NHS Dentistry in England

Jim Shannon Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I thank my hon. Friend for that intervention. He is right to say that there are commissioned units of dental activity that are not being delivered. There are all sorts of reasons for that, which I hope to cover in my speech. Ultimately, however, we need to look at the contract itself and consider whether it actually works for patients. The contract was introduced by the Labour party in 2006. We know that it does not work today and is in urgent need of reform, which I will come on to in my remarks.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will make a little progress first and then I will give way to the hon. Gentleman.

We have heard about other examples and concerns elsewhere, but in Cornwall we do not have the capacity to assess the patients in the backlog, let alone to treat them. This is not just about dental health. Dental examinations pick up the early warning signs of mouth cancer, or poor periodontal health associated with diabetes, for example. I should declare an interest, Mr Stringer, as the chair of the all-party parliamentary group on diabetes. It is estimated that 60,000 people with type 2 diabetes had their diagnosis missed or delayed because of the cancellation of dental examinations.

I will now give way to the hon. Member for Strangford (Jim Shannon).

[Jim Shannon]

I know that this debate is about NHS dentistry in England, but may I say—regionally—that the problems are just as real in Northern Ireland as they are anywhere else? My concern is that there is no access to NHS dentistry any more in Northern Ireland; either people pay for dentistry, for example through a subscription, or they do not get it.

Does the hon. Member agree that dental care should not be restricted to those who have the money to pay? The impact of this situation will clearly fall on those who see dentistry as being the bottom of the list when it comes to paying? People in the poverty trap who feel the pressures of rising prices will be even more detrimentally affected than ever. Does he feel that now is the time for Government all across the United Kingdom of Great Britain and Northern Ireland—although I appreciate that the Minister who is here today does not have responsibility for Northern Ireland—to do something specifically for people on the breadline?

[Derek Thomas]

I thank the hon. Gentleman for his intervention.

It is probably fair to say that although the responsibility lies with the Minister here today, it is not her responsibility, or even in her power, to ensure that every member of the British public can access NHS dentistry, simply because NHS England, or indeed any part of the NHS, does not commission enough dentistry to cover the whole population. Perhaps the Minister will clarify today the Government’s expectation regarding access to NHS dental care, and say whether there is a right for everybody, whoever they might be, to access that care. However, it is a very important point that has been raised. It surprises people that we do not commission enough dentistry to meet the needs of every one of our constituents.

It is not enough to blame the pandemic, although it has certainly not helped. I was raising the state of NHS dentistry in Cornwall before we had a single case of covid in this country. Over two years ago, I spoke about the difficulty of recruiting and retaining dental staff. At Prime Minister’s questions two years ago, I raised the shocking results of the lack of access to NHS dentistry for children in Cornwall. I also told hon. Members that these inequalities needed to be addressed quickly and creatively.

Outside this House, I have been working to improve access to dentistry in the constituency, most recently by getting the council to overturn a decision not to allow electrical works to proceed in St Ives that would have delayed the opening of a new dental surgery until the autumn. I have been meeting the regional health commissioners and Cornwall’s public health officers to discuss dentistry on a regular basis, and I cannot fault their speed and creativity. Their south-west dental reform programme has been working hard to improve access by helping to reopen a surgery in Hayle and in St Ives, piloting child-focused dental practices, and developing its own evidence-based workforce plan, but the Government must lead the way. Resolving these oral health inequalities is not just this Minister’s responsibility; it will require a cross-Government approach.

NHS England has launched a drive to recruit dental professionals to the south-west, but a key challenge in Cornwall, and maybe other parts of the country, is finding housing for those who want to take up a job in dentistry. I am working on that issue with the Department for Levelling Up, Housing and Communities. The national food strategy was a wasted opportunity. We could have extended the sugar tax, which has successfully incentivised the reformulation of sugary drinks. That would have helped oral health as much as health in general. I shall continue to argue for a national food strategy that is truly strategic, even if the Government have made a tactical withdrawal from tax rises to support public health.

The Minister has responsibility for the dental contract. In oral questions in January, she agreed that the contract was

“the nub of the problem”.—[Official Report, 18 January 2022; Vol. 707, c. 195.]

She said in February,

“there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

I could not have put it better myself. I have asked dentists in my constituency if they would prefer to see increased budgets or reform of the UDA contract, and they asked for reform.

There are two main issues with the dental contract, both of which are not just obstacles to dental health but actively create problems for the future. First, the current system does not focus on prevention. When units of dental activity are the sole measure of contract performance, there is no incentive for preventative work; nor is there an incentive to make the best use of the whole dental team’s skills when the practice cannot make a claim for payment for a course of treatment purely because it was initiated by someone other than a dentist.

I made sure that the title of the debate referred to NHS dentistry not NHS dentists. We need to recognise the contribution of the whole team of dental professionals —dental nurses, hygienists, therapists and technicians—and use them. Again, this is about not just saving money, but using professionals in the best way we can. Yesterday I spoke to a dental nurse who works with people in care homes. If she wants a resident to switch to a high-fluoride toothpaste, she has to get a dentist to prescribe it. Our regional dental commissioning team has been running a pilot to take supervised toothbrushing conducted by dental nurses out to the community. Given that more five to nine-year-olds are admitted to hospital for tooth decay than for any other reason, this work should be at the heart of NHS dentistry, not something that is topped up by flexible commissioning.

Second, the UDA method does not properly reward dental practices for their work. A dental practice is faced, in effect, with a UDA cap for an entire course of treatment, which means when a patient has complex needs, the money involved does not even cover the overheads of the practice. The predictable result is that dental practices are moving away from NHS work. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Every time a dentist leaves the NHS and is not replaced, approximately 2,000 people lose access to dental care. If you cannot do the arithmetic in your head, Mr Stringer, 3,000 times by 2,000 is 6 million, so 6 million patients have lost access to a dentist just over the course of the pandemic. For every dentist leaving the NHS, another 10 are reducing their NHS commitment by a quarter on average; that is another 500 patients losing access to an NHS dentist. According to the British Dental Association, 75% of dentists plan to reduce the amount of NHS work they do next year.

The fewer dental practices there are doing NHS work, the more pressure the remaining practices are under. A recent BDA members survey found that nine in 10 owners of dental practices committed to NHS work found recruitment difficult, with 29% of vacancies going unfilled for more than a year. That is nationwide, but one provider in Cornwall told me that their surgeries were unused 52% of the time due to shortages of dentists and nurses. The vast majority said that it was the UDA contract that was the biggest factor in their recruitment difficulties. The Minister said last week that the Government are serious about reforming the dental contract, but I want to press that point. It is not enough to be seriously planning a reform; we must be planning serious reform. Tweaks to the existing system are not enough when the contract is fundamentally flawed.

I have focused on the contract because we need the Minister to focus on the contract. Other Members will no doubt raise the issue of recognising overseas qualifications, passing the section 60 order that would give the General Dental Council discretion over qualifications, maintaining the mutual recognition of professional qualifications with Europe and extending that to the Commonwealth, and expediating the process for experienced candidates to register with the NHS. Dental care professionals need to be allowed to initiate treatments. The issue of funding will come up—for a catch-up programme of overseas registration exams in the short term, and university places in the long term—but it is striking how many of those proposals are cost neutral. We could even save money by catching mouth cancer in the early stages when it is more easily treated.

To quote the Minister, the contract is the nub of the problem. I urge her to commit to a firm date when we will see the end of units of dental activity, and a better contract focused on prevention and increasing access.

Community Pharmacies

Jim Shannon Excerpts

Tuesday 21st June 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Sir Gary. It is a pleasure to speak in this debate. First, I congratulate the hon. Member for Bootle (Peter Dowd) on setting the scene so very well. This subject is something that I am sold on. It is something that I fully endorse, as others have done. We all see the real benefits of it. I have a great interest in the topic. I believe that community pharmacies are an untapped resource that we need to unlock with clever funding and foresight. Over the years, I have worked closely with a number of pharmacies in my constituency of Strangford and have been impressed by the expertise and the potential that is ready to be unlocked.

Pharmacies were involved in covid-19 jabs. They do flu jabs, blood pressure tests and asthma checks, as the hon. Member for Bootle mentioned. Staff can look out for signs of illness and can, if necessary, refer people on—because they know the limitations of the service as well—and that is a good thing. I got the girl from the office to send through details of some of the things that they can do right there and then; people do not have to go to A&E to get these things done. Pharmacies can deal with athlete’s foot, diarrhoea, haemorrhoids, head lice, groin infections, threadworms, thrush, earwax, mouth ulcers, scabies and verrucas. Staff can deal with all those things, at the initial stage, in pharmacies. Although some of those things are probably fairly personal, pharmacies do have the ability to deal with them.

During my time in the Northern Ireland Assembly, I was a strong advocate for what was then called the minor ailment scheme. Although that may still be in operation to a small degree, the potential for more is at our fingertips. The enthusiasm and energy that local pharmacies have really excites me. I get extremely excited about the potential, about what could happen, when I speak to owners such as James McKay of McKay Pharmacy in Newtownards to hear of the schemes that he has ready to go—making space for community physio and nutritionist provision in tandem with the local GP surgery that has premises abutting the pharmacy. There is scope for a real community facility—with much more provision than perhaps pharmacies, with their space, can provide—and that needs to be progressed and replicated.

I was not surprised to read that, on average, pharmacies undertake more than 58 million informal consultations per year. I had to get malaria tablets for a trip to Nigeria just a few months ago. In the past that would have meant a trip to a Belfast private doctor to get a private script, at a large cost. But this was a matter of popping down to my local pharmacy, answering some questions and getting the malaria tablets. Last week, I had a bit of toothache. Again, I went down and spoke to the lady. She gave me the tablets; she gave me the gum rub, and there and then seemed to have solved the problem. Similarly, I believe that those informal consultations prevent an additional 70,000 people from needlessly attending A&E or an NHS walk-in centre every week. Yet community pharmacies receive no specific funding for holding such consultations. That needs to change. I look to the Minister, as I always do. She understands these issues extremely well and, more often than not, she has the answers to the questions we ask.

Delivering minor ailment care through community pharmacies rather than GPs could result in a 53% total cost reduction to the NHS. The cost of providing 40 million minor ailments GP appointments per year is £1.2 billion; it would cost just £560 million to transfer those appointments to pharmacies as a community pharmacy consultation service. Those significant savings cannot be ignored. In this day and age, when finances are important, it is important we look at these issues. It is not simple, straightforward maths and is more than just a number exercise.

We must understand that community pharmacies are ready and willing, and local GP practices are calling out for pressure on surgeries and treatment rooms to be relieved, as well as that on accident and emergency departments. This change makes sense. It has been shown to work in the past and will work again in the future. Let us make the most of the expertise we have and take the pressure off our GP practices where it is possible to do so. We need to get treatment and training in place and get the right people doing the right things.

The future of community pharmacies is intrinsically linked with that of the NHS. We need to work smart as well as expecting them to work hard, and get the minor ailments scheme in a funded and good position. This is a tremendous opportunity to do something good with our health service, in a way that we save money and also deliver better care across the whole community. Everyone of us here today is excited at the possibility of what could happen. I am sure when she responds the Minister will give us some encouragement. I know one thing: if this happens, we all gain.

[Sir Gary Streeter (in the Chair)]

We move to our Front-Bench speakers. I call Steven Bonnar.

Access to GP Services and NHS Dentistry

Jim Shannon Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

I will give way one more time and then I need to make some progress.

[Jim Shannon (Strangford) (DUP)]

It is not just about GPs and surgeries; it is about dental access as well. In my constituency and across the whole of the United Kingdom of Great Britain and Northern Ireland, dentists are prepared to take private care and monthly care, but they will not take NHS patients. As poverty levels and prices rise, dentistry is at the end of the queue. Does the hon. Gentleman agree that dentistry is at crisis point and that Government intervention is absolutely critical?

[Wes Streeting]

The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.

[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.

The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:

“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]

Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.

Battersea Funfair Disaster: Child Trauma Support Services

Jim Shannon Excerpts

Tuesday 21st June 2022 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

This year is the 50th anniversary of the Battersea funfair disaster. I want to start by remembering the victims, their families, and the survivors. I also want to pay tribute to and thank two of the survivors, Hilary Wynter and Liz Haigh-Reeve, for their tireless campaigning to have the tragedy recognised and remembered.

The Big Dipper rollercoaster was the main attraction of the Battersea Park funfair which opened as part of the festival of Britain. Tragically, on 30 May 1972, a carriage of the rollercoaster broke loose and plummeted backwards through a barrier killing five children—Alison Comerford, Thomas Harmer, Shirley Nash, Debora Robertson and David Sait—and leaving 13 injured. The disaster is one of the deadliest rollercoaster crashes in history. However, it has largely been forgotten and there has been no justice for the victims, their families and the survivors.

To mark the anniversary of the disaster, I attended a special memorial ceremony together with families and survivors in Battersea Park where a plaque was unveiled and a tree was planted. That is the first step to creating a new legacy and a permanent memorial.

There is another silent tragedy associated with the incident, on which I will focus the rest of my speech. It is something that I am determined to change. Survivors have spoken about the devastating impact that childhood mental trauma has had on their lives. As one told me,

“bones are mended, physical injuries fixed, but the dreadful damage to our mental health goes untreated.”

Damage from trauma is not necessarily skin deep: some wounds penetrate through to our minds, leaving lasting damage that can be just as debilitating. Although the funfair and the big dipper are long gone, some of the survivors of the disaster still struggle to go to Battersea Park, and have been unable to shake off their horrific memories of that incident. I am sure many survivors of other tragedies, such as Hillsborough, the Manchester Arena terrorist attack and the Grenfell Tower fire, have been through similar experiences.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on securing this debate on childhood trauma support services. I would mention helpfully to her, and probably to the Minister as well, that we in Northern Ireland have faced 30 years of a terrorism campaign during which many young children, women and men have lost their lives. Such trauma can last way beyond the time that it happened. Does the hon. Lady agree that some discussions with the responsible Minister in Northern Ireland might be helpful when it comes to devising a policy and a strategy to address trauma and child mental issues, which I know she wishes to see?

[Marsha De Cordova]

The hon. Gentleman is right: we can all learn, and it would be useful for the Minister to say whether she would like to meet Ministers in Northern Ireland to look at what works well.

Childhood trauma can have a lifelong effect, and can have lasting consequences for a child or young person’s development, including psychological, behavioural and emotional problems. Those problems can occur into and throughout adulthood, presenting related challenges in many aspects of that person’s life. According to the UK Trauma Council, childhood trauma refers to the ways in which some events and experiences are so extreme that they overwhelm a child’s ability to cope. Many different experiences can lead to such trauma: for example, physical or sexual abuse can be traumatic for children. One-time events like the tragedies I have mentioned can take a psychological toll on children as well. Ongoing stress such as the effects of the pandemic can also be traumatic for a child, even if it just feels like everyday life to an adult.

We know that the pandemic has had a huge negative impact on children and young people’s mental health and wellbeing. The Children’s Commissioner’s Big Ask survey found that one in five children was not happy with their mental health, and that figure rose to two in five for some groups. Childhood trauma does not have to involve experiences that are directly related to the child: for instance, watching a loved one endure major issues can be extremely traumatic, as has been highlighted by the impact of the cost of living crisis on children’s mental health. According to the Childhood Trust’s latest report, 47% of children surveyed felt stressed, 21% of parents said that their children smiled less, and most concerningly, 9% of parents claimed that their children had started self-harming. The results of that report should worry us all, as all those types of trauma will affect children’s development and wellbeing.

The Government need to invest in mental health services to ensure that children who experience trauma today do not face the same painful ordeal that survivors of the Battersea funfair disaster have gone through over the past 50 years. Spending on children’s mental health remains behind investment in adult mental health services. It is worrying that children and young people’s mental health services are among the most under-resourced and that the quality of care varies between different parts of the country. A BBC freedom of information request revealed that 20% of children are waiting more than 12 weeks to be seen for mental health support. That is why I was pleased to secure this debate on better provisions for children’s mental health services and childhood trauma.

The Government need to correct the historical underinvestment in children and young people’s mental health and the postcode lottery of services and support provision. To do that, they must create a comprehensive child mental health strategy, and childhood trauma services must be prioritised as part of that. The UK Trauma Council has called for the Government to invest in the development and delivery of specialist trauma provision so that children and young people have access to the support that they need. It also called on the Government to equip all professionals who work with children and young people with the skills and capacity to support those who have experienced trauma.

Labour has already set out its plan on tackling the mental health crisis, which includes giving adequate funding to mental health services. We have also committed to radically expanding the mental health workforce, including, crucially, investment in children’s mental health that includes putting open-access mental health hubs for children and young people in every community and ensuring that a full-time mental health professional is in every secondary school and a part-time professional is in every primary school.

Labour’s focus on early intervention is so important, because it can prevent the ongoing effects of trauma into adulthood. It would ensure that children are properly supported and resolve problems before they escalate. I will therefore ask the Minister about the Government’s plan for children’s mental health services and, specifically, childhood trauma care. When will her Government introduce a comprehensive child mental health strategy that includes prioritising trauma and investment in the development and delivery of evidence-based trauma service provision? How are they ensuring that children’s mental health services are a high priority in the NHS? That includes increased investment.

The Government have made £139 million available to support children and young people’s mental health in the community, but we need to see more investment. How are the Government working with professionals in contact points including in schools and the third sector so that children can access support when problems emerge?

Much work also needs be done to ensure that every child and young person gets the support that they need for their mental health and wellbeing. We need to step up as a society and be more ambitious in our call for better support for children and young people’s mental health. More funding and resources will be an investment in our children’s future. It is time for the Government to act and listen to the voices of children and young people, especially those suffering from trauma. If we do not act now, when will we?

--- Later in debate ---

[Gillian Keegan]

Yes, and of course we always try to ensure that, as the targets we put in are worked throughout the system, those targets are met. That is why we measure those things. Maybe it would be helpful to the hon. Lady if I gave some recent examples. In the wake of the Manchester Arena terrorist attack, which sadly affected many children and young people, the Greater Manchester Resilience Hub was set up to provide a central point for mental health advice for those directly affected, including children and emergency responders. The hub worked with other agencies to develop packages of care.

In response to the tragic fire at Grenfell Tower, more than £10 million has been spent on treating the mental health of those affected. In the year after the fire, 2,674 adults and 463 children were screened for symptoms of post-traumatic stress disorder, and the St Charles Centre for Health and Wellbeing was opened up so that those affected could be treated in dedicated therapy suites. I hope the hon. Lady will recognise that we have seen a dramatic change in both attitudes towards mental health since the days of the Battersea disaster, and the NHS services available to support people with their mental health.

[Jim Shannon]

I am very encouraged by what the Minister has just said. In my intervention on the hon. Member for Battersea (Marsha De Cordova) I suggested some contact with the authorities in Northern Ireland, which unfortunately have a long 30 years’ experience of trauma, especially among children. Has that happened?

[Gillian Keegan]

I have not met my counterpart in Northern Ireland but, having heard the hon. Gentleman’s intervention, I sent a WhatsApp message to request that a meeting be set up, because it is probably long overdue. We can learn a lot from each other, and I am always keen to learn from anyone I can.

Over the past 50 years, we have seen the transformation of NHS mental health services for children and young people. From the passing of the Mental Health Act 1983 and the establishment of mental health trusts to more recent developments including the Time to Change campaign, which between 2007 and 2021 helped to improve the attitudes and behaviours of some 5.4 million people towards those living with mental health problems, these are all important steps along the way towards destigmatising mental health.

The publication of the five-year forward view for mental health in 2016 made the case for transforming mental healthcare in England. The implementation of the “Transforming children and young people’s mental health provision” Green Paper from December 2017 has seen the introduction of senior mental health leads and mental health support teams in schools and colleges. We regularly talk about that programme, and I am sure it will make a massive difference to young people, particularly those affected by the pandemic. The 2019 NHS long-term plan commits to expanding and transforming mental health services in England so that an additional 345,000 children and young people will be able to access NHS-funded specialist mental health treatment by 2023-24.

We are continuing to build up those services and the staff, as in some cases demand outstrips supply. As part of this work, we have all-age 24/7 urgent mental health helplines in all areas of England so that people experiencing a mental health crisis, or those worried about someone experiencing such a crisis, can speak to a trained professional. The helplines were established during the pandemic, so they are a relatively new addition to the landscape, but I am sure they are very welcome because many people have sought these services.

We are also accelerating the coverage of mental health support teams in schools and colleges from the 287 currently in place to over 500, covering around 35% of pupils by 2023-24. There are currently 16 mental health support teams operating in or planned for south-west London, so they have already started to roll out.

Our hard-working NHS community mental health services treated over 420,000 children and young people in 2020-21, an increase of around 95,000 on the previous year, so we can see there has been a massive increase in demand for these services, which is why we are working very hard to try to build up the mental health workforce.

Although none of us wishes to see a repeat of the events in Battersea Park and the many things that have happened since, not only in mental health but in safety, I assure hon. Members that the NHS will always be there to support the survivors of such tragedies. However, it is important that we never forget. I am therefore grateful to the hon. Member for Battersea for securing this debate and for making us all aware of something that happened. This issue is important to her constituents, and this debate will ensure that we all remember the tragedy and learn from the events of that day.

Question put and agreed to.

Infant Mental Health Awareness Week

Jim Shannon Excerpts

Thursday 16th June 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate. The right hon. Member for South Northamptonshire (Dame Andrea Leadsom) deserves every credit. She and I came to this House in 2010, and she has spoken about this issue in Westminster Hall and in the main Chamber on many occasions since. She will correct me if I am wrong, but I do not think that there has been a time when I have not supported her in such debates.

I do that for a number of reasons: first, because of our friendship as MPs, but secondly, because I fully support and endorse the right hon. Lady on this issue. I am always challenged by her contributions because they are so full of detail and knowledge about the right way to do things. The input of mothers is so much greater than the input of the dad. As a father and not as a mum, I cannot take any credit for how my children turned out; it is really down to my wife. She is the lady who did all the hard work—I was very rarely there—so I recognise the role of the mother in particular is critical, and it moulds the child for the future. For that reason, I am really pleased to come along to this debate.

[Munira Wilson]

Will the hon. Gentleman join me in saying that it is a wonderful thing to see cultural change and dads taking a much more active role? My husband is the primary carer of our two children and is very much the dad at home, and he has been since they were tiny, while I have always been out there working.

[Jim Shannon]

I was reminded when the hon. Lady mentioned that that I was at a function last Friday for the centenary of the Royal Ulster Constabulary. One of the councillors of my party is a house dad and he looks after two children. I will not mention his name, but he said to me last week, “Jim, I’d rather be working.” I said, “You are working, you’re just looking after the children. It’s slightly different.” But yes, the hon. Lady is right; society is changing, and sometimes that is the way it is. I have to say that I do think the role of the mother is much more important. That is just me; maybe I am old fashioned. I just see a slightly different and more critical role for the lady.

A growing body of evidence from the fields of clinical and social science shows that the areas of the brain that control social and emotional development are most active during the first three years of a child’s life. The hon. Member for Twickenham (Munira Wilson) referred to that, and referred to three to five years as well. That is important. Careful nurturing of a child’s social and emotional health during their early years is vital to provide them with the skills necessary to form relationships and interact with society later in life. It is so critical to get that right in those first few years. The hon. Lady has always said that in debates in the Chamber and elsewhere. I am my party’s health spokesperson, so I am pleased to be here, given my personal interest in the issue and as a grandfather with five grandchildren. The sixth is on the way, so we will shortly have a sixth one to nurture and look after. It means that the Shannon name will live on, and more so when the sixth grandchild arrives.

Developments start during pregnancy, and the choices and experiences of the mother during that period can have a significant impact on maternal and infant social and emotional health. With that in mind, Northern Ireland has a dedicated mental health strategy. I know that the Minister is aware of all those things, not just because some of her ancestry comes from that part of the world, but also because she makes it her job to be aware of what is happening in the regional Administrations. Although we have a mental health strategy in place, the pressures of lockdown and covid have greatly impacted child mental health, and any strategy must take that into consideration.

I want to focus on that issue, which the right hon. Member for South Northamptonshire referred to in relation to covid. Covid has put extra pressure on what the right hon. Lady is trying to achieve, and what we are trying to achieve in this debate. We have more children than ever who, as we say in Northern Ireland, make strange with strangers. I will try to explain what that really means. The right hon. Lady referred to isolation during covid, and it is as critical and stark as that. Covid babies were literally prevented from seeing other children; that is a fact of life. “Being strange with strangers” means nothing more than not knowing how to act with wee children of their age or how to react to adults who want to be friendly and acknowledge them. Children being strange with strangers, having not seen other children and adults during formative periods of their lives, is a critical issue that needs to be addressed.

Ever mindful that health, education and so on are devolved matters—although the issue for Northern Ireland will be similar to here—I have a major ask of the Minister, which I will be happy if she can respond to. What extra assistance, help, funding or advice can be given to parents whose children were born or were between two and five during covid—those two stark years when life was so different and we could not interact? What can be done to address that issue as we come out of covid and move forward in a constructive way?

Naomi from my office—who is my speechwriter, by the way; I keep her busy and make sure that she is across all these things—and I are of a kindred mind and spirit, so it is easy for us to discuss the issues that I want to speak about, because we look at how to do things the same way. She helps with the creche and the children’s church on Sunday morning, and she has told me, based on her personal experience, that it is only after a full year of being back that some mothers can slip back into the main service without their children getting upset. Let me explain what that means, Madam Chair. In the last two years, the covid pandemic put pressures on families like never before, which meant that the children probably did not leave their mum very often. Now that the creche and the children’s church is back, the children are able to stay there and their mums are able to leave.

That wee period is an example. In Naomi’s opinion, it has taken a year for those children to feel safe, even in a safe place—wow!—if their mother is not there. My fear is for those mothers who have been unable to leave their children—those who do not attend church, do not have a creche or nursery, or do not have access to other adults who could help. The right hon. Member for South Northamptonshire said how important it was for mums to have another mum to talk to, and even that was partially lost in the pandemic. I also wonder about pre-school and nursery children.

We must consider the effect of lockdown in a very detailed way. It is a genuinely big question to ask the Minister, but I see it in my constituency, and I am sure that everyone in this debate will be on the same page. I recently read a report by the National Children’s Bureau that highlighted the post-covid position. Although support for babies and infants, and their families has always been critical, the unprecedented covid-19 pandemic has refocused efforts on prevention and early intervention to address new or increasing risks, which is what this debate is really about.

Although it will be some time before the long-term impact of the pandemic is known, evidence already suggests a number of areas for concern, including the rising cost of living. The pandemic has moved on, but other things are impacting on young children, from babies right through to five-year-olds, including the cost of living and increasing fuel poverty. These are real things that every mother and every dad has to look at every day. I am no different from anybody else in this Chamber; I think that we are all the same. We are hearing regularly from our people and our constituents about these issues, and we worry about that. Again, that is not all the Minister’s responsibility; it is just to show the impact that these things are having.

Many people and families are increasingly reliant on food banks, which comes on top of already unacceptable child poverty rates, and against the evidence about the links between poverty and adverse childhood experiences. I never fail to get quite upset when I read those stories in the press about wee children who have been abused or, in the cases that make the press unfortunately, killed. I just cannot understand how those things can happen. I cannot understand the mindset of anybody who does that, and I cannot understand how social services did not step in earlier. This is just me, speaking from the outside. I find those stories quite painful to read, Madam Chair; I think we are all the same in that regard. Sometimes, you just have to flick over the page—not that you are disregarding it, but because it is so awful that you just cannot read it all. Those are some of the things of the day, along with concerns about parental mental ill-health, which is being driven by isolation, job uncertainty or the loss of a job, the loss of loved ones, illness and anxiety, among other factors.

I will just make a couple of quick points—I am coming to the end of my remarks; time is flying on here. I am greatly encouraged by foster families. The right hon. Member for South Northamptonshire is absolutely right about that. I know foster families who do some fantastic work, and they have a love for their children. Although they are not their biological children, they are their children. Those children get the love they did not have in their own homes, for whatever the reasons were. I know some foster families who have adopted maybe 20 or 30 children—that is incredible. They give affection and love, which is so necessary for a wee baby or small child between three and five, which are such important years.

Increased pressures in the home and the rising incidence of domestic violence—which is unfortunately another issue that happens with a regularity—are putting young children at risk of witnessing or experiencing abuse, and it impacts parental wellbeing. They see their mummy or daddy—let’s be honest, more often their mum—getting beaten, and that affects the child. The right hon. Lady is right: the experience of that three to five-year-old seeing that will have an impact for years to come. That is why this debate is critical and why over the years, when she has brought us to Westminster Hall and the Chamber, I was always there. I understand—not as good as the right hon. Lady does—what she is trying to achieve.

Services are facing pressure as they seek to continue the delivery of essential support to infants, parents and their families within the constantly changing environment that they find themselves in. The environment is changing all the time, and the pressures are great. There have been delays in access to services and support during lockdown and the pandemic, particularly for isolated and vulnerable families with newborns. Sometimes mothers have difficulty dealing with their children—it happens. It is a fact of life, but having someone to speak to and to help at that early time is so important.

The hon. Member for Twickenham is absolutely right about the need to invest in our children and young people. I see it as an investment and an opportunity to get it right, so that the children of the future can grow up to be Ministers, Chairs of Committees, doctors, teachers or MPs. We should give them the opportunity to do that. Let us get things right at the early stages. Every child deserves a good start in life, as the right hon. Member for South Northamptonshire said. I agree wholeheartedly with that, and I hope the debate can in some way move us towards that.

The need is clear, and we need to be just as clear in our pathway to support and help and in how this will be funded and promoted in every area of this United Kingdom of Great Britain and Northern Ireland. I am pleased to be an MP here and part of a nation that is united across the four regions. I say that to the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—she and I are good friends. It is important that we have a strategy and a way forward for all four regions to achieve what the right hon. Member for South Northamptonshire said: giving every child a good start in life. If we could do that, we would be doing well.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 14th June 2022 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

Of course every suicide is a tragedy. We must do all we can to help to prevent suicide. In the last financial year, we provided £5.4 million to 113 voluntary, community and social enterprise organisations; we also provided £510,000 for the Samaritans helpline for people experiencing distress. That is in addition to more than £10 million we provided to voluntary and charitable mental health organisations in 2020-21.

[Jim Shannon (Strangford) (DUP)]

As IVF treatment is incredibly time sensitive, will the Secretary of State consider increasing the funding available to allow couples to make use of private facilities on the NHS, to help families have the children that they so much want?

[Maria Caulfield]

I cannot comment on health in Northern Ireland specifically as it is a devolved matter. IVF will be a significant factor in the women’s health strategy, because we recognise the disparities that exist across the country in how couples currently access IVF.

Menopause

Jim Shannon Excerpts

Thursday 9th June 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

As always, I am thankful to be able to speak on behalf of my constituents. I want to start by congratulating the hon. Member for Swansea East (Carolyn Harris). I have been fortunate in my life to have always been surrounded by powerful women. It was my mother to start with, then my wife, and in the political sphere the hon. Member for Swansea East, who is a really powerful lady. Whenever she asks me to be involved with debates, she is pushing on an open door. She knows I will be more than happy to support her—I always have been.

When the hon. Member for Swansea East started this campaign some time ago, she and I talked about it, and she was very keen to have a man on board. I am very happy to give my support, for a number of reasons. I do it because the request is right: it is about raising awareness. As a man, I do not find these subject matters particularly easy to discuss—it is probably my old-fashioned, traditional nature—but I know that these things happen. It happened to my wife, Sandra. We have been married 35 years. She is an extremely powerful lady. She is very understanding and has stuck with me for 35 years, so I think that tells you all about that lady.

I remember that when we married she had period problems. The doctor she went to see was very good and he said, “Sandra, when you have children, everything will change.” Well, it did not. We had three children fairly quickly in a period of five to six years. We both wanted children. I was very fortunate to get three boys. I think Sandra would have liked a wee girl, but it did not work out that way. Throughout her life, she always had problems with her periods—they were always very heavy—but then she came to the menopause.

I am pleased to speak in this debate and give a man’s point of view. I am giving a husband’s point of view, too, because I understood from the very beginning what the problems were for my wife. It was all the things that the hon. Members for Belfast South (Claire Hanna) and for Guildford (Angela Richardson) referred to: the night sweats, the brain fog, the pain, the agony. She just could not get settled and was always restless. I understood why that change was coming in Sandra’s life. I was not there all the time—perhaps that was better for her, actually—but whenever I was, on those three and a half days a week, I understood that she was having terrible difficulties. We are lucky that the boys have left the house, but the two cats and the dog absolutely dote on her. They do not understand what is happening, but they trot alongside her.

I tell that story because I want the ladies here—the right hon. and hon. Members—to know that I do understand, although I have not experienced it personally. The hon. Member for Belfast South asked what would happen if men could live through this. I tell you what—we would have a different attitude. I have lived through it with my wife, and I think I understand it—I hopefully understand it well.

I have been very pleased to see more businesses and people seeing the benefit of bringing menopause into the light. The civil service has launched a menopause strategy, citing that females account for 50% of the 24,000 Northern Ireland civil service workforce, and that more than 55% of the female employees are over the age of 45, so a significant number of employees are likely to be affected by the menopause. The aim of the policy is to raise awareness and understanding of menopause and outline the support available.

The hon. Member for Belfast South and I, as Northern Ireland MPs, understand this debate from a Northern Ireland perspective, but also because we are active constituency MPs. We understand the importance of having a good workforce who are able to do the work and understand when things are not right.

The hon. Member for Cities of London and Westminster (Nickie Aiken) referred to GPs. I have seen a change—I just whispered this to the hon. Member for Belfast South—in GPs and doctors in my constituency. The hon. Member for Cities of London and Westminster inadvertently, or maybe purposely, referred to her friend from Killinchy. Men have retired and ladies have taken their place, so I hope that means that there will be better understanding. Giving depression and anxiety mediation is the wrong thing to do; HRT should be given. I hope to see those changes. I see them in my doctor’s surgery and in the surgeries and clinics in Newtownards. That seems to be replicated across the whole of the constituency, and I suspect it is happening in other parts of Northern Ireland. The hon. Member for Belfast South, in conversations we have had, has said that women GPs and doctors have to take time out to look after their families. That happens at times, but I see a change coming, with a better understanding, so that in the future we will hopefully not have the problems that we once had in the past.

I referred to the strategy for the 24,000 members of the Northern Ireland civil service workforce, and that comes on the back of the first meeting of the UK-wide menopause taskforce, which has been established to strengthen co-ordination across Government and raise awareness of the impact of menopause, improving care and support for women and ending the taboos and stigmas what still surround a natural part of ageing.

I echo the request that every other Member has made. I am very pleased to see the Minister in her place. I have seen more of her this week than I have seen of my wife—she has been in this Chamber on three or four occasions to respond to debates. She said to me, “You’re back again,” to which I said, “Well, I never leave here.” I am so pleased to see her in her place. I know that she has understanding of the issue and compassion. When the hon. Member for Swansea East was introducing the debate, the Minister was cheering as much the hon. Lady was—that’s the Minister. I look forward to her response.

I am pleased that the taskforce is attempting to lead the way. While I am thankful to all the big businesses that are stepping in to acknowledge this medical issue, my mind turns to those smaller businesses that do not have a human resources department to guide them. I ask the Minister—I do not know whether this is under her control; responsibility might lie with another Minister —what support are the Government offering smaller businesses to help them understand the issues that their workforce are facing, and to support their workforce throughout their journey?

I am very fortunate to have always had powerful women in my life. I have six ladies in my office—apart from me, it is a purely female staff. That sometimes gives me an understanding of what happens in the office among ladies. One of the lovely ladies in my office had a hysterectomy and went through her menopause in her mid-50s. The hon. Member for Cities of London and Westminster referred to the age of 51 in relation to the menopause. I do not miss too much in the office; I usually have a fairly good idea of what is cooking. One of the other girls in the office did a small thing that I think made a big difference. She bought her a wee pink fan—I use the word “wee” all the time; it is a Northern Ireland thing—that sat on her desk and made a psychological difference for her. The girls were telling her, “We know what you are going through.”

[Caroline Nokes]

The hon. Gentleman makes a brilliant point about the small pink fan. Some of the interventions, changes and support measures that employers can put in place are small, cheap, unobtrusive and not difficult.

[Jim Shannon]

The right hon. Lady is absolutely right. As with constituents, the small things that we do are big things in their lives.

At the same time that my staff member had her hysterectomy, one of the younger girls in the office—I have two girls in their early 20s in my office—was going through endometriosis treatment, and her medication pushed her into menopause. It was drastic for a such a young girl, and one who is keen to have children someday— I very often feel for her.

The issue of menopause and perimenopause affects a large amount of the working population. It is great that work has begun to recognise that, but that support should be in every avenue of work, not simply the big companies. Can the Minister therefore give us some indication of what is happening for smaller companies in that regard?

The hon. Members for Cities of London and Westminster and for Belfast South asked about HRT. We would really appreciate an update on the supply of HRT medication. When ladies present themselves to GPs, there needs to be a better understanding of how to respond. In this House we need to ask ourselves how we can come alongside the small business owner to ensure that they are aware of how the small things—as the right hon. Member for Romsey and Southampton North (Caroline Nokes) said—can make a huge difference to the quality of life of their employees, as well as to the environment and productivity in the workplace. It has been said for many years that a contented workforce is a productive workforce, and which of us does not want to understand how to get the best work out of our employees and allow them a decent quality of life?

The hon. Member for Cities of London and Westminster and I must have been speaking to the same script writer. I remember the days when people muttered under their breath, in hushed tones, that someone “must be going through the change.” People almost whispered it—“don’t say it too loudly.” Today’s debate is about saying it loudly, because it is important. That is what the hon. Member for Swansea East has done, right down the line. I admire her courage and determination to make things happen, which is infectious—I come to all her debates and support her in everything she does. I do it because I want to, but also because it is right. This is a debate that is right.

It is time for us not to be ashamed of the menopause or to try to hide it; we should accept that it is a part of life with medical implications. We need appropriate responses in the workplace and appropriate responses from the general public—from men and all those out there who do not understand it. That may be because they do not want to, or because they have a wee bit of trepidation about it. We should give those businesses the opportunity to learn more, and put in place effective policies. That is up to the Departments for Work and Pensions and for Health and Social Care, working in partnership and, respectfully, what I believe we must see.

Again, I am thankful for the opportunity to represent my constituents, and to represent my wife, obviously, since I have first-hand knowledge of how this has affected her. I have always tried very hard to be supportive and understanding. I hope that this will not be another lost opportunity, where words are spoken but no action is taken. To be fair, today’s debate is about actions, and there are people here who drive actions.

I said this in the last debate, and I will say it again:

“Eighty per cent. of women suffer from menopausal symptoms; 100% of women deserve support.”—[Official Report, 21 October 2021; Vol. 701, c. 1023.]

For me, this debate is about every one of those 80% of the ladies, and giving them my 100% support, as everyone else here today does. I look forward to hearing the Minister’s response shortly, and to the participation of my male colleague, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar).

Cancer Care: Young Adults

Jim Shannon Excerpts

Wednesday 8th June 2022 Westminster Hall

[Julie Marson (Hertford and Stortford) (Con)]

I beg to move,

That this House has considered cancer care for young adults.

It is a pleasure to serve under your chairmanship, Mr Paisley. Normally I would say that it is a pleasure to be here in Westminster Hall speaking on a particular issue but, of course, it is not a pleasure today. I wish I was not here raising the issue of cancer in young adults.

It is an issue that is horrible to confront and contemplate, but what I feel is nothing compared with what Simon and Andrea Brady feel. Every day they have to confront the reality of what happened to their daughter Jessica, who tragically passed away on 20 December 2020, aged just 27. They are here today because of Jess. I am here because of Jess. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) is here because of Jess, and the Minister is here because of Jess—I thank them both for that.

I pay tribute to Simon and Andrea. They are utterly determined in the face of their terrible loss to effect change in Jess’s name. I hope I can do justice to them and to Jess in supporting their call for that meaningful change. We are asking for Jess’s law—a practical change designed to save lives. Jess’s law would be that after the third contact with a GP surgery about a condition or symptom, a case should be elevated for review. After five contacts, it should be red-flagged and set procedures and guidelines should be followed, including a referral to a specialist.

We are clear that this should not be a tokenistic exercise, such as a simple, inconclusive blood test with the patient given an all-clear. The investigations need to be thorough and conclusive to make a real difference and to save lives.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this debate forward. I am moved by her plea on behalf of her constituents. I thank her for her dedicated efforts and for consistently raising the importance of cancer care for young adults like her constituent Jessica, who she has spoken about on a few occasions.

In Northern Ireland, trusts that run screening tests for certain types of cancer, such as breast, cervical and bowel. Does the hon. Lady agree—indeed I think she is asking for this—that it is time to introduce early intervention blood testing for those with symptoms of cancer to ensure early detection? Doing that would mean catching these cancers earlier.

Health and Social Care Leadership Review

Jim Shannon Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

Yes, I do.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and for the commitment to quality leadership within the NHS. As he said himself, that is so important. The review findings and recommendations are a method to deliver that improvement. Retention of staff—the consultants, the GPs, the doctors and the nurses—is core to any improvement, so what is being done to retain staff and not lose them? Is it the Secretary of State’s intention to share the findings with regional Administrations, particularly the Northern Ireland Assembly, to provide betterment across all the United Kingdom of Great Britain and Northern Ireland?

[Sajid Javid]

The hon. Gentleman will know that the review specifically looked at the NHS and care in England, but there are important lessons here that can be drawn on by, for example, the health service in Northern Ireland. On the issue of retaining staff, the NHS is undertaking many initiatives to improve that, but I hope he will agree with me that one key way to retain staff is to ensure we have good leadership and good managers.

Government Action on Suicide Prevention

Jim Shannon Excerpts

Wednesday 8th June 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

As my party’s health spokesperson, I am happy to speak in this debate and to look at how we can improve the mental health services we have in place.

I thank the hon. Member for Bristol East (Kerry McCarthy) and congratulate her on her consistent efforts in tackling issues around suicide prevention and normalising the feeling of not being okay. There is no doubt whatsoever that more needs to be done to support those feeling low and I am pleased we can discuss that today.

This is a difficult subject to address because we all know people who have passed away as a result of anxiety or depression, and whose difficulties meant ultimately they could not cope with life. The framework for the NHS five-year plan in tackling suicide was first published in 2012. It aimed to help those directly affected by suicide and recognised the lasting impacts suicide can have on family and friends. I am grateful that the Government, and the Minister in particular, have set aside £57 million in funding allocated for mental health services by 2023-24. We should welcome that because it shows that the Government and the Minister have recognised the need to do something specific. I hope that that will address issues across the whole of the United Kingdom of Great Britain and Northern Ireland, as I understand some of those moneys will come to us in Northern Ireland through the Barnett consequential.

For me personally, the subject of the debate is quite difficult. The current suicide rates back home in Northern Ireland are devastating, and I use that word on purpose, because they are. Figures indicate that suicide has increased since 2015, with levels increasing from one registered suicide in 2015 to a shocking 100 in 2019. The Northern Ireland Statistics and Research Agency has not yet provided the figures for registered suicides in Northern Ireland over the two-year period of the pandemic, but I have no doubt in my mind that, unfortunately, some may have struggled all too much over the covid period. That is not to mention that, in 2018, it was revealed that more men died by suicide in Northern Ireland than anywhere else in the United Kingdom: an average of 29.1 per 100,000.

My constituency of Strangford has unfortunately had those experiences as well. In Newtownards, the largest town that I represent, there was a period that saw a spate of suicides among young men—a group of young friends. If someone takes their life, those around them are deeply affected. What thoughts does the Minister have on how to address that issue? Every one of us here can probably confirm that that is an issue—I know that I can. It was quite difficult when some of the funerals took place: that circle of friends was decimated and devastated by what took place. In addition, data is presented in the year the suicide was registered, so as inquests are a long process, there are many still to be discovered. I see that in my own constituency.

There is more that can be done in all aspects of government. In health, education, the Department for Digital, Culture, Media and Sport, and transport, there is a lot of room for much-needed improvement in suicide prevention. There are also increased suicide rates among young children. Another thing that grieves me and, I think, others in this House is that social media is one of the most prominent confidence-killers in modern society: children being nasty to other children online. We read truly horrendous stories in the press of young boys and girls taking their lives because they feel pressurised by other children, or sometimes exploited by adults. We have a duty to ensure that, through legislation such as the Online Safety Bill, they are protected and not subject to abuse. I understand that that is not the Minister’s responsibility, but it might be helpful if she can tell us about any discussions with other Ministers on how the Government can address those issues.

We have spent a lot of time discussing the pandemic and its impact on our daily lives, which is not always good—sometimes it is uplifting, but sometimes it is quite disheartening. We must not underestimate the effects of isolation on mental health. As we come out of the pandemic—in England, there are no longer requirements for isolation—people have the opportunity to seek proper face-to-face help. The issue is now whether the support is readily available and accessible for all, which is where we must step in to help with suicide prevention. We should be ever conscious of where we are and how we move forward. I know that the Minister is a lady with a deep interest in her portfolio, and that she understands the issue only too well. I am hopeful that in her response to all our requests, she will speak about what extra help there will be after the pandemic to ensure that those who face today’s complications, problems and overwhelming issues will receive the assistance that they need right now.

Suicide affects many people, and it leaves a nasty scar for friends and loved ones left behind. That is the story in my constituency, and in the cases that I have seen; there has been a spate of young lives lost. As the hon. Member for Bristol East mentioned, Mr Speaker made some powerful comments on the death of his beloved daughter. He stated:

“When it happens, you never get over it”.

How true that is for everyone. For those I know who have lost loved ones, that scar, deep pain and hurt are right in their heart. We can see it in their eyes; they do not have to say a word—look at them, and there is the story. We must learn from this and put our words into action; through legislation, through support, through normalising talking and breaking barriers, we can tackle suicide and initiate support for those who need it. Everyone here is all too aware that there is a fine line and balance between normalising talking and keeping your life, and perhaps tipping over the edge. We all have to face that line; some people have faced it and unfortunately ended their life as a result. It is about how we step in, how the Government step in and how the Minister steps in to make a difference.

Mental health has been characterised as a silent killer, but it affects us all at some stage, through our families, through our friends and through our constituencies. We all share the heartache of suicide and what it can do to families. I commend and thank the hon. Member for Bristol East for bringing forward this timely debate on such a crucial issue. As a former member of the all-party parliamentary group on suicide and self-harm prevention, I can assure her that in this House we all share the desire to do everything we can to help to address suicide prevention. We look to the Minister, as we often do, for the answers to our questions, which we seek not for ourselves, but for our constituents.