work to ensure that there is accountability for everyone.

[Kevin Hollinrake]

That is a good point. There are clearly different legal jurisdictions in Northern Ireland and Scotland, with of course the Court of Session in Scotland. From a legal perspective, the counsel in those jurisdictions are the people who discuss this. In wider issues such as failure to prevent, banks and many other stakeholders have people who will consult during the process. I am happy to keep up the conversation with the hon. Gentleman.

[Jim Shannon]

The reason I asked the question is quite specific, although it might not necessarily relate to the issue directly. The Minister refers to banks. A number of local organisations and community groups back home, which are registered and constituted as community institutions, have had their bank accounts closed. Banks have closed their accounts down because they say they are non-profitable. Is it right that banks should be able to do that? I know the Minister understands the matter—

Future of Horseracing

Jim Shannon Excerpts

Wednesday 25th October 2023 Westminster Hall

[Matt Hancock]

I totally agree and could not have put it better myself. That shows the cross-party nature of the work needed to ensure that racing has a bright future, for the reasons the right hon. Gentleman set out and those that I have set out. I completely agree with every word he has said.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman for securing this debate. He said he would outline three reasons why this is important. Can I add a fourth one? With the costs of stabling and even learning to ride escalating, does he agree that there is a danger that the sport will soon be enjoyed only by the elite? Does he agree that steps should be taken to ensure that people of all classes should have access to the sport and the opportunity to take part? In my constituency, we have that. I hope we can agree that as well in this debate.

[Matt Hancock]

I could not agree more. The hon. Gentleman’s intervention shows that this is an issue for the whole United Kingdom, and for people of all backgrounds across the country. In my constituency, I have Heads of State rubbing alongside those from every background who love horseracing. It brings people together, and we should celebrate that. The hon. Gentleman is right to raise that point.

These are the three issues I want to raise with the Minister. The first is levy reform, which was promised. Critically, although we legislated a decade ago that anyone betting on a horserace through an offshore platform counts for the levy, we should also say that anyone betting on an offshore race counts for the levy. Otherwise, people will be increasingly driven to betting on races that happen overseas, and the international problem is significant. Prize money, which entices people to put horses into GB races, at an average of £16,000 per race, is lower than in Ireland, at £22,000, and France, at £24,000. That is not sustainable.

Levy reform is critical, and it is vital that the horseracing and gambling industries come together, shepherded by the Department for Culture, Media and Sport, and bring forward a strong, credible proposal. I say to those who are in and support the gambling industry that they need people to bet on races—that is, real betting, on unknown outcomes, as opposed to computerised betting on a smartphone, where everybody knows they will lose money if they keep going. Horserace betting is a joy and a pleasure for millions. It is the best way to defend gambling, and supporting the horseracing industry is massively in the interests of the gambling industry.

The second issue, which deeply affects my constituents, is the importance of ensuring that some of the necessary occupations for horseracing are on the Migration Advisory Committee’s shortage occupations list. I have written to the Home Office about this issue and they said, “Speak to the Department for Digital, Culture, Media and Sport.” The DCMS Minister is here today, so this seems an opportune time to raise the issue.

Rural Postal Services: Sustainability

Jim Shannon Excerpts

Wednesday 25th October 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this forward. It is more than just post offices; it is about rural communities. Does he agree that isolated communities rely heavily on a reliable, frequent service, and investment should be made to ensure that daily deliveries, as the postie does his rounds in our rural constituencies, are not a bonus but are a standard? Would he join me in thanking posties and delivery personnel who carry out this vital service on difficult roads in difficult conditions at the right time for us all?

[Jamie Stone]

Again, a very good intervention; I completely agree. I have described a success story, for which I thank the Post Office for seeing that it happened. Now I turn to a more difficult situation. On the north coast of Sutherland, in my constituency, there are two local post offices at villages called Melvich and Bettyhill. They are now worried about their viability.

--- Later in debate ---

[Jamie Stone]

I will say in passing that I am very considerably encouraged by the number of interventions. It leaves me in very good heart.

[Jim Shannon]

There are more to come. [Laughter.]

[Jamie Stone]

Perhaps I asked for that one.

As I said, there are ways of keeping the post offices open. Getting rid of the Driver and Vehicle Licensing Agency services is absolutely not one of them.

IVF Provision

Jim Shannon Excerpts

Tuesday 24th October 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I thank the hon. Member for Jarrow (Kate Osborne) for raising the issue of IVF provision and setting the scene so well. I will raise some examples from my constituency, where IVF treatment issues have had a detrimental effect on ladies who wish to have a family, with costs and financial implications for their lives, which have been changed in dramatic ways. A number of my constituents have contacted me about the issue over the years.

I am ever mindful that the Minister present does not have responsibility for the figures or the subject matter in Northern Ireland, but there is a real anomaly that I have to put on the record. I always bring a Northern Ireland perspective to these debates, as everyone knows. I do so because I hope to add to the conversations that we are having and perhaps show where the shortfalls are.

This important issue has an impact on many parents daily—it is indeed daily—and it is a pleasure to speak about it as my party’s spokesperson on health issues. Nothing is more precious than the gift of life. It is awful that for so many it is a struggle, so it is great to have the opportunity to debate, discuss and request further provision of IVF across the United Kingdom.

I will first highlight some differences between the mainland and Northern Ireland to add perspective to the debate. It was recently brought to my attention by a young constituent going through the process of IVF that on the mainland a person whose BMI is 35 can access medicated ovulation support, but in Northern Ireland it is 30. Sometimes that request is difficult for people in Northern Ireland to achieve. On the mainland, too, a person whose BMI is 30 can qualify for IVF, but in Northern Ireland it must be 25. Again, the criterion set in Northern Ireland is more stringent and difficult to achieve than that on the mainland. That is not the Minister’s fault, but it provides perspective for the debate.

Many women in Northern Ireland have stated that the BMI issue is by far the biggest, and it leaves them with a feeling of sheer inequality. We have a clear issue of inequality in the system. Some of my constituents have come to the mainland to get IVF treatment. It can have a significant cost for them, which cannot be ignored. Why do they have to have a lower body mass index and be smaller to achieve the same fertility treatment as their English counterparts?

There is definitely an equality issue to be addressed. The hon. Member for Jarrow set out inequality in the system, and I support what she said. I reiterate the clear inequalities that my constituents face in comparison with those here. It is also worth mentioning that a woman suffering from polycystic ovary syndrome will struggle to lose weight at the same pace as someone who does not have PCOS.

There is already a prolonged process in place before people even achieve the criteria set back home. In England, according to NICE, women under 40 should be offered three rounds of NHS-funded IVF treatment if they have been trying unsuccessfully to start a family for two or more years. In Northern Ireland, it is only one round, and if the person or their partner has prior children, the entitlement is zero. As the hon. Member for Jarrow set out, the inequality is very apparent. Additionally, given that the chances of success vary depending on age, one round can be completely worthless in some cases. Unfortunately, some of the ladies who have come to me over the years have put themselves into debt in excess of a five-figure sum just to have a child, and the treatment may not be successful. Some of them are still paying the money back, and they have not had the child they sought to have in their life. It really is frustrating.

The Stormont Executive committed in 2020 to increase the number of funded cycles for a woman to have a baby. However, this is purely dependent on the money that Northern Ireland receives under the Barnett consequentials. Financial capacity restraints are the reason why the change has not been implemented. In this afternoon’s Westminster Hall debate on the future of NHS funding, I will highlight the issue of IVF funding and how it affects my constituents. We cannot expect to have a sustainable NHS if we do not make the effort to fund it properly.

I understand that capacity is different in Wales, where women are able to have only two rounds of IVF treatment. The fact that women in Scotland and England get three is completely unjust, as those in Northern Ireland get only one. It is a clear example of how we continue to be left behind, and it demonstrates the inequalities in the system for us in Northern Ireland.

NHS funding for IVF cycles varies considerably across the United Kingdom. In 2021, Scotland had the highest rate of NHS-funded IVF cycles, at 58%, compared with 30% in Wales and 24% in England. I know that the hon. Member for Livingston (Hannah Bardell) will give the figures for Scotland; I commend the country for achieving that percentage. Let us give it credit for doing so, because we should all be trying to achieve that.

The figures for Northern Ireland are not available, although I have sought hard to get them. I have written to the Department of Health back home to see whether they can be accessed, so hopefully I will have them in the next week or two. Self-funding is not always an option for couples due to the sheer cost of the process, but it is important to note the comparison.

Every time a lady undergoes an IVF cycle and is not successful, anxiety, depression and disappointment creep into the process. Then she might do it again and again. I know of one lady who has had IVF treatment at least five times, but it has never been successful. I feel for ladies who are keen to have a child and who go through the cycles of IVF treatment but are not successful. I believe that children make a marriage or a relationship. They might sometimes stress parents out but, at the end of the day, children are a bonus and a pleasure to have. I am pleased that at least some of us have had that opportunity.

I urge the Minister to take my comments into consideration and to discuss these matters with the Department of Health in Northern Ireland. I seek the Minister’s input; she always responds with compassion and understanding, which we appreciate. In relation to where we are in Northern Ireland, will she accept my request to have discussions with the Department of Health back home and see whether there is some way we can work together better to help my constituents and those across Northern Ireland who do not have funding for IVF? We must allow people in Northern Ireland the same right as those in the rest of the United Kingdom, and implement NICE’s recommendation to have three cycles of IVF for women struggling to conceive.

I wanted to make this small contribution to the debate, because it is important that we share our experiences. For those in Northern Ireland whose IVF treatment has been successful, the experience has been wonderful, but for many people it has not. The inequalities are clear.

Birth Trauma

Jim Shannon Excerpts

Thursday 19th October 2023 Commons Chamber

[Theo Clarke]

I thank my right hon. Friend for her intervention and for her excellent work on the start for life programme to ensure that children under five get the help that they need.

It was the most terrifying experience of my life— I genuinely thought that I was going to die—so I put on the record my immense thanks to the fantastic NHS team at Royal Stoke University Hospital, who carried out my surgery, and to the midwives who were with me during labour. I thank in particular my surgeon Nitish, my midwives Michelle and Stacey, my health visitor Chris, my mental health advocate Judith, and Nicole at the perineal clinic. However, the entire experience has also completely opened my eyes to challenges in post-natal care in this country.

I remember being wheeled into the recovery ward after surgery, where I encountered a nurse who had not read her notes and assumed that I had had a C-section. I was then moved to a side room, where I was hooked up to a catheter and a drip, and was lying in bed next to my baby, who was screaming in her cot. I could not pick her up. I pressed the call button for help, and a lady came in and said, “Not my baby; not my problem,” and left me there. That is unacceptable behaviour, especially when you are extremely vulnerable. I have subsequently met the hospital trust chief executive and the chief nurse, and I appreciate their apology and commitment to providing quality, safe care to women in Stafford going forward.

I spent nearly a week in hospital. One of my main reflections was the lack of aftercare for mothers. There is so much focus on the baby that we sometimes seem to forget that the mum has had a traumatic experience and needs care, too. I had never heard of birth injuries before. I later discovered that during childbirth I had suffered from what is known as a third-degree tear, when the baby stretches the vagina and rips the muscle in the back passage called the anal sphincter, which it is vital to repair. It is important to say that, although many women will have no issues in childbirth, some will, like me, be unlucky and have a third or fourth-degree tear, which occurs in about three in 100 vaginal births. I now know that around 20,000 women a year in the UK suffer from birth injuries. The consequences of an untreated obstetric tear can include urinary and faecal incontinence, as well as ongoing pain, so it is clear that we must do more to help those women.

On my return from maternity leave, I contacted those at the Birth Trauma Association, who are here with us today, and asked them to bring some mums to visit me in Parliament. I discovered that there is huge disparity across the UK in care for mothers who have experienced birth trauma. I was genuinely shocked at some of the stories those mums shared with me. For example, Gill Castle suffered from a fourth-degree tear and now has a stoma bag, and she had to give up her job as a police officer. She has since become an amazing campaigner on birth injuries, and I congratulate her on just becoming the first person with a stoma bag to solo swim the English channel.

It was so upsetting to hear their stories following that meeting, including sad examples of babies who had died and examples of medical negligence. That is why I decided to launch a new all-party parliamentary group on birth trauma with my Labour co-chair, the hon. Member for Canterbury (Rosie Duffield), who I am delighted is here today supporting the debate. Our APPG is cross-party, and we are so pleased that many colleagues from across the House have joined us to provide support. I welcome NHS England’s commitment to addressing these issues and the fact that it has now set out a three-year delivery plan for maternity and neonatal services, published in March, but it is clear that we still need to do more to improve post-natal care.

Birth trauma is caused by traumatic events or complications in birth. It is a term that can apply to those who experience symptoms of psychological distress after childbirth or physical injuries sustained during delivery. Those can include surgical procedures such as a sudden emergency requiring a caesarean section or a long and very painful labour in a severe state of pain for many hours.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for her courage in sharing her personal story with everyone in the Chamber and those further afield. One of my staff members had an emergency C-section. It started before she was under anaesthetic, and she was unaware it was coming. The trauma of it was very real, and it is clear that she should have been offered help to come to terms with it. She left hospital with a beautiful baby, yes, but she also left with a scar and a memory of traumatic events that she could not process because she did not know what was happening, and it all came upon her very quickly. Does the hon. Lady agree that in such scenarios, counselling and help should be offered at the beginning and should be accessible for all?

[Theo Clarke]

I thank the hon. Member, and I absolutely agree. If he will bear with me for a few more minutes, I will get on to that later in my speech.

I was talking about examples of birth trauma, which can also include a premature or very ill baby, having a difficult forceps birth, or a post-partum haemorrhage with severe loss of blood. Women have told me that they felt fearful that they or their baby might die. The traumatic event can be exacerbated by unkind or even neglectful care, or when women who feel physically or emotionally damaged after a traumatic birth are expected to look after their baby without any help.

Research shows that 4% to 5% of women will develop post-traumatic stress disorder after birth, which translates into about 30,000 women a year in the UK. The diagnosis of PTSD does not just relate to mothers but can also include fathers who have been present at their partner’s birth. Many of them have told me that they were kept in the dark about what was happening to their partner and baby. Symptoms of PTSD can include flashbacks or nightmares; negative alterations in mood such as guilt, sadness or self-blame; and a feeling of being constantly anxious and on high alert.

Birth trauma is obviously compounded by the stress of looking after a newborn baby, including months of sleep deprivation. Mothers have written to me to say that medical procedures that remind them of birth, such as a cervical smear test, can induce feelings of terror. Others became so fearful of their baby coming to harm that they refused to leave the house or let anyone else hold their baby. In many cases, their relationship with their partner has deteriorated because the woman has become so distressed. Women have told me that they found it impossible to return to work due to flashbacks or because they have physical injuries that make it impossible to do their job. Psychological, as well as physical, birth trauma also occurs when the mother is separated from her baby immediately after birth, which is what happened to me, and when they are poorly treated by healthcare professionals.

I was extremely lucky that I was treated by a specialist perinatal mental health team called the Lotus Service in Staffordshire, which included trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing, known as EMDR, in addition to attending a specialist perineal clinic for my tear. I welcome the fact that NHS England is setting up regional perinatal mental health services, but I am afraid that it is still patchy, and many women still face long waiting lists for therapy. In 2014, fewer than 15% of localities provided specialist perinatal mental health services for women with complex or severe conditions at the full level recommended by National Institute for Health and Care Excellence guidance, and I am afraid to say that 40% provided no service at all.

Clearly, we must end the postcode lottery that mothers in the UK currently face. It is unacceptable to me that a mother can receive a different level of care just because of where she lives, so today I call on the Government to ensure that perinatal mental health services are available to all mums across the UK.

I turn now to post-partum psychosis, which is a serious mental health illness that can affect mothers after they have had their baby. Tragically, it affects around one in 500 mothers after giving birth. Post-partum psychosis is very different from what is sometimes called the baby blues, which is more about mild mood changes post-birth: this is a serious mental illness that is treated as a medical emergency. Symptoms can range from hallucinations to manic moods and delusions, and it can sometimes take up to a year to recover. In my constituency of Stafford, we are privileged to have an amazing parent and baby unit at St George’s Hospital, which I recently visited. It is a specialist facility that aims to provide in-patient mental health services for women experiencing psychological and emotional difficulties specifically related to the latter stages of childbirth and early motherhood.

Next, I want to highlight the recent reports into maternity care at Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham, which have all identified problems in birth that arise from inadequate care. Sadly, those reports identified problems such as understaffing, poor team working or a culture of blame, which all contributed to the very sad and avoidable deaths and injuries of mothers and babies. We also know that a difficult birth is much less likely to lead to a woman developing trauma symptoms if the staff treat her with kindness and dignity, make sure that consent is obtained for procedures, respect her wishes for pain relief, and display sympathy when she is clearly distressed.

I have spent the past few months meeting with experts in the field, including the Royal College of Obstetricians and Gynaecologists, the Birth Trauma Association, the MASIC Foundation and the Maternal Mental Health Alliance. Following this, I partnered with Mumsnet—the online forum for mothers—to conduct a national birth trauma survey, given the lack of data. Our survey received 1,042 responses. The key results showed that 53% experienced physical trauma; 71% experienced psychological or emotional trauma; 72% said that it took more than a year to resolve; 84% who experienced tears said that they did not receive information about birth injuries ahead of time; and 32% experienced notes not being passed on between shifts. These results are shocking, and we shared them recently at our first meeting of the all-party parliamentary group on birth trauma.

I was very grateful that Dr Ranee Thakar, president of the royal college, came to that meeting to talk to us about her initiatives, including on obstetric anal sphincter injuries—known as OASI—which, as I have already mentioned from my personal experience, are third and fourth-degree tears. Long-term consequences can include chronic pain, sexual dysfunction, and difficulty or inability to control the bladder, bowels or passing of wind, and can significantly affect mental health and people’s ability to carry out everyday activities. We need to break the taboo by talking about this, and that is what I am trying to do today. Childbirth has been identified as a key risk factor for the development of pelvic floor dysfunction later in life, with one in 12 women having a pelvic organ prolapse.

To reduce the likelihood of birth injuries, UK experts led by the royal college created the OASI care bundle, which has already been rolled out in 19 new maternity units since 2019. That care bundle has been significant in reducing birth injuries by 20%, so today I call on the Government to roll it out across NHS England to all hospital trusts. I also put on record my thanks to Mr Speaker for extending my proxy vote after my maternity leave, in order for me to recover from my own birth injury. This new system of remote voting will make a huge difference to MPs who are new mothers or have had to undergo major surgery, as I did.

Sadly, ahead of today’s debate I have been inundated with hundreds of emails and letters from mothers who have experienced birth trauma. I thank each of those, and in some cases the partner, who have taken the time to write. I know how difficult and painful it is to talk about this. With their consent, I will briefly share some stories that I believe powerfully highlight the issue.

One mother, who gave birth in Leicester General Hospital, writes:

“I delivered my son naturally and without intervention, but I did suffer a third-degree tear. This wasn’t really explained to me at the time, other than to tell me that I needed stitches. It was only afterwards, when I received a copy of the consent form, that I realised exactly what the surgery had been for.”

Another mother writes:

“Labour was progressing well, then I started to…tear, so an episiotomy was performed. But I had torn all the way to the back, I was taken into theatre for repair…which took nearly 2 hours. I lost about 1 litre of blood… Currently I experience pain and bleeding after bowel movements, pain during sex”

and, as we can imagine, a

“smear test several months ago was agonising”.

She said she had been

“experiencing nightmares, awful intrusive thoughts and panic attacks, all concerning leaving or being separated from my son”,

and she was referred to her GP for post-traumatic stress disorder.

A mum called Stacy says:

“I was told I’d either need forceps or a C section so would be taken to theatre. I couldn’t read the form I was so out of it and I remember my signature sliding down the page”.

Another writes:

“I suffered birth trauma, feeding issues, bad medical advice, poor mental advice, long term sleep deprivation”,

and even PTSD was triggered in her husband.

Sadly, there have also been examples of inequalities in treatment among ethnic minority groups. One mother explains that

“the nurse did not spot my haemorrhage due to the colour of my skin. There needs to be more diversity training, as the medical professionals fail to recognise symptoms in non-white patients”.

Finally, an NHS doctor who served as an obstetrician wrote to me to say:

“Occasionally it was dads who were traumatised. Watching your partner experience a major obstetric haemorrhage and literally being left holding the baby whilst she is being wheeled away from you into the operating theatre was…a distressing experience and as time went by the dads were sometimes left wondering if they might be bringing up the baby as a single parent. Everyone was busy with their wife in theatre and no one came to speak to them for quite some time”.

Unfortunately, none of these are isolated incidences—they occur all too frequently—so the Government must take action to improve the experiences of women who have traumatic births.

I welcome the fact that the Department of Health and Social Care published its 10-year women’s health strategy for England last year. I also welcome the appointment of Professor Dame Lesley Regan as the Government’s first ever women’s health ambassador for England, and I look forward to meeting her in a few weeks’ time. However, on reviewing the Government’s strategy, I was surprised to find the mention of birth trauma only once in the entire document, which was in the context of a call for evidence for the public inquiry. Given that the public in their response to the Government’s strategy included a request for birth trauma, it is now essential that this is delivered in any future updates to the women’s health strategy. So today I am calling on the Government to add birth trauma to the women’s health strategy in a meaningful way.

Lastly, I want to touch on staffing. We know that our brilliant NHS workforce is essential to ensuring safer and more equitable maternity services. This has been recognised in both the Ockenden and the East Kent reports. We know that safe staffing levels are essential to the provision of safe maternity care, and we also know that workforce recruitment remains a priority concern. I note that NHS England’s long-term workforce plan has set out commitments to support our maternity and neonatal workforce, but unfortunately staffing gaps remain, with an 11% vacancy rate.

In conclusion, it is so clear to me that so much more needs to be done to support women who experience traumatic births. Today I call on the Government to add birth trauma to the women’s health strategy; recruit more midwives; ensure perinatal mental health services are available across the UK; provide appropriate and mandatory training for midwives with a focus on both mental and physical health; ensure that the post-natal six-week check with their GP is provided to all mothers, and will include separate questions on both the mother’s physical health and her mental health in relation to the baby; improve our continuity of care so there is better communication between secondary and primary health care, including explicit pathways for women in need of support; provide post-birth services nationally, such as birth reflections, to give mothers a safe space to speak about their experiences in childbirth; roll out the obstetric anal sphincter injury care bundle to all hospital trusts in England to reduce the risk of injuries in childbirth; provide better support for partners and fathers; and, finally, have better education for women on their birth choices and on risks in order to ensure informed consent.

Let me thank all the birth trauma organisations and the mothers who have contributed to this campaign. I really hope that the Government will listen to my plea today, and ensure that women who suffer from birth trauma will now receive additional support.