Glaucoma and Community Optometry

Debate between Jim Shannon and Caroline Dinenage

Tuesday 30th April 2024 Westminster Hall

[Jim Shannon]

I thank the Minister. That appeal was a wonderful way to end this debate. I began the debate today by asking that we move towards measures to getting more people tested. The Minister has just done that. He has thrown out a challenge to everyone across this great United Kingdom of Great Britain and Northern Ireland, to do just that.

My hon. Friend the Member for East Londonderry (Mr Campbell) is well aware, as I am, of the merits of what we do in Northern Ireland, of the investment that optometrists are making personally and the need to work together. I am encouraged by the helpful contributions of the Minister, the shadow Minister and my hon. Friend.

The hon. Member for Denton and Reddish (Andrew Gwynne) referred to the fact that routine glaucoma testing can save eyesight. We all know that, and that is the purpose of the debate. We need more people to take the test—that is the purpose of the debate. The response from the Minister outlined a plan. I loved the term the hon. Member for Denton and Reddish used when he referred to turbocharging access to ophthalmology services. Wow! That is exactly what we need: a turbocharger. The Minister, in his response, turbocharged the challenge of eye tests and optometry.

The hon. Member for Denton and Reddish also referred to Labour’s commitment to making eye care a priority, which I welcome. I think that is where we are, and that that will follow hard on what the Minister and the Government are doing. The hon. Gentleman also referred to the 6,000 opticians on the high street with whom we can have a better partnership, and he stated that inaction was not an option—how true that is. He said that it was important to ensure there was not a postcode lottery, and he said that Labour would act.

The Minister always tries to be helpful, positive and proactive in his responses. That is what I like in any Minister, and it is what I particularly like about this Minister. It is helpful to have something to be encouraged by. The Minister has grasped the modus operandi of the debate, and why it is important, even though the subject is not in his portfolio. He referred to the need for people to have an eye test every two years, and said that the Government were working with high street opticians to ensure ICB involvement. He also said that the Government were pushing to increase the number of ICBs engaged with that. He said that the pandemic had created some problems, but also referred to an increase in cataract surgery. I think that is positive. Another positive that is sometimes forgotten, to which the Minister referred, is research. Well done, Minister and well done to the Government.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.

[Dame Caroline Dinenage (in the Chair)]

Thank you very much.

Question put and agreed to.

Resolved,

That this House has considered glaucoma and community optometry.

Autism and Learning Disability Training

Debate between Jim Shannon and Caroline Dinenage

Tuesday 21st November 2023 Westminster Hall

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered autism and learning disability training for education staff.

It is a great pleasure to speak under your chairmanship, Mr Vickers. I am grateful to have been allocated parliamentary time to discuss the very important issue of autism and learning disability training for education staff. The debate arises in response to three e-petitions: petition 639050, which calls for education staff to be required to have trained in learning disability and autism and which has received over 69,000 signatories; petition 638530, which calls for mandatory training for teachers in attention deficit hyperactivity disorder and autism and which has 1,500 signatories; and petition 634354, which calls for training on neurodiversity for university staff and which has over 16,000 signatories.

I thank everyone who took time to sign the petitions, which clearly relate to issues that are of huge concern to people across the country. I also thank the nearly 3,000 people who contributed to the Commons engagement team survey and gave their views on more education staff training. Some of the stories which they have shared with us have been exceptionally troubling. I am grateful for the time and effort that has gone into communicating those stories, which in some cases involved sharing very painful experiences.

There are around 200,000 autistic pupils in England and nearly 75% of them are in mainstream schools. According to research by the National Autistic Society, only a tiny proportion—just 26%—of autistic pupils feel happy at school. Three in four parents or carers—74%—said that their child’s school place did not fully meet their needs, and more than one in four parents, or 26%, waited over three years to receive support for their child.

Autistic children often speak of feeling misunderstood and of school being a place where there is bullying and loneliness. Such experiences lead to issues with mental wellbeing, sometimes to self-harm, and to a lack of self-esteem and self-confidence. The responses to the engagement survey starkly support the claim that autistic children do not always have a positive experience at school. In fact, in cases in which things go badly wrong, autistic children not only miss out on their education, but have experiences that can haunt them throughout their lives—stealing their future prospects, leaving them struggling to get into or stay in the workplace, and driving very distressing health impacts. Those detrimental effects can continue well into adulthood.

Deborah, the mother of one autistic child, said:

“After nine years of experiencing the school system…she removed her son completely and started home education so that they could mend his mental health and school-caused trauma.”

One mother told us of the

“Huge emotional impact”

that had

“led to serious mental health issues and withdrawal from education and society as a whole.”

She stated that her child’s experience had

“led to isolation, complete withdrawal from any form of education and reluctance to interact across all levels of society.”

The National Autistic Society’s education rights helpline has seen a huge spike in calls related to college and university education.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward the debate. All of us have an interest in autism, and I know that others have a personal interest in it, but we are here to support the hon. Lady. Back in 2020, the former Education Minister in Northern Ireland—now Lord Weir in the other place—published an enhanced autism training programme. The hon. Lady referred to universities, and it is important to note that it is not only children who are affected by autism. Does she agree that the same considerations from that report must apply to colleges and universities across the UK, so that older students who suffer from autism have the same support as those in schools? I think the hon. Lady’s answer will be yes, but I am curious about her response.

[Dame Caroline Dinenage]

The hon. Gentleman anticipates correctly and, as ever, makes an important contribution to the debate. That is why we are discussing a petition, which over 16,000 people signed and which calls for university students to be included and for the education to go up as far as university lecturers and other university staff.

Before I go any further, I want to say that this is not a problem with teachers per se. This debate is not about attacking the teaching profession nor is it meant in any way to undermine or criticise teachers and other education professionals. We know that teachers up and down the country do a remarkable and very important job, in many cases in increasingly challenging circumstances. Teachers are passionate about supporting their pupils. They want to give them the very best possible educational experience and the best life chances, but they need the right support to do that. This debate is about ensuring that teachers are given the best tools and advice they need to give autistic and neurodivergent children, children with a learning disability and, in fact, all the students they care for the best possible support and the best possible chance to have a happy, healthy and safe learning environment.

Youth Programmes and Girlguiding

Debate between Jim Shannon and Caroline Dinenage

Tuesday 19th September 2023 Westminster Hall

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered the role and future of youth programmes and Girlguiding.

It is a great pleasure to serve under your chairmanship, Sir George. We are so lucky to live in a country that gives our young residents so many opportunities to learn new skills, have adventures and make lifelong friends. From the guides to the scouts and from the Duke of Edinburgh awards to the cadets, volunteers across our country devote so much of their time and energy to the youth programmes that add so much to the formative experiences of our young people. It has been an incredibly difficult few years for children and young adults. The damage caused by the covid pandemic is impossible to fully ascertain, but NHS figures show that the number of children seeking help for their mental health has risen by almost 50% since the start of the pandemic. Schools were closed and socialising banned, and all of this means a lasting and painful legacy for our young people.

We all know that outdoor activities and spending time with friends in nature are good for people’s mental wellbeing. There are myriad different studies to that effect. Even NHS England has started offering nature prescriptions. So now is the time we need more opportunities for young people to have fun and spend time outdoors, and to socialise and be children. As more and more young people spend longer and longer on the internet or their phones, cooped up indoors, now is the time to provide more opportunities for them to get out and do something fun and adventurous—to build a raft and see if it sinks, go abseiling or learn life skills such as cooking. Now is not the time to be pulling away from providing these opportunities, so I ask the Minister what his Department is doing to provide more opportunities for young people that get them out and about, help them learn new skills and help them build friendships.

The girl guides have a very proud tradition of having this kind of positive impact on the lives of girls not just in the United Kingdom, but across the world. The board of Girlguiding has recently taken two incredibly concerning decisions regarding the future of the organisation: the proposed closure of all five of its outdoor activity centres across the country; and the full shutdown of British Girlguiding Overseas. It goes without saying that Girlguiding has touched the lives of so many thousands of girls across the globe. First and foremost, I would like to take this opportunity to thank the thousands of people across the country and across the world who have given countless hours, evenings and weekends, and much more to the betterment of opportunities for young girls everywhere.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this forward. It is a subject that is very important to us all, which is why we are all here. Does the hon. Lady agree that the positive mental health influence for children of organisations such as the girl guides, as well as the scouts, the Campaigners, the Boys’ Brigade and the Girls’ Brigade—I have them in my constituency in some numbers—cannot be overstated? Does she agree that our thanks should go to those in the voluntary sector and the churches, which are deeply involved in this, who give of their time to teach children skills and practical topics, but also to build self-confidence and self-worth? Their value to society should be highlighted and recognised, and the hon. Lady has done that well today.

[Dame Caroline Dinenage]

I thank the hon. Gentleman so much for making such an excellent point. I did not mention the Girls’ Brigade and the Boys’ Brigade, which, as he says, make such a wonderful contribution. They build the formative skills that young people need to face the challenges of life ahead, and make such a huge difference to individuals’ lives.

That is why this decision to close down every single one of the five Girlguiding activity centres across the United Kingdom is so bizarre. Girlguiding is closing down opportunities for young women and girls who would otherwise struggle to afford them. This decision comes after the body blow to Girlguiding that is the move to end their overseas operation, which serves thousands of girls across the world and has been doing so for decades. Both of these utterly bizarre decisions came after no real warning and no consultation with members.

National Carers Week

Debate between Jim Shannon and Caroline Dinenage

Thursday 8th June 2023 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered National Carers Week and respite for carers.

I thank the Backbench Business Committee for allowing us time to debate in the House today the important issue of unpaid carers. I thank, in particular, those Members who supported my application for the debate, including the right hon. Members for Kingston and Surbiton (Ed Davey) and for Dwyfor Meirionnydd (Liz Saville Roberts), and the hon. Members for Bolton South East (Yasmin Qureshi), for Strangford (Jim Shannon), for Brighton, Pavilion (Caroline Lucas), for Motherwell and Wishaw (Marion Fellows) and for St Albans (Daisy Cooper).

As all hon. Members and those watching the debate will know, it is taking place during Carers Week, which is held each year to raise awareness of those caring unpaid for family and friends who are living with a disability or who are frail or unwell. It is led by Carers UK but supported by Age UK, Carers Trust, the Motor Neurone Disease Association, Oxfam GB, Rethink Mental Illness and the Lewy Body Society. I encourage everyone who does not already know to go and find out more about the brilliant work of all those organisations.

The latest census data from 2021 shows that millions of people—in fact, 5.7 million people across the UK—are currently providing some form of unpaid care for a friend or family member who, due to illness, disability, mental health or an addiction, cannot cope without their support. The majority of people providing that care are women. Indeed, many of us may be personally caring for someone, or will have someone in their family, or will know of friends or neighbours, who go to great lengths to support people they love. There are virtually no families untouched by this responsibility across the country.

I speak today as co-chair of the all-party parliamentary group on carers. I am a former Minister for care and had responsibility for unpaid carers when in Government. However, my first experience of this came when my mum was a carer for my grandmother, who was living with dementia. At the same time, I had just had my first baby—he is now 20. My mum was attempting to support me in bringing up a small baby and my grandmother who was living with dementia. She was part of the generation of sandwich carers we see across the UK, who are sacrificing their own health and wellbeing, their own relationships and their own profession to show such love and dedication for someone else.

We know that caring can be an incredibly profound experience. For many carers it is a very positive experience that enables them to build a very special bond with those they care for. In the vast majority of cases, it is driven simply by love. But we also know that it can take its toll on their own health and wellbeing. Caring can take such a different variety of forms. It can be anything from really intimate personal care to quite complex healthcare, right the way through to the emotional support of being a stable companion and providing encouragement to the person they care for. The care can be utterly lifechanging for those who receive it. One person said to me:

“The difference she makes to my life is unbelievable. She has given me back the freedom to actually go out and enjoy my life.”

However, we also know that caring can be extremely complex, and there is no denying that it can be exceptionally challenging as well. Indeed, too often the efforts that carers go to, to keep those they love safe and well, leaves people exhausted, burnt out and struggling to live a life beyond their caring responsibilities. As a result, many carers are extremely concerned and worried about the future. Beverly told me about her caring responsibilities and the impact they have on her life. She said:

“I am a full-time carer to my son who has Down’s syndrome and my husband who has Parkinson’s. By full time, I mean every hour of every day, day and night. I do it because I love them and I want them to have as good a life as possible. It is a never-ending round of jobs like cutting meals, making sure meds are taken, washing, appointments, making sure they are appropriately washed and dressed—and that is without having elderly parents to support. The sad thing is that you also forget to look after yourself.”

That is one of the biggest messages I want to get across today. Many carers like Beverly find that their relationships are impacted by their caring responsibilities because of a lack of support and recognition. That can lead to social isolation and mean that carers who are struggling to balance paid work and unpaid care have to leave the labour market or reduce their hours of work.

There are also significant financial costs associated with caring. Carers often use their own incomes and savings to pay for support services and care equipment for the people they care for. We also know that carers can face poorer health outcomes than non-carers, with a high proportion struggling with their own physical and mental health problems, and experiencing very low levels of wellbeing.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. She is right that there are so many unpaid carers across the whole of the United Kingdom of Great Britain and Northern Ireland. My brother was involved in a motorbike accident some 19 years ago, and my mother, my wife and my son all look after him. Conservative estimates say that £162 billion per year is saved through unpaid care. That is just one example of the vital nature of carers. The hon. Lady refers to the impact on those who care: the pressures psychologically, financially, emotionally and physically. Does she agree that some consideration must be given by Government for respite care? I know how important that is to some of my constituents. I suspect she will confirm that when she replies to me, but I think something needs to be done there.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right. Respite care comes up time and again as one of the big asks for unpaid carers. They want to carry on doing the role they are doing. They deeply love the people they are caring for. They take a huge amount of personal responsibility and pride with the care they are giving, but they need that little bit of support. Around the time of covid, in particular, we saw many, many unpaid carers going on for months, years even, without the ability for any kind of respite. The figure he quotes is crucial: £162 billion a year is the value that unpaid carers are saving our health and care system. That is an incredible amount of money. It is like a whole separate, second NHS, saving that amount of money. The huge pressures placed on the other NHS we have result in delays for unpaid carers in obtaining the primary and secondary healthcare appointments that they need. The record demand for our social care services means that carers are not getting the support that they need.

I want to spend a little time exploring some of those challenges in more detail. Other Members across the House will add their own voices. As I noted earlier, many carers are struggling with poor mental and physical health. According to Carers UK research, one in five carers says that their physical health is bad or very bad, 30% suffer from poor mental health and over a quarter say that they often or always feel lonely. Carers provide many hours of support for the people they care for, but very few are able to take a break from their caring. That results in tiredness and, in some cases, exhaustion and burnout. As the hon. Member for Strangford said, worryingly, 41% of carers have not taken a break from their caring role in the last year. A carer called Anton told me about the strain that caring is placing on him:

“It is hard, often draining and mentally and emotionally painful work, bordering on damaging. Due to my responsibilities and the amount I am depended on, I am often anxious, feel hopeless and depressed.”

Carers are not getting the support that they need from our health and social care systems, as both systems are under intense and increasing pressure. Many carers have experienced delays in accessing healthcare appointments and services. One fifth of carers who request a GP appointment have to wait more than a month to see a doctor, and over a third have had to wait more than a year for specialist treatments or assessment. That causes additional stress and anxiety, and results in many feeling isolated or forgotten about.

This year, only a quarter of carers said that they had undertaken a carer’s assessment in England—a statutory right under the Care Act 2014. Of those who received an assessment, many were concerned that it did not lead to any improvements in the support provided to them. Could the Minister outline what she is doing to ensure that those carer assessments are not only conducted but conducted properly and that the outcomes are delivered? In fact, 39% of carers said that they did not even know what a care assessment was—that is the severity of the problem. A carer called Trevor told me:

“I get no support whatsoever. It has taken nearly 4 years to get a carer’s assessment from the Local Authorities which is now imminent. I have no expectations whatsoever.”

What is the Minister doing to communicate with local authorities to make sure that those important carer’s assessments take place? Debbie contacted me to tell me:

“I’ve had no support whatsoever. Support seems to consist of ticking a box to say I’m a carer but nothing more.”

It is just not good enough.

I want briefly to touch on the financial impact that caring can have. The cost of living means that carers currently face unprecedented demands on their finances. Concerningly, more than half of carers say that they are extremely worried about managing their monthly costs. A quarter told Carers UK that they are cutting back on essentials such as food or heating, and over three quarters said that the rising cost of living is the main challenge that they will face in the coming year. Many have been desperately trying to find ways of saving money, but that can be difficult because, quite often, the people they are caring for need life-saving care equipment that requires energy, or they need to ensure that the person they are caring for is kept warm. David told me about the financial impact that caring was having on him:

“I have been a full-time carer for my wife for over 10 years, and I’ve found that the money I get doesn’t even cover energy bills. It’s a constant struggle: all unpaid carers want is enough money to pay our bills and still have something left over to buy things when we need to. We are saving the country a lot of money by doing what we do and some recognition would be appreciated.”

[Dame Caroline Dinenage]

That is absolutely right. The Government have spoken about a social tariff for energy, but identifying who the carers are and how they can access that support is vital.

Gary told me about the financial struggles he has because of caring:

“After giving up a reasonable salaried job to care for my wife, we fell into severe financial hardship and were resorting to food banks. When the cost of living crisis happened, it was so bad I had to take up part-time taxi driving, which takes me away from my care role, in order to survive, but I can only earn so much due to the limits imposed or lose the carer’s allowance.”

That is adding additional stress and complexity to his life.

Supporting carers to stay in or return to paid work is essential. We want to ensure that carers can live a life free from poverty in older age, but 75% of carers who are working alongside their caring responsibilities are worried about juggling work and care. Increasing numbers of employers are recognising the importance of supporting carers in the workplace, and it is vital that they maintain flexibility so that people can continue to do their incredible juggling acts.

Nicola told me that she had to give up her career as an embryologist to care for her daughter, who has Angelman syndrome. She said:

“We have no family support, no help from the council and my daughter is awake for hours in the middle of the night, which means that we are unable to sleep and are completely exhausted. The only income I now receive is carer’s allowance. We solely rely on my partner’s income, which covers our bills. We have already moved to a cheaper house, but it is still extortionate as we live in Surrey and my partner has to commute into London daily.”

Lucy, who cares for her disabled son, who has cerebral palsy, told me:

“I have had to give up my job as a company director as his needs and required medical operations means I cannot keep a job any longer. I have gone from having a £40k+ job and am now claiming carer’s allowance.”

Finally, more needs to be done to support and help carers to recognise themselves as carers. Many are not doing so, which means they are missing out on the support they need. Research that the charities involved with Carers Week released on Monday found that 73% of people in the UK who are providing or have provided unpaid care in their lifetime—roughly 19 million people—have not identified themselves as carers. Research also shows that half of all carers take over a year to recognise that they are in a caring role, with over a third taking over three years to recognise themselves as carers.

That is particularly pertinent to young carers, who may not know that they are carers. In many cases, their situation can be misinterpreted. Schools can perceive young carers to be bad students because they are not paying attention, when in many cases they are just extremely tired and stressed by their caring responsibilities. Schools need to go much further to identify young carers in their midst and to support them.

In cases where a young person is supporting a parent with mental ill health, there is a stigma attached and they do not want to tell their friends. I remember meeting one young gentleman at a carers’ festival that is run every year, which is a wonderful way of supporting young carers to live life like normal young people and enjoy themselves. He told me that his mother had made many attempts to take her own life and that, as a very young child, he had to get used to phoning 999 for the ambulance to take his mum away and save her. He never told his school about this because of the stigma attached to it; he felt deeply isolated and ashamed. We need to double down on our efforts to ensure we identify young carers in schools.

[Jim Shannon]

I thank the hon. Lady for giving way; she is very generous. Figures mentioned in the press last week indicated that some 25% of those who care have mental stress, depression and concerns themselves. She has outlined that from a young person’s point of view—what she says clearly illustrates the need for Government to grasp the role of carers and the impact that role has on them.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right about the mental pressure put on carers because of the responsibilities they take on, but also because of the perceived lack of support or respite. It is important that we recognise that that can mount up and overwhelm people, and that they can experience burn-out and ill health.

I want to recognise the work of Governments across the UK and the range of actions they have taken to provide carers with more help and support. In England, the Government aim to support carers primarily through adult social care reform, but also provide support through the Better Care Fund. In the context of reform, I was pleased to note that there is a specific chapter on support for unpaid carers in the White Paper “People at the Heart of Care”, which states that the Government will

“build on the foundations of the carers action plan”

—which I published when I was Minister for Care—

“to set out a new strategic approach”.

I look forward to hearing more about that. Perhaps the Minister will give us further details about the timescales. I should also like to hear more about the £25 million investment that the Department of Health and Social Care has pledged to make in support of unpaid carers. I understand that the details will be announced shortly, but given that it is Carers Week, I should be grateful if the Minister could indulge us and give us a sneak preview of what might be coming up.

I should like now to think back, briefly, to the support that the Government provided to help carers through the pandemic. A number of measures were introduced, including a highly effective identification programme. The Government worked with local authorities, GPs and local carers’ organisations to identify new carers and ask them to come forward for the covid vaccine, for which they were prioritised thanks to fantastic lobbying work by Carers UK and the Minister—who was also the Minister at that time, although there have been a few bumps in the road since then. It is great to see her back in her place. The programme demonstrated an ability to identify carers that does not seem to be moving on into everyday life, and I should like to see that continue. The Government also relaxed some of the rules applying to claims for carer’s allowance, and I should like to see that continue as well.

Further significant steps have been taken in the last year. The Carer’s Leave Act 2023, which gained Royal Assent only last month, will provide dedicated employment rights for carers for the first time. I congratulate the hon. Member for North East Fife (Wendy Chamberlain), my hon. Friend, on her work in securing the passage of her private Member’s Bill, because the Act is a game-changer.

Despite those successes, however, I believe that much more needs to be done. Carers have contacted me to let me know about key areas in which they wanted more support. If the House will indulge me for a little longer, I will run through some quotations. Bryony told me that she wanted carers to be given more financial support:

“Carer’s Allowance should be higher to reflect the impact and reasons it is claimed. I didn’t choose not to work; I didn’t choose to lose a well-paid career. I will always choose my son, but the financial burden is destroying families.”

Tracy talked about the need to be able to take a break from caring:

“Respite is essential. If carers reach burnout, the person they care for could end up in care sooner. If you support the carer and they feel valued without having to worry about finances, they would be less stressed and able to cope day to day.”

Rebecca called for greater recognition for carers:

“I feel we are overlooked by all the groups in society. It makes you feel bottom of the pile in everyone's priorities.”

Sarah said that she needed better signposting to the support available to help carers with their responsibilities:

“It would be fantastic if there was a directory of support and benefits that are appropriate as soon as a diagnosis is recognised. For years we didn’t claim Personal Independence Payment and Disability Living Allowance for our daughter because we didn't know about it. For over ten years I didn’t know I was entitled to Carer’s Allowance. I also didn’t know for the last three years my daughter was entitled to elements of Universal Credit. This would have helped us as a family and taken the stress and pressure off for myself to be able to ‘fight’ in other areas of my daughter’s life.”

The testimonies that I have shared are my reason for being here today, and the reason I support the call from the charities that are backing Carers Week for the Government to establish a cross-departmental ministerial group to focus on the help that carers need. I was delighted to learn earlier this week of the Minister’s commitment to establishing just such a group. Carers’ issues do not fall solely within the remit of the Department of Health and Social Care; they are everywhere, involving everything from energy prices to the circumstances of the young carers we have spoken about, carers in employment and carers’ benefits. The establishment of the ministerial group will ensure that carers’ needs are understood and responded to at the highest level of Government, and will improve ministerial oversight of policies and measures that support unpaid carers.

It is my hope, and that of the all-party parliamentary group on carers, that this work will lead to the development of a full and financially supported national carers strategy. Such a strategy would help to ensure that we went further in respect of a range of measures to help unpaid carers, including improved data sharing to ensure that carers are identified and support and entitlements are not missed; better support for and identification of carers at key transition points—for example, when people move from children’s to adult’s services; more funding for social care to ensure that unpaid carers are given the support that they need once they have been identified; and a review of carers’ financial support and benefits, including carer’s allowance, to ensure that they are fit for purpose and prevent financial hardship.

I want to encourage all those in the House today, and those watching the debate, to involve themselves in the activities taking place during Carers Week, and to reach out to the thousands of people in each of our communities who do so much to support the people whom they love. I also want to encourage all Members who have not already done so to join the all-party parliamentary group—I hope you do not mind the quick advertisement, Madam Deputy Speaker—which I co-chair with Baroness Pitkeathley. We have some exciting plans for the coming year.

Let me end by saying what I say every year. While Carers Week is an important opportunity to recognise, for one week in the year, the extraordinary lengths to which carers go, we must also recognise that they go to those lengths every single day. Every week should be Carers Week. Day in day out, year in year out, carers work to ensure that their loved ones are cared for, are safe, and lead the best lives that they can. That is something that happens 52 weeks of the year.

Medical Technology Regulations and the NHS

Debate between Jim Shannon and Caroline Dinenage

Tuesday 28th March 2023 Westminster Hall

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered medical technology regulations and the NHS.

It is a great pleasure to serve under your chairmanship, Sir Gary, and to talk about the importance of medical innovation and medical technology in our NHS. We know that the NHS faces significant challenges, but medical technology—or health tech, as it is often called—holds many of the solutions that are necessary to achieve things such as delivering improved patient outcomes and facilitating the transition to more sustainable models of health and care delivery. It also has massive potential to drive economic growth.

Health tech includes everything from laboratory tests to wound care dressings, mental health apps, implantable defibrillators and critical technology—everything that is absolutely fundamental to the diagnosis and treatment of health conditions. Life-saving and life-enhancing health technologies, such as cardiac pacemakers and artificial knees and hips, are already highly regulated products. While we were part of the EU, UK-based health tech was subject to CE marking, but now there is a need to develop sovereign regulatory arrangements that provide equal levels of patient safety while protecting timely access to global life-saving and life-enhancing health technologies.

The Medicines and Healthcare products Regulatory Agency is solely responsible for regulating the UK’s medical devices market and is mandated to ensure that patient safety is protected, irrespective of where a product is manufactured. The MHRA has a huge responsibility on its shoulders, and it is for that reason that I welcome the Chancellor’s commitment in the spring Budget to reform regulations around medicines and medical technologies. In fact, that was the thrust of why I asked for this debate, so it is lovely to be able to welcome that announcement rather than to be pushing for it. It is a much more comfortable position for me to be in.

The Chancellor confirmed that the MHRA will receive £10 million of extra funding over two years to maximise its use of Brexit freedoms and accelerate patient access to treatments. He also confirmed that the MHRA is moving to a new model, which will allow near automatic sign-off for medicines and technologies that have already been approved by trusted international partners in places such as the USA, Japan and Europe. That is important, because the US Food and Drug Administration—the FDA—is recognised as delivering high-quality, innovative health tech to its citizens in a timely manner while maintaining high standards of patient safety. Those product regulation-equivalent routes, which recognise the decisions of trusted jurisdictions that have already looked at medicines and technologies very carefully, can protect NHS patients’ access to high-quality products and allow our own regulator to focus resources on where they can make the most impact.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this issue forward, and I apologise to her and others for not being able to stay—I have another meeting at 5 o’clock, as I mentioned to you, Sir Gary.

I am my party’s health spokesperson, so I am very aware that regulation is essential to our health service. I strongly believe that regulation and demand should go hand in hand on health. Regulating the use of apparatus, instruments, tools, scanners, drugs and monitors is one thing, but does the hon. Lady agree that accessing them is another? It is imperative that we ensure that patients can make use of life-saving treatments. Aspiration is good, but delivery is better.

[Dame Caroline Dinenage]

It is always a great pleasure to see the hon. Gentleman, who always make very sensible interventions on these issues. He is absolutely right: we need the right regulation in place, but we also need to have the facilities to make sure that, once technology and treatments have been approved, they are easily and quickly accessible to those who most need them.

I will be the first to admit that I was not the biggest advocate of Brexit. However, the freedoms afforded by Brexit allow us the opportunity to recognise approvals from any jurisdiction that we deem appropriate. Of course, any products that enter the UK market via regulatory equivalence routes from trusted international jurisdictions will need to be approved by the MHRA and to be subject to strict vigilance and post-market surveillance requirements, so a number of checks and balances are in place for British patients. However, this new system post Brexit gives the UK more control to determine what products can be placed on the market.

As the hon. Member for Strangford (Jim Shannon) said, we must ensure that the regulatory system is robust but also prevent the UK from becoming a secondary market, where patients and clinicians have less access to technologies. The right system not only increases the UK’s access to the newest innovations but increases patient safety by maintaining access to the widest possible range of thoroughly regulated and already available health technology from around the world.

Therefore, my first question to my hon. Friend the Minister—I should warn him I have two or three—is whether he can confirm the timescales for the new model to ensure continued patient access to health tech and whether there will be a sense of urgency about this. The Minister and you, Sir Gary, will know that the pandemic, through the early innovation of the vaccines and the remarkable work done by British scientists, demonstrated the UK’s ability to be a real science and technology superpower. However, there is an urgent need for action to ensure that we do not lose the opportunity to impact patients’ lives and effectively deliver on this ambition and this ability.

We have the potential to make the United Kingdom the most attractive place in the world for innovation and, in particular, medical innovation. We know that medical technology helps to deliver better patient outcomes, improves care pathways, drives cost savings in the NHS, reduces the burden on the workforce and, critically, can help to reduce the backlogs. This matters to people’s lives. In the Hampshire and Isle of Wight integrated care board area, more than 54,000 people are waiting to start treatment. The average time people are waiting in my local area to start their treatment is 16.9 weeks, with 47% of patients waiting more than 18 weeks. That is why we need to capture the potential of every way possible of ensuring that people get access to treatments as effectively and quickly as possible.

In Gosport, 1,500 people have a dementia diagnosis. Dementia is one of the biggest healthcare challenges facing us as a nation, but there are some exciting and innovative developments there too. The EDoN—Early Detection of Neurodegenerative diseases—project will use wearable tech to detect signs of dementia even 10 to 15 years before symptoms appear. Too often, a dementia diagnosis comes far too late—once symptoms are already well advanced. This technology could be game changing by allowing people to make advance lifestyle interventions that might minimise the impact of the condition. However, it will also enable scientists to make a huge contribution to research and clinical trials of drugs and interventions that will work, inevitably in the long term, through to treatments and cures.

This is also an area where we need to see the rapid approval of new treatments as they become available. In January, the FDA—the US regulator—approved the first treatment shown to slow degeneration in dementia. Two drugs are currently on trial in the UK, and the people conducting the trials expect to publish their findings later this year. Neither drug has an easy name to pronounce: donanemab and lecanemab. Can the Minister please assure me that the MHRA stands ready to accelerate the approval of these schemes as soon as they become available—it sounds as though one is imminent; it may be in the next couple of months—so they can start supporting patients at the earliest opportunity?

If I may just flag one issue with the Minister, one obstacle to these drugs being available on the NHS is the National Institute for Health and Care Excellence guidelines, which often approve medicines based on their cost-effectiveness. In this case, it will be remaining years of healthy lifespan versus the cost to the NHS. The cost of dementia is of course largely not borne by the NHS—the cost to it is only about £1.5 billion a year, compared with the £26 billion borne by the adult social care system and the informal care sector.

Will the Minister kindly agree to meet Alzheimer’s Research UK to discuss how we can best ensure that UK patients get swift access to the best possible dementia drugs as soon as they are available and that the systems designed to offer checks and balances, such as NICE, do not prove to be an obstacle to that?

Will the Minister assure us that every effort will be made to engage with the global health tech industry to ensure that the UK proactively seeks innovations for the benefit of UK patients while encouraging UK-based innovation? There is a lot of innovative practice going on right under our noses. Health tech will play such a key role in driving not only UK national economic growth but great amounts of regional growth. There is an organisation called SIGHT, or Supporting Innovation and Growth in Healthcare Technologies, which is a business support programme developed by the University of Portsmouth to provide help and guidance to small and medium-sized businesses in the healthcare technology sector. In the Wessex region, which is where Gosport sits, 10% of the workforce is employed in the health economy, and more than 300 health and life sciences companies are focused on medical technological innovation. The SIGHT process will provide an important boost to the regional economy through its support for the sector. What steps is the Minister taking to encourage local innovation and entrepreneurship in the medical technology sector, and how can he enable the implementation of innovation in the local care system, which can sometimes be quite risk averse?

To maintain the NHS’s access to the 600,000 currently available CE-marked products, it will be important not to add unnecessary burdens on to manufacturers that already supply a relatively small market, so transitional arrangements provide for a dual regulatory regime, with the unilateral recognition of CE marking in place until July 2024, subject to legislative approval. That recognition could be continued and expanded for the benefit of the NHS and patients across the country. Perhaps the Minister could talk a bit about that.

We need to act fast. A recent survey by the Association of British HealthTech Industries—the ABHI—shows that one in five products is expected to be removed from the market over the next five years, and one in 10 companies is halting all innovation activity. That has been driven by persistent uncertainty, constrained capacity in the system and increasing costs. The ABHI survey also highlighted that 67% of the health tech industry expect a delay in bringing innovation to the UK, and the figure rises to 86% for those manufacturing in vitro diagnostic medical services.

The right kind of regulation will be key in setting the standard as to whether the UK is an attractive place to do business and promote innovation. It will ensure that UK patients continue to receive world-class technologies such as surgical robots and digitally enabled remote care, and it will protect our ability to react swiftly and effectively to any further pandemics by developing the latest diagnostic tests.

In addition, I understand that the Government are already committed to a medical device information system. That will collect key details of the implementation of all devices, which will be linked to a specific register to research and audit patient outcomes. That will deliver a system that allows the UK to record and access device safety and patient outcomes. That medical device roadmap lays out an ambitious vision for how the UK can become world leading in this space and a real global superpower in digitally enabled health tech. Will the Minister assure us that its delivery will be prioritised to ensure that we build on the positive reaction to its publication?

There are concerns that existing capacity constraints may impact the MHRA’s ability to deliver and most effectively use the additional funding that the Chancellor has made available. Making the most of expertise and capabilities across the ecosystem will be crucial. As well as the development of more product regulation equivalence routes to allow for the recognition of approvals in other trusted jurisdictions, we must explore all other options to ensure the expansion of existing capacity, including by reviewing the role that the MHRA can take in direct regulation, providing it with both the resource and political impetus to increase UK regulatory ambition, and enabling the development of recognition and innovation systems.

The recent commitment by the Chancellor and the Prime Minister is welcome, and it indicates that the Government truly recognise the need to ensure that there is appropriate focus and support for the ambitious innovation programme that supports clinical and patient need, availability, and choice. It is by investing in developing the skills required that we can ensure that the UK continues to be a leader in regulating the technologies of the future.

The freedoms afforded by Brexit allow us to seize the once-in-a-generation opportunity to deliver a best-in-class regulatory system and enable the health tech industry to support the drive for the UK to become, and continue to be, a global science and technology superpower.

Cyber-troop Activity: UK

Debate between Jim Shannon and Caroline Dinenage

Tuesday 9th March 2021 Westminster Hall

[Caroline Dinenage]

It is a unit that expands. There are full-time members of staff dedicated to this, but that is obviously a tiny number in normal circumstances. It expands enormously when the Government disinformation unit is stood up.

[Jim Shannon]

The hon. Member for Newcastle upon Tyne Central (Chi Onwurah) has referred to the numbers in the unit, but surely the close working with the police forces across all the regions gives extra numerical strength to what the Government are trying to do.

[Caroline Dinenage]

The hon. Gentleman is absolutely right. We are working closely with the police and also the Army, as I have mentioned. I am always slightly nervous about what I am allowed to say around this issue, not being an MOD Minister, but there is the 77th Brigade, which is a military unit dedicated to this sort of activity and with which we work very closely.

While such information can come from a range of sources, we know that certain states routinely use it as a tool to exploit our open system by sowing division and undermining trust in our democracy, as the hon. Gentleman said. This can be through disinformation, cyber-attacks and other methods. We have made it clear that any foreign interference in the UK’s democratic process is absolutely unacceptable—it does not even need to be said—and it is, and always will be, an absolute priority to protect the UK against it. The UK, along with our G7 and NATO partners, is working hard to protect our democracy against disinformation as we work together to tackle the shared threat of covid-19.

We remain firmly committed to protecting our democratic values and our electoral processes, which I know the hon. Member for Midlothian is concerned about, and we have robust systems in place to protect the UK against foreign interference. As he says, it is all about working collaboratively. These systems bring together Government, civil society and private sector organisations to monitor and respond to interference in whatever form it takes. The hon. Member for Newcastle upon Tyne Central (Chi Onwurah) talked about these things sometimes coming in the guise of something that could look quite harmless but can actually be incredibly sinister.

It is absolutely vital to ensure that our democracy stays open, vibrant and transparent. The Government are strengthening our legislative framework, enhancing capabilities and engaging with partners to expand our efforts to ensure the maximum impact. That joined-up approach is supported through the defending democracy programme, based in the Cabinet Office, which provides a strategic co-ordinating forum, drawing together work and expertise across Departments on a number of fronts to protect democratic processes, strengthen the integrity of elections, encourage respect for open and safe democratic participation, and promote open, fact-based discourse.

The Government are taking steps to strengthen elections by introducing legislation, as the hon. Member for Midlothian said, to ensure that the framework is fit for the modern age, for example by updating online campaigning rules. In May 2019, the Government committed to introducing a digital imprints regime, which will inform voters about the source of online campaign material. In August, we launched a technical consultation on this proposal. It closed in November, and further details will be set out shortly.

During major democratic events, the Government stand up an election cell—a co-ordinated structure that works with relevant organisations to identify and respond to emerging issues and protect the safety and security of the democratic process. The counter-disinformation unit works closely with the election cell, co-ordinating the Government’s operational response to any evolving threat of disinformation and other forms of online manipulation. The Government are working really closely with partners to support the delivery of safe and inclusive elections. Of course, the next ones will be very shortly, in May.

The Government welcome the valuable analysis and insight from academia, including the Oxford University report, and we take seriously the findings of other experts in this field. Countering disinformation and other forms of manipulation requires a whole-of-society approach, and the Government are working closely with the Oxford Internet Institute and other stakeholders from civil society, academia and industry to much better understand the issues in this space. In particular, last year the Government launched a counter-disinformation policy forum, bringing together key actors in industry, civil society and academia to improve responses to misinformation and disinformation and, crucially, to prepare for future threats. This forum contributes to the collective understanding of challenges to the information ecosystem, allows us to improve the responses that our organisations can deliver to better mitigate evolving threats posed by false narrative and helps us to prepare for future advances in technology, which is of course what we are all really worried about; as we have already said, the technology evolves rapidly.

We are entering a new age of accountability for the tech industry. The hon. Member for Midlothian and others mentioned the online safety legislation. We announced plans at the end of last year for a groundbreaking rulebook that will make tech companies responsible for tackling harmful content on their sites. This new regulatory framework will give digital businesses much more robust rules of the road, as it were, so that we can seize the brilliance of modern technology to improve our lives while protecting children, building trust and, crucially, tackling criminal activity online.

The full Government response to the online harms White Paper was published at the end of last year and set out how the proposed legal duty of care on online companies will work in practice. It will of course defend freedom of expression and the role of the free press. The new laws will also ensure appropriate checks and balances on platforms’ power over public discourse and will promote a thriving democracy where pluralism and freedom of expression are protected. The laws will have robust and proportionate measures to deal with misinformation and disinformation. That is crucial, because we know that they can cause significant physical or psychological harm to an individual. An example is the anti-vax falsehoods that we are seeing around covid-19 at the moment. Crucially, the Bill will give Ofcom the tools it needs to understand how effectively disinformation is being addressed. That will be done through transparency reports, and then it can take action in the appropriate way, as required.

Covid-19: Cultural and Entertainment Sectors

Debate between Jim Shannon and Caroline Dinenage

Tuesday 2nd March 2021 Commons Chamber

[The Minister for Digital and Culture (Caroline Dinenage)]

I beg to move,

That this House has considered covid-19 and the cultural and entertainment sectors.

May I, too, extend a very warm welcome back to the hon. Member for Cardiff Central (Jo Stevens)? It is so lovely to see her back in her place looking so well.

I am so grateful for this opportunity to highlight the Government’s support for our world-class culture and entertainment sectors during what has been an extremely challenging year. The UK has one of the strongest cultural sectors in the world and a really proud tradition of supporting the artists, entertainers and creatives who do so much to enrich our lives.

Experiencing culture, whether it is through visiting a museum, wandering through the gardens of a heritage site or attending the theatre, can do so much for our mental and physical health, and I know that so many of us have leaned on films, TV, virtual exhibitions and all other types of art and entertainment to get us through the last year. Covid-19 has placed unprecedented pressures on organisations and individuals across the economy, but entertainment and culture have been particularly hard hit, relying as they so often do on social interaction and close contact.

[Jim Shannon (Strangford) (DUP)]

I spoke to the Minister beforehand. As she said, this pandemic has been greatly disheartening for the culture sectors. For example, Scottish dancing and Scottish piping are very important in my constituency, but the problem is that they do not have their own properties and they are not eligible for grants. It is essential that they have a restart grant to allow them to start again, and to allow our children to be active in such a wonderful way. What can the Minister do to make that happen?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to champion those small, local cultural establishments in our communities up and down the country that do so much to entertain us, but also to boost our wellbeing and our general sense of health. That is why, as part of the £1.57 billion culture recovery fund, the Barnett formula extended that funding to all the corners of our great nation. Indeed, the Northern Ireland Assembly saw £33 million, which of course it can choose to use how it wants to support all those wonderful cultural establishments that do so much for us.

Last week, the Prime Minister announced a very cautious but irreversible route out of lockdown, while also acknowledging that the threat from covid remains substantial. I recognise that, although this represents a turning point in the nation’s battle against coronavirus, many of our sectors will be impacted by continued restrictions and, of course, will be understandably frustrated at being unable to fully reopen just yet.

However, there is hope on the horizon through the events research programme announced in the road map, which will explore how larger events across the cultural and entertainment sectors can begin to reopen safely. I recognise, of course, that businesses are so keen to reopen as soon as possible, but, as the Prime Minister said, it is vital to take a measured and careful approach so that it is truly a one-way road out of this pandemic.

The success of the vaccination programme has offered us the protection to very tentatively start removing the restrictions. There will be five-week intervals between each of the four steps, to enable the scientific data to be evaluated and to ensure that the next step is truly safe before we take it.

Under the road map, outdoor sport and leisure facilities will be able to reopen at the second part of step 1, no earlier than 29 March. At step 2, no earlier than 12 April, indoor leisure facilities such as gyms can reopen for use by people on their own or in household groups, as can most outdoor attractions and settings, including hospitality venues that are outdoors, zoos, theme parks and drive-in cinemas.

Step 3, no earlier than 17 May, will see indoor entertainment venues such as museums and cinemas reopening. The Government will also allow some larger performing and sporting events, in indoor venues with a capacity of 1,000 people or half-full, whichever is the lower number, and in outdoor venues with a capacity of 4,000 people or half-full, again whichever is the lower. In the largest outdoor seated venues, where crowds can spread out, up to 10,000 people will be able to attend, or a quarter full, whichever is the lower.

Vaccine Misinformation Online

Debate between Jim Shannon and Caroline Dinenage

Monday 19th October 2020 Commons Chamber

[The Minister for Digital and Culture (Caroline Dinenage)]

I would like to start by thanking the hon. Member for Ogmore (Chris Elmore) for tabling this really important topic for debate, and for his wider work as chair of the all-party parliamentary group on social media, which does incredibly important work to draw attention to this vital issue. Vaccine misinformation and, indeed, disinformation are an important issue that the Government and I take incredibly seriously. It is vital that all UK citizens have access to accurate information; it is a key part of our democracy. At their worst, disinformation and misinformation can threaten our democratic freedoms and cause harm to individuals and to our society.

During a time of national crisis, it is even more important that people have access to accurate information about covid-19. Throughout the pandemic, really harmful misinformation and disinformation of many kinds have been observed online, including conspiracy theories about 5G, fake claims about the health risks of wearing masks and the promotion of dangerous and false covid-19 cures. These are just a few of the many falsehoods that have been circulating online, and their impact is not limited to the online environment. They have real-life consequences, ranging from people needlessly spending money on items to protect themselves, to an increased risk of individuals not following crucial public health advice and thereby putting their own and others’ health at risk. And of course, we saw the disgraceful acts of vandalism and harassment that were spurred on by the groundless 5G conspiracy theories.

We are also aware that some people are almost certainly exploiting covid-19 to target minority groups online. I recently met members of Britain’s East and South East Asian Network, who highlighted the increase in online racism that their members had experienced during covid-19. We are absolutely clear that there is no place for racism, offline or online. Hateful content on digital platforms is a growing problem in the UK. It inflicts harm on victims, creates and exacerbates social divisions and erodes trust in platforms. We cannot continue to put up with it.

Worryingly, as the hon. Gentleman has said, we are seeing significant amounts of vaccine misinformation online. Confidence in vaccines across the UK remains high, but it is only natural that people should have questions about the vaccines that are available to them and about how they have been developed. However, it is simply unacceptable that some individuals online should seek to exploit citizens’ legitimate questions and deliberately create and share vaccine falsehoods for their own personal, political, or, worst of all, financial gain. We have seen a range of baseless and, in some instances, absurd narratives being shared about vaccines, including by individuals in the public eye, as the hon. Gentleman mentioned. They are much like those that we saw around 5G, and I will not give further time and attention to those groundless theories by repeating them here.

However, the act of sharing such falsehoods should not be confused with well-intentioned citizens asking perfectly understandable questions, as the hon. Gentleman said, including about how safe vaccines are. I remember the considerable misinformation that began to circulate about the MMR vaccine and its suggested link to autism in the early 2000s. I was a first-time mum at the time, and I found this false information, and the rate at which it spread, hugely unsettling and hugely worrying. That was of course in the days when social media was in its infancy. It did make a huge difference to a number of us who were mums at the time as to whether we would get our children immunised, and I am sure that it led to a rise in the number of measles cases subsequently. I urge those who have questions to seek advice from reputable sources such as the NHS and Public Health England, and to speak to trusted healthcare professionals.

[Jim Shannon]

I believe, as I think other Members would agree, that we need to have one message coming from all four Administrations—Scotland, Northern Ireland, Wales and England—together. It is very important that that happens. The hon. Member for Ogmore (Chris Elmore) referred to it. It is a critical factor so that we all hear the same story no matter what part of this great United Kingdom of Great Britain and Northern Ireland we live in.

[Caroline Dinenage]

The hon. Gentleman is absolutely right. We do all have to be singing from the same hymn sheet and giving out the same information.

We are taking a very proactive whole-of-Government approach to this. My Department—the Department for Digital, Culture, Media and Sport—has the responsibility for monitoring and analysing anti-vaccine narratives. My officials are working very closely with the vaccine taskforce, which comes out of the Department for Business, Energy and Industrial Strategy, while the Department of Health and Social Care is responsible for delivering effective communications around the vaccine. I meet my ministerial colleagues very frequently on this.

First and foremost, we are working with partners in the NHS, including GPs and nurses, to explain to patients the importance of vaccines. I am pleased that many organisations in the media and social media are acting very responsibly in providing accurate information. We are also working at pace to ensure that accurate information is available and accessible online, but we also have to address the swathes of inaccurate and misleading content alongside it. That is why we stood up the cross-Whitehall counter-disinformation unit in March as part of the Government response to covid-19.

ARM: Foreign Acquisition

Debate between Jim Shannon and Caroline Dinenage

Monday 21st September 2020 Commons Chamber

[Caroline Dinenage]

I will in a moment. I will make a bit of progress, then I will be happy to take the hon. Gentleman’s questions.

The Enterprise Act 2002 allows the Government to call in transactions on four public interest grounds: financial stability, national security, media plurality and public health emergencies. When a Secretary of State decides to intervene under the Act, they declare a public interest intervention notice. That triggers a deadline for the Competition and Markets Authority to conduct what it calls a phase 1 investigation. The CMA will then engage with the parties while it gathers the information and publishes an invitation to comment notice. That invites views from the merger parties and other interested third parties on the transaction under review. At the end of that phase 1 stage, the Secretary of State can: clear the merger, clear the merger with undertakings, or refer the merger to a phase 2 investigation. At the conclusion of the phase 2 investigation, the Secretary of State would consider if the transaction meets the threshold for intervention on public interest grounds under the Enterprise Act, and therefore make a decision on the necessary steps if and when it would be appropriate to do so.

The reason I am explaining that to the hon. Gentleman is that I think it is really important to articulate the number of very careful steps we would have to take in that process. In this instance, the Secretary of State for Department for Digital, Culture, Media and Sport would be the final decision maker. It is obviously extremely critical that he does so with an independent mind, having received all the relevant information and without prejudice. I am sure he will understand that while I am very happy to stand at the Dispatch Box and answer as many of his questions as possible, I have to be very careful not to say anything that could in any way prejudice that decision or any future moves. However, I will try to answer as many of his questions as I can.

As the hon. Gentleman will know, on Monday 14 September Nvidia and Softbank Group announced a definitive agreement under which Nvidia will acquire ARM Limited from Softbank in a transaction valued at $40 billion. The announcement stated that Softbank will remain committed to ARM’s long-term success through its ownership stake in Nvidia, which is expected to be under 10%. Furthermore, the statement said that ARM will remain headquartered in Cambridge. Nvidia and Softbank have made statements to the media expressing their commitment to maintaining ARM as a successful business in the UK. They have suggested that they will build on ARM’s R&D presence here by establishing a global centre of excellence and will create a platform for global innovation with industry partners across multiple fields. We will consider all those statements incredibly carefully.

[Jim Shannon]

Yesterday’s papers suggested that last year ARM paid some £268 million in tax and that it has the potential to be Britain’s first trillion dollar company. Has the Minister had any assurances from the company about its commitment to keeping its tax base here, and thereby the tax it pays to Her Majesty’s Revenue and Customs her as well?

[Caroline Dinenage]

We have had conversations with the company at various points over recent months. However, I do not want to prejudice the situation in any way, shape or form, so I do not really want to discuss any of its commercial aspects, if the hon. Gentleman will forgive me.

Arts, Culture and Heritage: Support Package

Debate between Jim Shannon and Caroline Dinenage

Tuesday 7th July 2020 Commons Chamber

[Caroline Dinenage]

I set out earlier the road map that we are looking at. 

We hope to be able to have socially distanced outdoor performances very shortly, and soon after that, during the summer, we hope to be able to confirm when we can have socially distanced indoor performances. We are working at pace, alongside Public Health England, and doing pilots and other scientific studies to see how soon we can fully get all our theatres and public-heritage and cultural spaces up and running and back to full steam. We want desperately to do that, but we have to keep people safe.

[Jim Shannon (Strangford) (DUP)]

I welcome the package, and my party welcomes it as well. What support is there to help churches such as St Margaret’s here in Westminster? Will the Minister consider a stand-alone scheme? As well as providing prayer, worship and communion services, such churches are also tourist attractions because of their wonderful history and beautiful buildings, but find themselves in dire straits financially because of their inability to access any grants and because they have no tourists or visitors because the business aspects of their buildings are closed.

Oral Answers to Questions

Debate between Jim Shannon and Caroline Dinenage

Tuesday 29th October 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for the response so far. Will she outline what discussions have taken place with independent groups such as Specsavers, which does excellent work providing wider access to NHS-funded tests and hearing aids, with special reference to more rural areas?

[Caroline Dinenage]

The hon. Gentleman is right to raise this. As I said in my first answer, it is important that we can work collaboratively with organisations in the private sector and across the NHS to make sure that patients, wherever they are in the country, in urban or rural areas, can access the right care and support when they need it.

Lower Limb Wound Care

Debate between Jim Shannon and Caroline Dinenage

Tuesday 23rd July 2019 Commons Chamber

[Caroline Dinenage]

I do apologise—I went to university in Wales, so I should get that right.

I must congratulate the right hon. Lady, first, on securing the debate, and, secondly, on making such mammoth, gargantuan efforts to be here. She did that with some help from her friends on the 12th floor of St Thomas’s, the experts in the Gallery—I am going to have to be careful what I say. She is nothing short of an inspiration to all of us, both as a long-standing Member of Parliament who is greatly respected in this place and as a human being. We are so grateful for the fact that she has made it here today, and we wish her a very speedy recovery. We look forward to her being back here to monitor every development that the Department can bring about in the context of wound care and how we look after people in hospital more generally. She is a great inspiration to all of us, and I thank her so much for raising this issue in the House.

I think we all recognise the importance of ensuring that patients have access to high-quality lower limb wound care. As a Government, we are absolutely committed to ensuring that people receive the right care in the right place at the right time, whether through acute services, a local GP or services based in the local community. As the right hon. Lady knows, wound care treatment is a vital service which, during the initial period, is predominantly provided by a community nurse. That crucial provision offers relief to those with leg ulcerations or diabetic foot ulcerations and pressure ulcers.

As Members will know, venous disease is the most common type of leg ulceration, and can cause great distress and suffering to patients and their families. The right hon. Lady spoke powerfully of the pain that she has suffered, and that others suffer, as a result of the condition. I think it is important to keep that in mind because of the side effects that having to live with enduring pain for long periods can have on a person’s emotional and mental health and wellbeing.

Our priority is for leg ulcers of this type to be treated early and in the community when that is possible, without the need for further hospital admissions or GP appointments. I think that that preventative approach is right for patients and for the system. It is key for wound care to be delivered effectively and efficiently. Good wound care not only saves patients from distress and suffering, but gives nurses more time to deliver other important services, and alleviates pressure on acute services. That is why NHS England and NHS Improvement have commissioned the Academic Health Science Network to develop and deliver a national wound care strategy programme for England, which aims to improve the quality of wound care provision. It is a comprehensive programme, which covers improving prevention of pressure ulcers, wound care of the lower leg, and management of surgical wounds.

The programme’s work will be informed by the following priorities. First, it will improve patient experience and outcomes by developing national clinical standards of care and a more data-driven approach. I know that the right hon. Lady is very keen on that. Secondly, it will work with industry to ensure that the right wound care products are reaching patients at the right time through the development of a much more robust supply, delivery and distribution model. Thirdly, it will aim to improve the current patchy provision of wound care training—of which I know the right hon. Lady is well aware—and the inconsistencies in the availability and quality of educational resources. As well as improving the care provided by healthcare professionals, that will allow patients to become more capable in self-care.

The right hon. Lady raised several issues that I should like to follow up. Let me first pay tribute to the work done by the Lindsay Leg Club Foundation in relation to community-based leg ulcer care. I am pleased that the committee of the lower limb clinical workstream of the national wound care strategy programme includes members of the foundation. As the right hon. Lady said, leg clubs are organised by the local community rather than health providers, but leg club nursing teams are employed by NHS local provider services, clinical commissioning groups and GPs. That is why it is so important for everyone to work together to support people as much as they can in the community. I can imagine that when this condition starts it is so painful that people can feel extremely alone and isolated, and the provision of leg clubs and other support mechanisms in the community, to offer the information, advice and support that they need, can help them to stop feeling that isolation and fear.

I also join the right hon. Lady in welcoming the all-party parliamentary group on vascular and venous disease. It is important for us to have all-party parliamentary groups which really recognise conditions of this kind, and which are doing their best to push the Government, and us in the Department of Health and Social Care, to do everything we can to support people who suffer from them.

The programme that I was talking about started its work in late 2018, and since then has brought together a range of experts. It has recruited over 500 stakeholders from a very broad range of private and public sector organisations to its stakeholder forum, and it is important that we have people with real experience from across the country taking part in this and influencing the decisionmaking. They aim to deliver their recommendations by the end of the 2019-20 financial year. We look forward to receiving them and the positive impact that they will have on patients’ lives. This is just for England, but NHS England is in communication with wound care leads in the three other devolved nations to ensure that they are sharing this learning across the piece.

The research in this area is also very important. The Department funds research into all aspects of human health through the National Institute for Health Research at the level of about £1 billion a year, and the NIHR has funded a number of studies focusing on lower limb wound care, including venous leg ulcers and vascular problems. A five-year funded programme on complex wounds comprised 11 new and updated reviews of the existing literature, a survey and interviews with people with complex wounds, their carers and health care professionals. There has also been a series of venous leg ulcer studies using randomised control trials to investigate the clinical and cost effectiveness of new versus traditional venous leg ulcer treatments from types of compression bandage through to compression hosiery to larval therapy.

The right hon. Lady also spoke about the importance of having the right staff, expertise and medically trained people to be able to deliver the care, and it is no secret that community nurses are a fundamental part of our health system; they provide vital services that ensure patients are treated where they are most comfortable, which often is in their own home, and that they are supported to manage their conditions and to live independently. To help deliver our vision for community services, we are investing an extra £4.5 billion a year to spend on primary medical and community health services by 2023-24. The key to delivering the long-term plans and vision is ensuring that we have the right nursing numbers, particularly in the community, and that is why the interim NHS people plan is prioritising taking urgent accelerated action to tackle some of the community nursing vacancies. That will be done in a range of different ways, including increasing supply through under- graduate nursing degrees, clearer pathways into the profession through the nursing associate qualification and apprenticeships, and tackling some of the misconceptions about the role of community nurses, which sometimes deter people from entering the profession. In addition, in May 2018 we announced £10 million for incentives to postgraduate students to go on to work in some of the areas that we care very passionately about and where we want to recruit the best people, such as mental health, learning disability and district community nursing roles.

[Jim Shannon]

I am pleased to hear this very positive response from the Minister. In Northern Ireland we have a very good community nursing programme that is delivered through the social care services. It cares for those who need care and a change of dressing for their wounds every day. The Minister referred to contact with the regions and devolved Administrations; will she contact the Northern Ireland Assembly and the permanent secretary of the Department of Health, Richard Pengelly, so they can give some idea of what we do there?

[Caroline Dinenage]

The hon. Gentleman is always full of brilliant ideas and we will only move forward as a nation if we share best practice and the expertise gained from different parts of our country. So I would be very keen to speak to his colleagues at the Northern Ireland Assembly and see if we can gain any learning from that.

Living with Dementia

Debate between Jim Shannon and Caroline Dinenage

Tuesday 25th June 2019 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

As ever, Mr Paisley, it is a great pleasure to serve under your stewardship. I thank the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this important debate, the hon. Member for Cambridge (Daniel Zeichner) for supporting her in doing so, and the Backbench Business Committee for allowing time for it. I also thank all the other Members who have taken part in the debate, and in some cases shared very personal journeys and stories about their family’s experiences with dementia and, indeed, some interesting and inspiring best practice from their constituencies—things that other areas can learn from.

I also thank the hon. Member for Oldham East and Saddleworth for her personal commitment and dedication to people living with dementia, both through her work on the all-party parliamentary group on dementia and in her constituency. She is so committed to making Oldham East and Saddleworth a really dementia-friendly place to live; she sets an excellent example of what we as Members of Parliament can do in our own communities, and I welcome her vision of making Westminster the first dementia-friendly Parliament. I will do everything I can to support her in that endeavour, because I know that her passion is driven by her experience of having a close family member living with dementia.

Other Members have spoken about their own experiences, and I have also had two very close family members living with dementia: my grandmother and my uncle, who passed away just before Christmas. I have experienced at first hand the impact that dementia has, both on the person who is living with it and those who love and care for them. Hon. Members from across the House have spoken about the importance of carers, and I have seen at first hand the impact that caring for my grandmother had on my mum—on her relationships, her professional life and her health and wellbeing. Those carers’ commitment should never be taken lightly. A dementia diagnosis is more than a diagnosis for that individual: it is a diagnosis for the whole family, their loved ones, their community and their workplace.

[Jim Shannon]

In my constituency, 1,152 people live with dementia. As the Minister rightly said, it affects a lot of families as well as the wider family circle. Has she given any consideration to respite care for those families to give them a break from the physical, emotional and mental pressure that they are under?

[Caroline Dinenage]

Respite care was one of the themes of the carers action plan that we published last year. SCIE is putting together guidance for local authorities on how they can best provide that crucial respite moment for those brilliant carers. [Interruption.]

A diagnosis is very much for an individual, but also for their families and loved ones and for their communities and workplaces. When those come together, it is possible to live well with dementia, as my hon. Friend the Member for Witney (Robert Courts) said. Such personal experiences make me passionate about my responsibilities as a Minister. The hon. Member for Halifax (Holly Lynch) challenged me to continue to push the Government to keep dementia as a priority, and I always will. I am proud of the Government’s commitment to deliver on the dementia challenge 2020 in full to make this the best country in the world to live for anyone with a dementia diagnosis.

The challenge aims to transform the lives of people with dementia, as well as their carers and their families, through better awareness, care and research. We have made significant progress as part of the challenge, but we know, as we have heard today, that there is still much more to do. We have already started our work on our strategy for the period beyond 2020. This is not something that finishes in 2020. It is simply the start of the next phase and we will publish our thoughts on it early next year.

One of the key successes of the challenge has been improved diagnosis. We are meeting our ambition, and today two thirds of people living with dementia receive a diagnosis, but we clearly still have some way to go. Of course, not everybody wants a diagnosis, but we know that a timely diagnosis enables a person with dementia to access the advice, information, care and support that can help them to live well with the condition and remain independent for as long as possible.

We are focusing on reducing the variation in local dementia diagnosis rates. There is a real geographical variation, and targeted support to identify and engage the areas most in need of assistance will really help. Reducing the gap in diagnosis rates will ensure that people with dementia have consistent access to a diagnosis wherever they are in the country. We also know that receiving good quality care improves the lives of people with dementia. Equipping our health and social care workforce with the skills that they need is therefore crucial to the quality of care for those living with dementia.

Since 2012—the hon. Member for Bradford South (Judith Cummins) mentioned this—1 million episodes of the tier 1 dementia awareness training have been completed by NHS staff, and more than 1 million care workers completed the care certificate, or common induction standards. We continue to work to meet our commitment that staff have the training appropriate to their role. We want to see more people doing the tier 2 training, which is much more robust, so we are exploring options to see how we can increase take-up for anyone who needs it.

Oral Answers to Questions

Debate between Jim Shannon and Caroline Dinenage

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

I am pleased the hon. Gentleman has raised this issue, because he is absolutely right that we need to drive up performance nationally on diagnosis for autistic people. It is only with diagnosis that people can get the support and help they need. We are collecting data for the first time. It will be published later this year for the first time. It will mean that each area can be held to account and given the help and support it needs to drive up those figures.

[Jim Shannon (Strangford) (DUP)]

Will the Minister further outline the steps that have been taken to push for a UK-wide, ring-fenced uplift to respite care funding for those who suffer from autism, bearing in mind that there is a two-year waiting list in some healthcare trusts for families to access overnight respite care?

[Caroline Dinenage]

That is a really good point. We all know that access to respite care can be incredibly valuable, both for autistic people and their carers and their loved ones. That is why we are supporting CCGs that want to invest in respite care, and we are looking more carefully at how we can direct funding to these important services.

Oral Answers to Questions

Debate between Jim Shannon and Caroline Dinenage

Tuesday 19th February 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this. When children’s hospices expand and include facilities for young adults, it can make such an immeasurable difference in their local area. In my area, the Naomi House children’s hospice has opened Jacksplace, which has been such a valuable resource. Hospices should be incredibly celebrated for all such facilities they offer.

[Jim Shannon (Strangford) (DUP)]

Will the Minister take this opportunity to guarantee that the £11 million children’s hospice grant will be protected for children’s hospices, and indeed further increased as a result of the long-term plan to reflect the growing demand and the complexity of care provided by these lifetime services?

[Caroline Dinenage]

Yes. I think this is a really strong signal to clinical commissioning groups about how the NHS values the services provided by children’s hospices—not just end-of-life and palliative care, as I say, but the other respite and outreach services they provide. That is why giving them access to up to £25 million will make an immeasurable difference.

NHS Menopause Services

Debate between Jim Shannon and Caroline Dinenage

Wednesday 13th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on securing this debate on health services and the menopause, and I want to start by celebrating the fact that we are discussing this subject. For too long the things that only affect women have been taboo; they have been brushed under the carpet—they have not been discussed in this place. One of the most magnificent of the many great side-effects of having a more gender-equal place is that we begin to discuss these subjects and those last taboos get addressed properly. It is wonderful to hear and see the men present in this Chamber who also care passionately about this subject; that must be celebrated too.

My hon. Friend has been a passionate and highly effective campaigner for improved awareness of the menopause and better support for women who are dealing with some of the difficult symptoms. I am very grateful and supportive of her work on this issue; in my eyes she is an absolute hero. I believe it is vital that we provide effective support and treatment for women with menopausal symptoms. It is of the utmost importance that we continue to work to improve that and to tackle the misconceptions attached to the menopause.

My hon. Friend raised the issue of HRT and expressed her concern that some GPs are not prescribing or recommending it to women who need it. No two menopauses are exactly alike and GPs play an important role in ensuring patients are given treatment that is appropriate to them. It is worth bearing in mind that the menopause is a natural stage in a woman’s life, and that many women will experience the menopause without troublesome symptoms or the need for treatment. Where symptoms do arise, HRT can be very effective in relieving them, and GPs should give menopausal women information about HRT as a treatment option, highlighting its risks, if they see that there are any, and its benefits. However, every patient is different and HRT might not be suitable for everyone. It is not the only treatment for menopausal symptoms, and GPs should also, where appropriate, talk women through all the non-hormonal and non-pharmaceutical treatments that are available.

My hon. Friend is right to say that there has been real confusion in the past about the safety of HRT. Concerns were raised in the early 2000s, as she mentioned, when a study said it was associated with an increased risk of breast cancer and heart disease. As a result, many women were advised by their doctors to come off HRT and the number of HRT users in the UK fell significantly. I cannot stress strongly enough that, as my hon. Friend has noted, the evidence base has since become clearer and the NICE guidance on the menopause is clear that HRT is a perfectly safe treatment in the majority of cases, and in most cases there is a far lower health risk in taking HRT than in drinking a couple of glasses of wine every day or in obesity, as my hon. Friend said.

The NICE guidance on the menopause also provides GPs with advice on how to recognise symptoms of the menopause. This guidance has helped prevent misdiagnosis, and my hon. Friend spoke very powerfully about how sometimes menopause can be mistaken for depression, which is incredibly worrying. Improving treatment of the symptoms of the menopause is also important.

We are also taking a range of other actions to improve support for women experiencing menopausal symptoms. This includes the work of the royal colleges, which of course play an important role in the education, training and professional development of healthcare professionals who treat women with menopausal symptoms. The Royal College of General Practitioners has produced a toolkit that includes learning resources for GPs on diagnosis and management of symptoms of the menopause. In addition, the Royal College of Nursing, in collaboration with the British Menopause Society, has produced a guide providing information for nurses who wish to become specialists in the menopause. That is very important, too. The Royal College is also aiming to develop a GP specialty that focuses on women’s health, which will be warmly welcomed.

Correct diagnosis and treatment of symptoms of the menopause are important, but we also have to focus on improving wider awareness of the menopause. An important part of this will be to have more open conversations around the menopause, so that we can start tackling the taboos that are attached to it. Taking this wider, bigger-picture approach is vital, given the huge impact that the menopause can have on all parts of a woman’s life.

In raising awareness and tackling taboos, we need to ensure that we reach out to all demographics, including boys and men. I cannot help thinking that if a similar hormonal transition affected men for an average of four years in the second half of their life, we would never hear the end of it—[Interruption.] Present company excepted, of course. As it is, the menopause has become something of a taboo, and we have to get over that. That is why it is so incredibly faith-restoring to see these incredibly liberated and forward-thinking gentlemen in the Chamber tonight, including my hon. Friend the Member for Walsall North (Eddie Hughes), who has talked about the menopause café that he runs. He should be championed for that. I was also pleased to see that the debate that was held on world menopause day last October was called by a male MP. These men are champions, in my eyes, and they deserve to be celebrated.

As my hon. Friend the Member for Redditch mentioned, education is absolutely key to promoting awareness and understanding of the menopause. The Government are making relationships education compulsory in primary schools and relationships and sex education compulsory in secondary schools. The underpinning focus in these subjects is to equip young people to develop positive attitudes to health, relationships and wellbeing. Schools will then have a really good opportunity to improve pupils’ understanding and awareness of the menopause.

Hon. Members will be aware that women represent 51% of the UK population and 44% of our workforce. They play a vital role in the nation’s health, but they do not always receive the most timely or appropriate healthcare. My hon. Friend mentioned the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is the Minister with responsibility for mental health, inequalities, and suicide prevention. She is doing sterling work on this issue, and she has set up a women’s health taskforce. This taskforce will work to ensure that women receive timely and appropriate care in relation to a whole range of issues, and as part of its upcoming early work, it will consider the menopause.

This work will be informed by a collaborative discussion that will be led by the brilliant chief medical officer and include the Royal College of Obstetricians and Gynaecologists, a number of academics who work in menopause research and GPs who specialise in the menopause. These discussions will feed into the taskforce’s wider objectives: to empower women to speak more confidently; to raise awareness and break taboos around women’s health problems; and to improve the access, quality and experience of care for women. I hope that that will help to address some of the important issues that my hon. Friend has raised today, and I am sure that my ministerial colleagues in the Department of Health and Social Care will be absolutely delighted to work closely with her on the taskforce’s developing work around the menopause, because she has done such sterling work in this area so far.

We need to ensure that workplaces provide the necessary and appropriate support for women. A recent study found that 41% of women aged 50 to 60 said that the menopause had affected their job, but that 70% did not tell their employer about their symptoms. This demonstrates the work that needs to be done to move beyond shame and silence to an open conversation about the menopause, because half the population will go through it. Giving better support to those women in work is not only right but fundamentally good for the economy. Women over 50 are now one of the fastest growing groups of employees. They have invaluable skills and experience, which means that they are incredibly difficult to replace. We should be looking to support them to stay in work whenever we can.

I am particularly proud to be responding to this debate tonight not only because I am hurtling very fast towards the menopause myself but because, when I was Minister for Women and Equalities, I chaired the very first parliamentary roundtable on awareness and taboos around the menopause in the workplace. This was the first ever meeting in Parliament that brought together important stakeholders and interested parties to discuss this important issue. We heard some incredible evidence. I remember one lady telling us that she had had to leave her workplace because all she wanted was a desktop fan to help her deal with the hot flushes, but the company would not let her have one and so lost an employee with incredible experience and huge amounts of skill, which just makes no sense at all.

[Jim Shannon]

I thank the Minister for her positive response. There is an old proverb that a problem shared is a problem halved, and the Minister has clearly indicated a method of doing that. I encourage her to get that message out across GP surgeries, education and all the relevant bodies.

[Caroline Dinenage]

The hon. Gentleman is an enlightened man. The work that we did at the very first roundtable led to an evidence review that was published in 2017, which talked about raising awareness and about the effects on women’s economic participation. The review led to the Women’s Business Council developing a toolkit to enable employers to support their employees more effectively, and I think we can all agree that that can be nothing but a good thing.

Mental Capacity (Amendment) Bill [Lords]

Debate between Jim Shannon and Caroline Dinenage

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Caroline Dinenage]

The role of the family is much greater in this amended legislation than it is currently. A number of families have told us through our work on this Bill that they feel very disenfranchised by the current system. For example, in the new system a family member or a loved one can be an approved person.[Official Report, 13 February 2019, Vol. 654, c. 7MC.] That would be the person’s advocate through the process. That method brings family members and loved ones much closer into the decision-making around this whole system.

[Jim Shannon (Strangford) (DUP)]

I received some correspondence from Age Concern, as the Minister knows. It wanted to raise two specific issues; I spoke to the Minister about this, but I want to raise it again to have it recorded in Hansard. The issues are the definition of the deprivation of liberty, which I understand the Government are including in the Bill, and access to advocacy. I reiterate, too, the point made by the right hon. Member for Wokingham (John Redwood): the importance of having family and loved ones as part of the process. We must not disenfranchise them; if we do that, we are doing this wrong. So will the Minister confirm that those things are in place?

[Caroline Dinenage]

Yes, that definition is included in the Bill, and it is also expected that people will have an advocate. That is an approved person; it can be a family member or loved one or it can be an independent mental capacity advocate, or indeed both if the family do not feel they are fully equipped to be able to support their loved one.

[Jim Shannon]

So the wishes and feelings of the loved ones and their families are at the heart of the Bill?

[Caroline Dinenage]

The wishes and feelings of the vulnerable person are at the centre of the Bill, and the wishes and feelings of their family will definitely be taken into consideration if their family is the approved person. We must always leave a little space in case the person does not want their approved person to be a family member for whatever reason.[Official Report, 13 February 2019, Vol. 654, c. 8MC.] The wishes and feelings of the individual must be at the heart of this, and that was at the heart of the original Mental Capacity Act 2005.

Patient Safety

Debate between Jim Shannon and Caroline Dinenage

Wednesday 28th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I wish to start by congratulating my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this really important debate on patient safety. All patients have a right to expect care that is compassionate, effective and safe. The courageous testimonies of individuals such as Julie Bailey, who exposed the scandalous failings at Mid Staffordshire NHS Foundation Trust, and Sara Ryan, who campaigned fearlessly following the death of her son, Connor Sparrowhawk, while in the so-called care of Southern Health, show that safer care starts with listening to patients and their families.

It is important that we recognise that there are many victims when care fails—the families and the loved ones, of course, but also the healthcare professionals who carry the burden of their mistakes. The great majority of NHS patients receive effective and successful care. However, according to international studies, levels of healthcare harm range from 1% for the most “negligent” adverse events, to 8% to 9% for preventable adverse events. We are clear that any level of harm over 0% is unacceptable, and we believe that the route to a safer NHS is through transparency, learning and action. What is most frustrating is when harm persists, despite our having the knowledge and wherewithal to prevent it. There are approximately nine “never events” in the NHS every week—avoidable harms such as wrong-site surgery or foreign objects left after an operation.

Thirty years ago, the aviation industry stood at a similar crossroads. Since then, there has been a massive reduction in fatal accidents every decade, despite a huge increase in the number of passengers. According to the Civil Aviation Authority, there is an average of one fatality for every 287 million passengers carried by UK operators. Compare that with the 150 avoidable deaths every week across the NHS. That rate would potentially equate to the loss of 52 airliners per year.

How has the airline industry transformed its safety record so successfully? The key has been a “just culture” that recognises honest human error, but continues to hold people to account for criminal acts or wilful negligence. Creating a safe space that protects the evidence provided by pilots and air traffic controllers when there is an investigation is a cornerstone of the approach. It helps to create a culture in which people can be open about their errors and a system of learning from one’s mistakes, rather than blaming individuals.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Sleaford and North Hykeham (Dr Johnson) on securing this debate on an important matter. NHS staff are greatly restricted by their work and the long hours they do. We all know that and pay tribute to them. Sometimes, however, we have to look at better ways of keeping records and at innovations to streamline things to make sure that the real focus of NHS staff is on the work that they do. Has the Minister looked at streamlining and innovations to take away the red tape that restricts the caring job that NHS staff do?

[Caroline Dinenage]

The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.

As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.

Respite Care for Vulnerable Adults: Teesside

Debate between Jim Shannon and Caroline Dinenage

Monday 12th March 2018 Commons Chamber

[Caroline Dinenage]

That will of course be a matter for the Secretary of State, who will deal with it in the appropriate way.

The Care Act also requires local authorities to take a preventive approach to addressing people’s needs in taking steps to intervene early to prevent or delay any worsening of an adult’s need for care and support. This would of course include the carers about whom the hon. Gentleman and his colleagues care so passionately. It is really important to allow carers to take the respite that we have spoken about.

The hon. Gentleman might be interested to know that the Autism Act 2009 requires the Government to have a regularly reviewed autism strategy and to issue guidance to local authorities, NHS bodies, and foundation trusts. In addition, the Children and Families Act 2014 introduced a new statutory framework for children with special educational needs and disabilities. This gives commissioners very clear responsibilities towards those with learning disabilities and autism, including those who may be affected by the review on Teesside.

[Jim Shannon]

I think that everyone in this Chamber will have a knowledge of autism. The Minister will be aware that we have an excellent autism strategy in Northern Ireland, and there is also a very good strategy in Wales. Has she had a chance to check out both those strategies in order perhaps to introduce them, in full, to England?

Oral Answers to Questions

Debate between Jim Shannon and Caroline Dinenage

Thursday 26th May 2016 Commons Chamber

[Caroline Dinenage]

We have a package of measures for women who are returning to work: affordable and flexible childcare, flexible working—up to 20 million people in the UK can now apply for that—and shared parental leave. That package really supports women who want to return to work.

[Jim Shannon (Strangford) (DUP)]

As the Minister will know, many women who wish to go back to work find that they are essentially earning wages to pay for childcare. With that in mind, what are the Government doing on part-time and flexible hours for those women who want to go back to work but have been discriminated against because of their need or desire for more flexible working?

[Caroline Dinenage]

I was one of those women—under the Labour Government, I was literally working to pay for my childcare. I am so proud that this Government have done more than any other to make childcare affordable and flexible; that is why parents with children aged three to four will be able to access up to 30 hours of childcare.

Oral Answers to Questions

Debate between Jim Shannon and Caroline Dinenage

Thursday 15th October 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

There are great opportunities for girls to participate in sport, especially in rugby and football, at schools and universities. What has been done to provide that same provision at clubs after university?

[Caroline Dinenage]

The hon. Gentleman makes an excellent point. We want to encourage that participation through school, university and out into life afterwards. That is why the This Girl Can campaign, which shows real women taking part in sport that is fun and not just competitive, has been such a fantastic way of encouraging them to get out there and lead a healthy lifestyle.