Dialysis Care Outcomes

Margaret Ferrier Excerpts

Thursday 19th May 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered dialysis care outcomes.

I thank you for chairing this debate, Sir George, and thank those who are here to participate—they are colleagues, but also friends. I am pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place and am especially pleased to see the Minister in her place, too. I am not being condescending when I say that; I am encouraged because the Minister understands the issues very well. I look forward to her response—no pressure, Minister. We are pleased to have this opportunity.

I thank our guests in the Gallery, particularly Fiona Loud, who has been instrumental, through me, in achieving this Westminster Hall debate. I thank the Backbench Business Committee for allowing the debate. I applied for it some time ago, but the Queen’s Speech meant that those applications to the Committee fell. It was originally supposed to take place on the Thursday before recess, but we are having it at the same time, 3 o’clock, as it would have happened on that day.

Dialysis is an important issue to raise, especially at this time of rising daily costs that directly impact people who choose to receive their treatment in their own home. In a question to the Prime Minister yesterday, the right hon. and learned Member for Holborn and St Pancras (Keir Starmer) referred to Phoenix Halliwell and the cost for those receiving dialysis treatment at home. There might have been a bit of confusion around how the question was asked and how the answer came through—I know that others will speak to that—but it pinpoints a key issue for this debate, which is the impact of the cost of electric and energy on people receiving dialysis treatment at home. That is of particular concern to me and others at this time of rising costs. There are global pressures on the price of energy. This is not a debate on energy, but on what is happening to those who have dialysis treatment.

It is not just adults who are affected by this issue. Fiona and I spoke to the Minister beforehand; we appreciate that very much. It seems that not every postcode covers children. Local providers have discretion as to whether they reimburse the utility costs for children. I know that Fiona, who I spoke to beforehand, is concerned about that, and I certainly am. One person who contacted us said that her son has been on peritoneal dialysis since January. It used to cost £115 per month for combined usage, but it is now up to £350—a massive increase of 220%.

Although this debate covers a health issue, it also focuses on the predicaments of those people in the health system. We need to review that and think about it again, so that we can understand it better. It is important for those we are concerned about that we understand where the pressures are—financial pressures are coming from all sides.

Others will refer to this, but even on the warmest day of the year—we experienced the highest temperature of the year on Wednesday—a person receiving dialysis will feel cold. Cold weather puts even greater pressures on household energy costs, but people who receive dialysis at home are being very adversely affected by rising fuel and heating costs. I will refer to that later, but I wanted to put those two issues on the record. They have been brought to my attention and are of deep concern.

I know that this is not the Minister’s responsibility, but I will give some facts from Northern Ireland, where attempts are made for every patient to be given approval to receive dialysis at home at first. It does not always happen, because sometimes patients are sent to the renal department at the Ulster Hospital, which is my nearest hospital and which I have visited on a number of occasions over the years.

Analysis by the UK Renal Registry showed the rate of home dialysis in areas of deprivation at the end of 2020. Unfortunately, however, there was no data available for patients treated in Scotland. My colleagues and friends from Scotland may have some figures. Overall, the rate of home therapy was lower for patients from the more deprived areas of England, Northern Ireland and Wales. In England, 22.9% of patients in the least deprived areas were able to access home dialysis, compared with 15% in the most deprived areas. The rate of home dialysis for patients in Northern Ireland was 7.2% in the least deprived areas, whereas it was 9.8% in the most deprived areas. I am alarmed at these figures. If someone has a certain amount of income, it means that they have to pay for their energy. However, someone who is deprived is under pressure to ensure that the energy, electric and heating levels in their house are at a certain level, so the impact on those in deprived areas is much greater than it is anywhere else.

Those from lower socioeconomic backgrounds are affected by renal failure in the same way as anybody else, but they do not have equal access to home dialysis and the freedom that that choice offers. I look to the Minister, as I always do, for a positive response on how we can take things forward constructively in a way that can deliver for dialysis treatment patients across this great United Kingdom. We need to address this issue on a UK-wide basis, and greater equality must be achieved. I am my party’s health spokesperson, so it is always a pleasure to speak in these debates and to highlight issues that are brought to my attention by people such as my friend Fiona Loud from Kidney Care UK.

Kidney disease costs the NHS more than breast, lung, colon and skin cancer combined. It has a greater financial impact. It is estimated to cost £1.4 billion a year—equivalent to £1 in every £77 of NHS expenditure. That is a massive figure and a significant expense, with 21 people developing kidney failure every day and almost 30,000 people on dialysis in the UK. Unfortunately, it shows no signs of slowing.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Acute kidney injuries usually come about as a complication from another illness, and they are more deadly than a heart attack. As the hon. Gentleman said, research indicates that about 30% of acute kidney injury deaths could be prevented with better care or treatment. Does he agree that this is an area that requires urgent attention, looking at kidney disease outcomes in the round?

[Jim Shannon]

I thank the hon. Lady for those wise words, and I absolutely agree with her. She is right. We should never be guided entirely by finance, but we cannot ignore the financial implications. If we—by which I mean the NHS—could better use the moneys for early intervention, early diagnosis and early medical action, and reduce the cost, that would be beneficial to the NHS.

The clinical and cost benefits of home dialysis are well established, but despite 17 years having passed since the National Institute for Health and Care Excellence first highlighted its ambition for just 15% of patients to take advantage of home haemodialysis, as many as eight out of 10 dialysis patients are still treated in centre. That is a big challenge, but it is something I believe in, and I am confident that the Minister can embrace that challenge and give us some idea of how we can move forward in a positive fashion to deliver even better.

Some of those people will have successful transplants, although a transplant is only a form of treatment, not a cure. I have a particular interest in this matter because I have a nephew called Peter Shannon, born with a kidney the size of a peanut, or the wee nail on my finger. I remember when my boys were running about—obviously, young boys or young girls are always full of life, but he never had the energy. He was always a terrible colour—yellow, the colour of a bowl of custard—and he never really moved forward physically until he had a transplant at the age of 16. When he had that transport, his life transformed; if only that were possible for everybody, but it is not. I have been a great supporter of organ transplants all my life, and I am very pleased that the Government accepted the legislative change to make everybody a donor unless they opt out. I was always in favour of that legislation. In Northern Ireland, my party —the Democratic Unionist party—had perhaps not truly embraced it in the past, but it has now. I cannot say I am a pioneer in the party, but I am pleased that that legislation has also been endorsed by the Northern Ireland Assembly.

Many other dialysis patients will have no choice but to dialyse to replace their kidney function and to stay alive. The majority will do so three times a week at a hospital or clinic, every week for the rest of their lives, because once a patient starts dialysis, they are on it forever unless they receive a transplant. Across this United Kingdom there are nearly 30,000 people, from young to old, on dialysis. They come from all walks of life and are united by a remarkable strength and resilience to continue with this long-term, gruelling, life-saving medical treatment.

When dialysis is needed, in an ideal world the patient and their care team will consider and decide together whether to dialyse at home or in-centre. There are two forms of home dialysis therapy, with haemodialysis being the most common. Tubes are attached to needles in the arm or via a line to the neck, with blood passing through an external machine that filters the toxins and water from the blood before returning it to the body—it is almost like a cleansing process, but medically. Suitable patients can safely undertake that procedure themselves at home, carrying out sessions that meet their clinical needs to a routine that fits their lifestyle, including overnight while they sleep. In peritoneal dialysis, which is the other form of therapy, a catheter is placed into part of the abdomen via a surgical procedure.

Since its introduction in the 1960s, most dialysis care is delivered in-centre, with patients required to travel to a hospital three times a week for four hours of treatment. Many patients who dialyse in-centre benefit from the care of the UK’s excellent nephrologists, nurses and support staff, and from a sense of community with others receiving dialysis. However, that treatment is more intense over a shorter period of time, which might not suit everybody. It can be extremely draining, and it often leaves patients feeling physically exhausted as the body is pushed so hard during those treatments, and their toxin and fluid levels build up again immediately while they face a long wait until their next dialysis session. As a result, those patients must adhere to strict fluid and diet restrictions, and they must also travel to and from their dialysis centre, which is a time-consuming and often exhausting experience.

I visited the dialysis renal unit at Ulster Hospital in Dundonald some time ago. It is a new centre, and I met many of the people there. I knew two of those people personally. One was Billy McIlroy, who passed a few years ago. He went there for his dialysis treatment three days a week, which I know kept him alive. Another guy called David Johnson also attended that dialysis unit. He got a kidney transplant eventually, so his life changed greatly. I had already been given the details of what happens in dialysis, but actually seeing it showed the reality—it gave a physical understanding—of what those people were going through three times a week. For them, travelling from home and going home again was six hours of their day.

[Margaret Ferrier]

On that point, the impact of kidney disease and treatment on patients’ mental health is huge. Good mental wellbeing can make a big difference to a patient’s recovery and ability to withstand difficult treatment. Does the hon. Gentleman agree that ensuring patients have access to mental health support is paramount to improving outcomes, and that the NHS must be better resourced to provide that?

[Jim Shannon]

I thank the hon. Lady for reminding us all of that. We often focus on the physical aspects of this condition, as we should, but we must also remember the mental health and anxiety issues that come alongside it. Patients suffer with uncertainty about how they are going to feel the next day, uncertainty about their future health, and uncertainty about their personal and financial issues and their family. The hon. Lady is right to remind us of that point.

By comparison, home dialysis therapies offer flexibility and have been shown to have a positive effect on a patient’s health. When patients dialyse more regularly, they are more effectively replicating the natural function of the kidneys. Studies have shown that longer, more frequent dialysis sessions, undertaken at a schedule of the patient’s own choosing, achieve better results than a thrice-weekly in-centre schedule. People doing alternate-day dialysis have been shown to experience fewer symptoms, such as shortness of breath, high blood pressure and left ventricular heart damage. People on home haemo- dialysis have an up to 13% lower risk of death than those on in-centre haemodialysis. That shows that if people can do more home treatment, we can improve their longevity. NHS England has acknowledged the limitations of standard in-centre haemodialysis, and in particular the increased risk of hospitalisation or death after the weekly two-day break between in-centre sessions.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) is right about the importance of mental health. Depression is the most prevalent psychiatric illness in patients with end-stage kidney disease, and she made that point powerfully. One study shows that rates within the dialysis population vary from 22.8% to 39.3%. Wow—those are big figures, and they show what the condition does. Studies have also shown that depression is a significant predictor of mortality in dialysis patients. That is particularly important for younger people on dialysis, who report a lower quality of life than young adults in general.

People who have the choice of dialysing for as long as they need and at a time of their choice have freedom and control. They can also better respond to their body’s reaction at that time, in the comfort of their home and with the reassurance of their family around them. Home treatment probably addresses some of the issues of depression and mental health issues as well. It enables patients to have a life outside their dialysis schedule and hold down a job. It allows them to have a normal life and pursue the dreams and ambitions that should be the right of any person, young or old. I can attest to that through my nephew, Peter Shannon, who has had an organ transplant. I have seen his life change. He bought his first house just last week, incidentally, at probably the highest time for house prices in the whole United Kingdom.

In the last 18 months, covid-19 has exaggerated the negative impact of differences in dialysis care, and heightened the need radically to increase home therapy provision. Analysis from the UK Renal Registry has demonstrated that the relative risk of death associated with covid-19 among in-centre dialysis patients was much higher than that of the general population in England, especially among those of a younger age.

The UK kidney community has been calling for patients to be provided with greater choice in their dialysis care, recognising the need for increased awareness and education around home therapies and greater equity of access across the country. In the UK, however, the overall percentage of dialysis patients receiving home therapies has increased only from 3.4% in 2011 to 7% in 2022. Although that has doubled, it is a long way off the figure of 15%. It needs to double again, and I think, respectfully, that the Government should set a higher target.

In 2021, the NHS’s Getting It Right First Time programme recommended that a minimum of 20% of patients in every dialysis centre should be on home dialysis. It set that target, and NHS England’s Renal Services Transformation Programme is working to increase the provision of and access to home therapies, in line with recommendations made by Getting It Right First Time.

Although there are dialysis centres exceeding the target, which we welcome—it is not all negative; many are trying to achieve those targets and goals—GIRFT’s own report highlighted that 33 out of 52 centres in England have not yet met the target. Again, I respectfully ask the Minister—she knows I do this constructively; I just want to get the stats so that we can understand the problems and how to do things better—to tell us what has been done to increase the number of those 33 out of 52 centres that have not yet reached the target. The Getting It Right First Time target of a 20% prevalence rate for home dialysis compared to in-centre care could be transformative for patients, and could deliver considerable cost savings for the NHS at a time when they are desperately needed. We can do the treatment better, deliver the medication and dialysis better, and we can do it for a better price. That seems to me to be good value.

To address adequately the low uptake of home care, a review of dialysis reimbursement should take place to ensure that training and educational needs can be met, and to incentivise higher frequency dialysis at home, such as alternate day treatments to support all dialysis centres to meet the 20% target. What steps are the Government taking to reach that 20% target? It is essential that clinicians are offered the tools needed for them to meet the GIRFT targets in an effective manner, such as providing staff and patients with detailed, unbiased education to empower them to make informed decisions about their dialysis. I see it—as I often do—as a partnership, with clinicians working alongside Government policy and patients to do better.

One of the most pressing issues facing people who receive treatment at home rather than in hospital is the rising cost of fuel and energy. I referred to that at the beginning, and there are three points that I wanted to make. People receiving dialysis at home are at particular risk from rising energy costs. The figures that I cited, and the question asked by the Leader of the Opposition at yesterday’s PMQs, gives an indication of the issue. There seems to be an uncertainty, and perhaps a postcode lottery, as to where there is help for energy costs, but the figure that I gave of £118 per month for a child, or whatever it is, but that now costs £350, indicates that there is a way to go yet. Dialysis machines, with their high energy consumption, keep people alive. Dialysis treatment at home adds between £593 and £1,454 to utility costs per year, and that is before this year’s 54% energy bill rise.

One effect of dialysis treatment is that many patients frequently feel cold due to the associated anaemia and the process of dialysis, so they need to heat their homes more often and for longer during the year. When we feel warm, they feel cold. When we feel exceedingly warm, they might feel normal. There are not many times in the year in this great United Kingdom of Great Britain and Northern Ireland when we have Mediterranean heatwaves, so for the dialysis patient, feeling cold is almost an everyday occurrence. We do not want people to have to decide between giving up the freedom and independence that home dialysis gives them, and going into a hospital setting just to save costs. Again, I ask the Minister urgently to address that matter, because the barriers to employment for people on dialysis, posed by frequency and length of treatment, and the physical toll and intense fatigue, already compound financial insecurity for home dialysis patients.

The NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, but reimbursement is inconsistent across the country, and many patients receive no or very little financial support to pay for the additional costs of treatment. For most home dialysis patients, the £200 repayable relief on energy bills and council tax deduction will simply not be enough, and a special, specific provision is needed. It is regrettable that the spring statement was a missed opportunity for the UK dialysis community. Consistent reimbursement, longer-term capped tariffs for vulnerable groups and immediate financial support are urgently needed. Again, I look to the Health Minister and the discussions that she has with her Secretary of State for Health, and ultimately with the Chancellor, to ensure that we can deliver extra, specific financial help for those on dialysis treatment.

Many in the kidney community feel that their voices have been unheard in Westminster for too long, and when a friend from the kidney charity asked me to secure this debate, I was very pleased to do so. I think that today’s debate does two things. It raises awareness—that is No. 1—but it also directly asks the Minister to become involved and address some of the anomalies. I welcome the re-establishment of the all-party kidney group. Its work, led by the hon. Member for Bassetlaw (Brendan Clarke-Smith), aims to promote improvements in the health and care services that are available to improve the health of people with renal failure.

I call on the Minister to respond to calls from voices in the renal community to support them, and ensure that a straightforward, accessible system is in place to enable people on home dialysis to be reimbursed for the additional cost of utilities, as set out in the UK Kidney Association guidance. Would the Minister perhaps be agreeable to that request? If I may, I would ask for a meeting on behalf of the APPG—perhaps the chair of the APPG, our friend and colleague, would do that—because then we could look at some of those issues. Those who are involved in this debate might wish to attend that meeting as well. NHS tariff payments for home dialysis must be sufficient to cover all associated costs, including reimbursement for additional utilities usage that should and must reflect current price increases. Again, I look to the Minister to pledge to work with energy companies, and the Chancellor to develop capped tariffs for people on medical treatments at home, such as dialysis.

Renal units should proactively offer support to all patients undergoing dialysis, to build their confidence and ensure that they are dialysing in the right way for them at the time. Again, Minister, we need to address the low uptake of home dialysis by implementing a review of the dialysis reimbursement tariff—I think we referred to that in the discussion that we had outside the Chamber, and I look forward very much to the Minister’s response. We must also ensure that training and educational needs can be met, and incentivise higher-frequency dialysis at home, such as alternate-day treatments, to support all dialysis centres to meet the 20% target. Let us meet that target. Let us do it here and back home as well, and achieve the significant cost savings that home dialysis can bring.

I will close with this comment: it is vital that all renal unit staff receive updated training to build their home dialysis knowledge, in order to help find solutions to the issues facing patients, and so that information for patients about transitioning to home therapies is standardised and includes details on the practical and financial support available. I place on the record my thanks to all renal staff. They do magnificent work; they are saving lives and they are keeping people alive. It is wonderful, and we thank them for it. The support available should also include a consistent approach to utility bill contributions from the NHS, in order to ensure equality for every renal dialysis patient across this great United Kingdom of Great Britain and Northern Ireland. The Government must ensure that educational resources are also provided to local authorities and trusts, enabling them to respond appropriately to the needs of people in their area who want to choose home therapies.

Thank you very much, Sir George, for the chance to raise the issue of dialysis treatment and bring it to Westminster Hall in a way that, I hope, both raises awareness and lets people out there on dialysis treatment know that we in this House care for them—I believe we do—and that we are seeking change. I look forward very much to other contributions in the Chamber today, but I look forward particularly to the response from the Minister.

Irish Diaspora in Britain

Margaret Ferrier Excerpts

Thursday 17th March 2022 Commons Chamber

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Member for Rochdale (Tony Lloyd) on securing the debate, which is an excellent opportunity to pay tribute to our friends from the island of Ireland and recognise their valuable contributions to mainland Britain.

The contributions of the Irish span every corner of Britain and every industry, so it is easy to forget the anti-Irish sentiment that was rife throughout even recent history, despite two former British Prime Ministers being born in Ireland. Even today, the Irish are not always painted in a positive light in the media. They are often portrayed comically as an outdated stereotype. It is shameful. Shameful too is the continuing and prevalent prejudice and racism aimed at the Irish Traveller community. The reasons behind those issues are for another debate on another day. I would like to keep my speech positive and celebratory, but I felt it was important to give that acknowledgement.

I start with contributions to the arts and ballet. Dame Ninette de Valois was born as Edris Stannus in County Wicklow, the garden of Ireland, in 1898. In 1905, she moved to Kent, England to live with her grandmother. At 10, she began to take ballet lessons. Her love for dance was apparent early on at a party with other children. Having watched another little girl dance, she demanded that she be allowed to perform an Irish jig. Edris took the name Ninette de Valois at the age of 13 as she began her professional training and made her debut in the west end. The name change reflected a public expectation of the kind of exotic name a dancer should have. In 1919, at just 21, she became the principal dancer for the Beecham Opera, which was at the time the resident company at the Royal Opera House. At 23, she joined the Russian Ballet, where she mentored Alicia Markova who would go on to become prima ballerina assoluta and one of the most famous British dancers of her time.

Ninette became the driving force behind ballet in Britain, establishing dance schools in London and Dublin. In 1956, they were granted the royal charter, so the schools became the royal ballet. She also, quite surprisingly, became very influential in the development of Turkish ballet and helped to establish the Turkish state ballet at the invitation of Turkey’s Government. Ninette is known as the mother of English ballet, despite her Irish nationality. She died in 2001 at the grand old age of 102 and with a legacy most dancers could only dream of.

Another woman who offered much to Britain, although in a different field, is Mary Morris. She left Ireland at 18 to come to London to train as a nurse at Guy’s Hospital in 1939. Mary was a prolific diarist and in her diary recorded much of the war. She dated the “real war” as starting on 31 May 1940, when ambulances came filled with dirty and wounded soldiers from Dunkirk. Mary witnessed the battle of Britain in the sky, and nursed the wounds of pilots hurt in the battle. She also tended to the German prisoners of war.

It was during her time as a nurse that she met a Frenchman named Pierre, whom she described in her diary as

“slim and dark, with beautiful brown eyes and masses of Gallic charm”.

Pierre invited Mary out to dinner and, despite strict rules around the fraternisation with patients, she accepted. She was reprimanded by her matron, but that did not stop Mary from spending more and more time with Pierre, visiting London and witnessing air raids. In 1944, Mary joined thousands of her fellow Irish nurses as a volunteer for the armed forces, where she was posted to Normandy and treated the wounded soldiers of the D-day landings. She described her ward as a

“multi-national microcosm of a Europe at war”.

When the war was over, she settled in Britain with her husband.

Ninette and Mary were two very different women, with two very different stories but a common thread. What they offered to Britain, through their services to the arts or to the war effort, helped form the Britain we live in today.

A little closer to home, the migration of Irish workers to Glasgow and the surrounding towns changed our corner of Scotland substantially. Even before the great famine, fares to Glasgow from Ireland were cheap and there was a lot of work and jobs to be filled: labour jobs, mining jobs and a thriving shipbuilding industry. There were also jobs for skilled workers, too, such as in the handloom weaving industry. The Irish workers were right at the forefront of trade union activity, something often forgotten. The contributions of those workers shaped the city and areas like Lanarkshire where my constituency sits, and that should be recognised.

Most of us will have some Irish roots in our heritage. It is not uncommon and it is something we are all proud of. The Irish who came here contributed to our society in more ways than we can possibly cover. I am pleased that we have this debate today to give it recognition. There is no day more fitting than today, and I wish everyone a happy St Patrick’s day.

Dementia Research in the UK

Margaret Ferrier Excerpts

Thursday 10th February 2022 Commons Chamber

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on securing today’s debate and on her continued work on this issue, which I know is appreciated by many throughout the House and beyond. It is a pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman); I enjoyed listening to the stories of his visits.

Dementia has a lasting impact on those who develop it and on their loved ones. While the patient begins to develop symptoms, maybe slowly at first, it may be frightening—memory loss, a struggle to communicate, mood swings, and a change in personality for reasons the person does not understand. Over the course of our lives we get to know ourselves very well, and losing that sense of self is incredibly sad. The impact on carers and family members must not be underestimated either. Depending on the level of severity, caring for someone with dementia can be a full-time 24/7 job, and that can be exhausting. A common feeling among carers is guilt—guilt that perhaps they cannot keep up; guilt that sometimes they resent their newly found role. It is human nature to be hard on ourselves.

About 90,000 people in Scotland are currently living with dementia, and that number is expected to increase to at least 120,000 over the next 20 years. The condition is prevalent, and numbers are rising. It is estimated that in the UK one in three people born this year will develop a form of dementia later in life. In South Lanarkshire, where my constituency sits, dementia is the leading cause of death for women, accounting for 16.2% of female deaths. That is a sobering statistic. Globally, there are now more people living with dementia than with cancer, which is why research on treatment, or a cure, is so important. There is still no effective treatment. We can see how investment in research has allowed scientists to make unprecedented breakthroughs in respect of cancer, for example: sustained funding for cancer research allowed scientists to understand it better, turning what was, at one point, seen as a death sentence into a chronic but manageable disease. However, the human brain is complex, and that plays a big part in why dementia remains so poorly understood. Research has historically suffered from under-investment, and sustained investment is vital if breakthroughs are to be made.

Let me draw another comparison with cancer research. There have been 74,000 cancer-related clinical trials since 2000, but fewer than 2,400 for Alzheimer’s. In the same timeframe, the Food and Drug Administration has approved 512 cancer drugs, but just six drugs for Alzheimer’s. The UK Government’s funding for cancer is almost three times higher than that for dementia. The pressure on the NHS cannot be ignored. More than one in four hospital beds are occupied by someone with dementia, and more than half of dementia patients will have at least one hospital admission each year.

[Bob Stewart]

It was the story from my friend, the hon. Member for Ochil and South Perthshire (John Nicolson), about his mother that twigged something in my memory. The real problem seems to be that the will to live disappears. People look normal, but they are just vacant. As an ex-soldier, having seen this with soldiers, I know that the will to live is crucial. When someone gives up the will to live, they are gone. We have to find a way of making sure that dementia sufferers keep the will to live because if that is vacant, it is gone. I think that is true but others might disagree.

[Margaret Ferrier]

I thank the right hon. and gallant Member for that intervention and the hon. Member for Ochil and South Perthshire (John Nicolson) for his story about his lovely mother—a really sparkling lady, who I remember seeing pictures of. It is very sad when people give up the will to live.

One in five hospital admissions are for potentially preventable reasons, such as a fall, infection or psychiatric difficulties. It is not all bleak though. There have been developments and we understand the disease better now than we did just a few years ago. New research from University College London and the University of Paris, published in The BMJ in December, found that those with two or more chronic health problems in middle age are more than twice as likely to develop dementia. That research was based on a long-term clinical trial showing how progress can be made if the resources are available.

I would like to mention the Glasgow Brain Injury Research Group based in the Queen Elizabeth University Hospital. The group looks at traumatic brain injuries, or TBIs, and the impact that they have on patients exposed to varying levels of severity of injury. It is pursuing an interesting workstream on the link between repetitive mild TBIs, incurred through sport such as football and rugby, and the increased risk of dementia. We all know of many famous footballers who have died from dementia, such as the great Billy McNeill. This is a fantastic piece of work and one of the many different research areas that could really deepen our understanding of how dementia occurs and develops and of subsequent treatment methods.

The medical community remains hugely optimistic. A survey of researchers at the UK Dementia Research Institute found that 90% of them felt that new treatments would be found within the next decade, and 72% held the opinion that the pace at which breakthroughs are being made is increasing. Vitally, though, 100% pressed the need for additional funding to allow breakthroughs to be made. They are the experts and we should listen.

Developments are already under way, but the key now is maintaining and accelerating the existing momentum. We have heard of the Join dementia research resource, which is piloting actively writing to all people with dementia after their diagnosis to invite them to participate in research. That would hugely benefit dementia research. In March 2021, Public Health Scotland revealed that less than half the people estimated to have had a new dementia diagnosis in 2018-19 were referred to vital post-diagnostic support. That outreach is essential. How will the Government support the JDR pilot and its roll-out across the four nations?

The lack of timely and accurate diagnosis is making it hard for current clinical trials to identify suitable candidates. The condition is severely underdiagnosed and the current backlog has only slowed things down even further. Transforming the current diagnostic process is pivotal. If diagnosis comes too late, we risk patients not being able to access treatments that might have helped to slow down its development.

The Government talk a lot about levelling up the UK, and I wonder whether that same attention could be given here. As part of the dementia strategy, the Government should invest in the development of multiple dementia clinical trial sites to form a network across the UK. Such a project would be in keeping with a true levelling-up agenda and make the UK an attractive centre for international life science investment. Better understanding of the disease leads to better support medically and emotionally. It will lessen the burdens on our frontline services. Early detection of the disease is crucial to allow patients to continue living independently and with dignity. That is one step that can be taken now. We need a stronger understanding among the general public about what to look out for and how to get help.

I wish to highlight the essential support provided by a number of charities for those with dementia and their support networks. They have also provided a wealth of knowledge to Members to support this debate, for which I am very grateful. Age Scotland, whose remit reaches much further, provides excellent support for older people in Scotland, as do Alzheimer’s Research UK, the Alzheimer’s Society, and Alzheimer Scotland, among many others. Charitable funding has become harder to come by over the past two years, and the work of those organisations in the face of that is invaluable and impressive. Their working commitment is commendable. The UK is a leader in biomedical research. That is something to be proud of, and something we must harness. I look forward to the Minister setting out today how plans for dementia research will be included in a national dementia strategy.

[Ms Lyn Brown (West Ham) (Lab)]

One of my constituents, in asking me to attend today’s debate and talk about dementia, mentioned that they did not feel that dementia is a sexy enough subject to get the funding for research. It is almost as if it is expected that most of us, at the end of our lives, will not be as sharp tacks in the box as we once were, and may therefore find it hard to attract the funding. Does the hon. Lady agree with my constituent?

[Margaret Ferrier]

I do not agree that people with dementia have nothing else to give to society. As the hon. Member for Bexhill and Battle mentioned, they have some great memory recall, and it can be good to work along with young people from schools. It is essential that we have funding to continue that work and research into dementia because as I said earlier, more and more of us may succumb to that terrible illness. I look forward to the Minister setting out how plans for dementia research will be included in a national dementia strategy, and how the Government are supporting the development of essential new technologies in that space.

Eye Health and Macular Disease

Margaret Ferrier Excerpts

Tuesday 11th January 2022 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

In 2018, the Royal College of Ophthalmologists found that there was a need for an extra 230 consultants and 204 staff and associate specialists over two years. Does the hon. Gentleman agree that recruiting and retaining staff in the ophthalmology workforce needs to be a primary consideration?

[Jim Shannon]

I certainly do, and I thank the hon. Lady for that intervention. That was one of my points; the Minister has heard it said there, and I will not repeat it. The importance of having the staff in place, to which the hon. Lady referred, is one of the asks in this debate. How can we address that? If we have the staff in place, we can address the issue of eyesight loss earlier.

We are all aware of the demand for NHS eye-care services over recent years. Ophthalmology is now the busiest outpatient specialty in the NHS, with some 7.9 million attendances in 2019-20. That gives one an idea of the magnitude of the issue. That is why this debate is important, and why today we need to look to take things forward. Waiting times have been made worse by the covid-19 pandemic—we understand that. The pandemic has meant that some patients faced a waiting time of up to six months to access care. We know that the wait can be a matter of weeks, but if patients have to wait six months for a diagnosis and medical response, their eyesight can deteriorate significantly in that time. Up to 22 people a month may suffer severe or permanent sight loss as a result of delays to follow-up care. Can the Minister tell us what we can do to address those issues, and what has been done to catch up on that in the pandemic?

--- Later in debate ---

[Jim Shannon]

How pertinent that intervention is. I will give a couple of examples now that I was going to give later because they are pertinent to this. The opticians and ophthalmologists in Strangford and Newtownards town have told me of two occasions in 2021 when people who went for their test were sent straight away to the Ulster hospital in Dundonald because they had a tumour. They had no other ailments, but their ophthalmologist or optician spotted something early on. They say the eyes tell the health of the whole body, and I think they do. In that case, two lives were saved, and there are probably many others.

[Margaret Ferrier]

Following that point, it is really important to use the available data effectively in understanding the level of serious eye issues experienced across the UK. Does the hon. Gentleman agree that streamlining data sharing across all health care providers should be mandated?

[Jim Shannon]

It is always important to have the data on health issues. The Minister, the shadow Minister and hon. Members will know that. If you have the data, you can respond to where the problems are. The hon. Lady is right; we need to have that data in place.

In 2018, the APPG on eye health and visual impairment took evidence from the charity SeeAbility. People with learning disabilities, including children in special schools, are much more likely to have a sight problem, but much less likely to access NHS sight tests. Last night, in a different debate on the welfare cap, the right hon. Member for Hayes and Harlington (John McDonnell) referred to those who will feel the pain of the welfare cap, but those with disabilities will feel it more. That is very real when it comes to health issues and it is why this issue is so important.

With that in mind, the APPG and SeeAbility asked for sight testing and glasses dispensing facilities in all special schools, which has now been taken forward by NHS England. That is excellent news and it shows that sometimes—hopefully all the time—APPGs and their partners can bring about changes. This will reach around 130,000 children and help to address and prevent avoidable sight issues and reduce the need to use hospital eye clinics.

The commitment by NHS England to reform must continue as these children have an equal right to sight. We will all follow matters closely, and I would like to see the rest of the UK following Northern Ireland. The excellent work by the Ulster University Centre for Optometry and Vision Science in special schools has also shown the same need. When we see that issue being addressed, it is good news. Let us all look at the opportunity for reform in England and in the devolved nations and seek to improve sight testing for adults with learning disabilities in the community too.

There are targeted schemes with optical practices in every area. Unfortunately, Minister, at the moment we see a patchwork across the UK. In some areas the service is good and in other areas it is not. We need to act across the board in all postcode areas to see the level of care and attention that we seek in today’s debate.

The health inequalities experienced by people with learning difficulties justify more attention. People with learning disabilities are dying of avoidable health issues at least two decades before their peers. We cannot have people living without good sight and even going avoidably blind because national health services overlook their needs. That cannot happen and should not be allowed to happen.

I have outlined the issues, but I want now to look at the good news; the positive, glass-half-full news about how we make the changes to address those issues, including improving the quality of life for people with macular disease and the pressure on family and friends that inevitably comes with that.

With rapid and appropriate treatments, whether those are pharmaceutical treatments, laser treatments or surgery, we can do the job better, working alongside opticians. They are keen to be involved, and to address these issues. As my hon. Friend the Member for East Londonderry (Mr Campbell) said, when a person gets an appointment from their optician, they should go to it: it is so important that they do so, and we want to make sure that people do that. So many cases of sight loss could be either treatable or preventable.

As the UK builds back from the covid-19 pandemic, there is an opportunity to transform eye care services, increasing capacity to deliver rapid and appropriate treatment for macular disease and other causes of sight loss. NHS planning guidance for 2022 focuses on tackling elective care backlogs. Minister, what has been done to address those backlogs? I understand that there are many backlogs—we know them all too well. We need to deliver 110% of pre-pandemic elective activity, but we must also support the NHS to transform services for the long term, to ensure there is enough capacity to treat patients who start to experience sight loss. Improved integration of eye care services must also be a priority for integrated care systems as they move towards implementation. That should include supporting lower-risk patients to be treated in the community, freeing up specialist service capacity for those patients who need it most. At the same time, as the hon. Member for Rutherglen and Hamilton West said, data sharing needs to be improved, for example through the electronic eye care referral system. That is just one example of what could be done to ensure that everyone has the information they need to improve the quality and timeliness of care.

We must also ensure that the NHS is making use of the most innovative treatments—the hon. Member for Sedgefield (Paul Howell) has referred to one of them—especially those treatments that help people living with sight loss to manage their condition as independently as possible, with less frequent need for hospital visits. If we can reduce hospital visits and improve care, we will reduce costs and improve long-term health. We must invest in the workforce we need to deliver current and future eye care. I am very pleased to note that the Government have already confirmed that the process to appoint a new national clinical director for eye care has begun. I hope that this role will provide much-needed leadership and drive forward a transformation of NHS eye care services, including improved integration, better use of data and expansion of the workforce, which I believe is essential to provide the high-quality care that will, in turn, deliver better outcomes for patients. That national clinical director should therefore be appointed as a matter of urgently, and I look to the Minister and to Government to give us a clear timetable for making that appointment.

To ensure accountability and transparency, the national clinical director for eye care should report to a single Minister with responsibility for eye care services across primary, secondary and community care. The role of that individual is critically important for outlining a strategy and moving forward. Sight loss is widespread, and its implications are significant for the NHS. The cost of sight loss to the public purse cannot be ignored, but it is most important for the patients whose lives will be irrevocably altered by a diagnosis such as macular disease. Timely access to appropriate treatment could quite simply be the difference between someone losing and keeping their sight. We want to ensure that people can keep their sight, so it is vital that we do all we can to ensure that every patient can get the treatment they need, when they need it—the earlier the better. When it comes to sight, every day matters. Every appointment is essential, and that principle must underpin our approach to the necessary changes to macular eye health in this post-covid world.

I thank the Minister again for offering her time. People will say, “Well, that’s her job”, but she comes here with a passion and an interest in this issue. It makes it much more pleasurable for me introducing this debate, and for other Members as well, that we have a Minister who can respond positively. I welcome the opportunity to continue these discussions following today’s debate—I know that the Minister is always agreeable to doing so. In anticipation of their speeches, I also thank all of my colleagues, right hon. and hon. Friends and Members, in this Chamber. Working together, we can and will achieve.

Asthma Outcomes

Margaret Ferrier Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered asthma outcomes.

Thank you very much for calling me to speak, Mr McCabe. This is an issue that is close to my heart and close to the hearts of others here. There are few families in the whole of the United Kingdom for whom asthma has not been a key issue; it has been an issue for my own, and I want to speak about that as well. I am grateful to the Backbench Business Committee for agreeing to have the debate. I am chair of the all-party parliamentary group for respiratory health, which recently completed an inquiry into this issue, so I am delighted to be able to raise the issue of improving asthma outcomes in the UK. I very much look forward to the response from the Minister. I am also very pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place, and I wish her well in her new role.

What does asthma mean to me? My second son, Ian, had asthma. He was born with very severe psoriasis, which meant that we had to apply cream to him three times a day when he was a wee boy. The doctor told us that the psoriasis would eventually go away, but that it would be replaced by asthma. I am not sure of the medical connection—I am not medically qualified to understand it—and I know only what the doctor told me and my wife. Ian has had asthma all his life now—he is 30 years old—and has used salbutamol, the wee blue inhaler, which is always there. It is very clear, from our family’s experience, that those salbutamol inhalers are really important. They are important for Ian. Asthma did not stop him participating in sports, but it meant that he always had to have that inhaler close by, should he at any time feel shortness of breath or need a wee helper.

In Ian’s class at school, there were many others who had asthma issues. As an elected representative, whenever I help constituents with benefit forms, whether for attendance allowance, personal independence payments or whatever, I always ask them about their medical circumstances. More often than not, asthma features among the ailments that they confirm they have—even for those of a different generation. They have often had it for many years. Asthma is an incredibly important issue.

I am pleased to see the Minister in his place. I always like dealing with him, because I always find his answers helpful. He has a passion for the health issues that we bring to his attention, and he always tries to give, and indeed succeeds in giving, the answers that one wishes to receive. Today, we are going to ask a number of questions, and we very much look forward to his responses. I am pleased to see hon. Members in their places. I had hoped that more Members would be able to attend, but I understand that last night was a late night for Members and that there are other pressing matters today.

I have always had a particular interest in respiratory health. This debate has arisen as a consequence of the APPG’s report, which we published last year: “Improving asthma outcomes in the UK”. We looked at the UK mainland, but we also had contributions from Scotland, Wales and Northern Ireland. Obviously, I bring the Northern Ireland perspective to any debate, wherever it may be about, and bring in Strangford too. I am my party’s health spokesperson in this place, and I work closely with my colleagues back home in the Northern Ireland Assembly, particularly with Pam Cameron, my party colleague. She and I work on many things together, including this topic.

Last year, the APPG produced a report investigating the reasons behind the UK’s poor asthma outcomes. We were pleased, honoured and humbled that recognised experts in fields relating to asthma responded to our invitation to take part. The experts ranged from clinical experts from primary, secondary and tertiary care to patient advocacy groups, national asthma champions and patients.

The inquiry was incredibly helpful and detailed. I thank Hugh McKinney of the APPG secretariat and his team for bringing together all the people who wanted to contribute. As a result of the inquiry and the report, many countries in the world now look towards us to learn about how we deal with asthma. They want to learn something from us here in the United Kingdom, and perhaps do things that wee bit better.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Member on securing today’s debate. As with most conditions, research and development is key to improving outcomes. Does he agree that funding into asthma research must be provided from a clearly defined central source and that there must be increased capacity for trials in hospitals?

[Jim Shannon]

I absolutely agree with the hon. Lady. No matter what the sphere of health, early diagnosis and attention is key. Indeed, my son is an example of that, as a child born with the ailment. There was early participation in his treatment by the doctors, including our own GP and those in the hospital. It is clear to me that that helped him on the pathway to better health. The hon. Lady is absolutely right and I thank her.

We received a large number of written submissions, including evidence from across the numerous asthma disciplines. We were encouraged that there was such a high level of interest. The APPG tries to do a catch-up once a month with stakeholders and those with medical expertise. Each month, we aim to hear from between 16 and 20 people who have an interest in the subject. They bring all their information to us, which we are pleased to have. We were incredibly encouraged that there was such a high level of interest, and I thank every one of them for their help and expert advice.

Let us consider the impact of asthma on people in the UK. The number of people affected by asthma in the UK is among the highest in the world, with some 5.4 million people sufferers. I had never done an interview with GB News until yesterday morning, but they were interested in this debate and a former colleague in this House was the interviewer. It was nice to catch up with Gloria de Piero again in her new job, and it was a platform and an opportunity to raise awareness and the questions were clear. That figure of 5.4 million people suffering from asthma came up early on in that interview.

[Jim Shannon]

I thank my hon. Friend and colleague for that point. He is right that there many charities and volunteers, as well as many people who have the disease. A great number of people have expertise, interest and keenness to help and assist them. COPD is one of the most debilitating diseases that I have ever seen. I never realised just how many people in my constituency suffer from COPD, but there seem to be a large number, some of whom are in the advanced stages of a deterioration in health. I have a very good friend who is an artist; we have been friends for many years. He is interested in rural and country sports, as I am, which is where our friendship came from. Today, he is completely dependent on oxygen 24/7 and rarely leaves the house. For a man who was active and fit, COPD has changed his life dramatically.

Some 65% of people with asthma do not receive a yearly review—I am keen for the Minister to respond to that—despite recommendations by the National Institute for Health and Care Excellence that they should. I respectfully ask the Minister, if they are not getting a review, why not? Asthma has an impact on every patient’s quality of life. A recent pilot study for Asthma UK showed that the impact can be considerable: 68% said asthma attacks hold them back from work in school; 71% said severe asthma affects their social life; 54% said it holds them back from going on holiday; and 66% said severe asthma has made them or their child anxious. When the child is anxious, the parent is anxious—we all worry about what happens. The study also found 55% said having severe asthma has made them or their child depressed. The issue of depression and mental health has come up during the difficulties we have had with covid over the past year and a half.

Asthma deaths in the UK have increased by one third over the last decade. Three people in the UK die from asthma every day, which is among the highest in Europe, yet studies show that more than two out of three asthma deaths could be prevented. Three people die every day and if we had the right things in place, we could save two of those three lives every day in the UK. I put that challenge to the Minister, who I hope will give us the confident and positive reply that we would like to see.

[Margaret Ferrier]

Air pollution can trigger asthma attacks, and it is believed that it is linked to the rise in childhood asthma. Does the hon. Member agree that tackling air pollution could also bring public health benefits?

[Jim Shannon]

I absolutely agree. The hon. Member is making points that we all agree with. I am glad she has brought that to my attention. I come to London to work and am aware of the air pollution and the steps that the Mayor of London and others that are taking to try to address that, by restricting the number and type of cars coming in. As the hon. Lady rightly said, people have died in London from air pollution and we must address that. In large metropolises and population clusters, where vehicles and the economy are concentrated, air pollution is important.

I am fortunate to have lived in the countryside all my life. It means that when I go out of my back door there are green fields and the neighbours are about half a mile away, so there is a distance between us as well. However, some 14,000 vehicles a day pass by us on the road—the A20 from Ards to Portaferry—which, by its very nature, shows where the problem is.

Asthma exacerbations lead to over 77,000 hospital admissions each year. It is estimated that asthma leads to a direct cost to the NHS of £1 billion and an indirect cost to society of £1.2 billion due to time off work and loss of productivity. This goes back to the intervention by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) when she referred to early diagnosis which can stop people losing work days and reduce the cost to the NHS. These factors cannot ignored be when it comes to addressing the health issues and helping to balance the books.

This year, the APPG’s intention was to produce a one-year-on report to highlight and emphasise the tremendous work that has been carried out by all those working in asthma. We intended to highlight the progress that has taken place in the past year, the actions of the Government, and any further areas that needed to be reconsidered. Our job will be to continue to note the progress—it may not be the progress we would like to see—and speak to the Minister to see how we can change that. However, covid changed everything. It changed our thinking dramatically. It has had a devastating effect on many lives and has impacted on asthma care. It affected the scope of our latest report, as well as concentrating on asthma outcomes one year on. We have also looked carefully at the impact of covid on respiratory health and asthma in particular.

I have the greatest admiration and respect for all those working in the NHS during these difficult times, especially those in respiratory health, which has been the hardest hit. They are all heroes—that word is used often, but it is true here—and a credit to the profession and the NHS. We are grateful and thankful to them all.

In the past year, covid has had an impact on those with asthma, COPD and the complex health needs that can sometimes be exacerbated by covid, leading to further difficulties. The past year has been difficult for every one of us. We have probably all lost loved ones to covid. In October last year, we lost my mother-in-law, who had complex needs. Covid took her, and we still miss her.

Today, I want to concentrate on the three critical issues identified by the clinical advisers who addressed our inquiry and shared their expertise and evidence. The first issue is the overuse of salbutamol reliever inhalers. We are not saying that people should not have them. That is not what the inquiry said or what the APPG is saying. We are looking at the potential overuse of those inhalers. The second issue is the new unified asthma guidelines. Thirdly, we need better use of biologics.

Prior to the covid pandemic, responders to our inquiry last year identified the overuse of salbutamol inhalers—the blue, not brown, inhalers—and oral corticosteroids as the biggest area of concern and the most important cause of exacerbation and unnecessary asthma deaths. In our report, the APPG also cited numerous studies that have shown that over-reliance on salbutamol may lead to the reduced use of preventer inhalers and to a greater risk of preventable attacks. Regular overuse has also been shown to increase the risk of asthma attacks, hospitalisations and deaths. The Department of Health and Social Care needs to look at the overuse of medications and whether that may do more harm. The evidence in this case seems to show that this is one of those situations.

A recent study by the SABA use in asthma global programme—the SABINA programme—found that high use of such inhalers was frequent among UK patients and

“was associated with a significant increase in exacerbations”

and in reliance on asthma-related healthcare. It stated the need to align SABA inhaler prescription practices with current treatment recommendations.

Some 22.5 million of these inhalers are dispensed to asthma patients each year, an average of five per diagnosed patient. Way back in 2019, before covid, and during one of the few times in my life I have had health issues, there was a week when I could not even come to Westminster, because the doctor told me it would not be safe to travel. My chest and breathing were at a level where he advised me not to travel. At that time, I was on the blue inhalers. I think I had three over that 11 or 12-week period. I may have had a wee bit too much, although I did not realise that at the time. That is one of the issues highlighted by the inquiry.

Patients using excessive numbers of inhalers should be flagged, identified and immediately seen by an asthma-trained clinician. I bring it to the Minister’s attention that we think it is time to rethink asthma treatment and get this right for patients and constituents across the United Kingdom of Great Britain and Northern Ireland. There are innovative approaches that demonstrate SABA-reduction.

A 2018 study in The Lancet suggested a maintenance and reliever treatment, with a combination steroid and long-acting beta-agonist, which would allow SABA-free treatment. That could be an effective way to reduce SABA overuse among patients, where clinically appropriate. As ever, it must always be done in consultation with and under the guidance of your doctor and those with health expertise.

The Sentinel project undertaken in Hull and East Yorkshire improved outcomes for adult asthma patients by identifying SABA over-reliance and appropriate implementation of a MART strategy. There is a pilot scheme, which could be the marker, the guide, the standard, the level for the rest of the United Kingdom. Data from that pilot Sentinel study demonstrated that MART can substantially reduce the SABA prescribing.

To ensure that that happens, it is important to restore the asthma reviews, which were hit badly by covid. It is time, ever mindful that covid is our priority, to look at the other issues in the United Kingdom, and asthma is one of them. Asthma UK’s latest annual survey showed that 66% of people with asthma are not receiving basic care for their condition, and that that level has fallen, for the first time in eight years. Minister, what has been done to address that fall? How can we do it better?

An annual asthma review is an important component of addressing that. I should be grateful if the Minister would update us on the progress that has been made on restoring the annual reviews. When we are responding to health issues in the United Kingdom we often need data, so it is important to have that in place.

We also suggested in our APPG report that primary care incentives might be necessary to drive the reduction of SABA use. We stated that the QOF—quality and outcomes framework—or the investment and impact fund have the potential to help with that. The patient pathway is also an important method to reduce SABA use, which brings me to my second point—the new unified guidelines.

Last year, in our inquiry, we analysed the challenges faced by clinicians in treating severe asthma. We found that almost all the experts identified the existence of multiple asthma guidelines as confusing, unnecessary and a cause for concern. If they are confusing to experts, and therefore for our constituents and patients too, we need to have a singular approach. Again, I look to the Minister for a response.

The Royal College of Physicians told us in its submission that

“national audit data collected from England, Scotland and Wales indicates that the standard of care against national guidelines (NICE and BTS) and recommendations from NRAD are variable and on the whole substandard.”

There is a need to get things right and singular. As a consequence, the APPG strongly welcomed the commitment to and the ongoing work to produce unified guidelines as a necessary step forward to improve asthma outcomes. We felt that it was especially important for our time-stretched clinicians that all guidelines on asthma should be in one place.

The unified guidelines were delayed due to covid, but are due in 2023. Our main concern, however, is that we understand that the draft scope for the new unified guidelines does not include severe asthma. I bring that to the Minister’s attention, because we feel it should. Perhaps the Minister will give us some indication of what will be done to address that, because that appears to me to be a serious omission, and others will agree.

It is unclear how any guidelines could be described as “unified” when the most serious type of asthma is not included. I have a concern, a question mark in mind, about that. It is especially puzzling when we consider that the existing NICE, British Thoracic Society/Scottish Intercollegiate Guidelines Network, Global Initiative for Asthma and NRAD—national review of asthma deaths—guidelines all give similar criteria for referring a patient for severe asthma.

If severe asthma is excluded from the scope of the unified guidelines, the concern is that newer treatment options will not be addressed properly, which takes us back to the intervention by the hon. Member for Rutherglen and Hamilton West. This is about early diagnosis and treatment at an early stage. If we do not get that right, we will have complications and problems later.

Those newer treatment options include the use of biologic treatments and the latest best practice in phenotyping, which were strongly recommended by both clinicians and severe asthma patients in our inquiry. The long-term plan states:

“We will do more to support those with respiratory disease to receive and use the right medication”,

but without severe asthma included in the unified guidelines, that is unlikely to happen. How can we make that happen, rather than being unlikely? Will the Minister therefore give me, the House and those in and outside this Chamber the thinking behind that omission? What is the possibility of adding severe asthma back into the discussion? If we can retrieve that and bring it back in, I will be pleased. I also wonder what can be done while we wait for the new guidelines. Four sets of guidelines are confusing for clinicians. Surely it would be preferable not to wait until 2023 for clarity. We need to act today—for the three people who die every day due to asthma. That is the imperative. Is there any way that the Minister can reflect on that and give consideration to updated living guidelines to reflect current best practice and treatment?

Unified or updated guidelines can materially affect my third point on biologic therapies. They are life-saving treatments for people with certain types of severe asthma and asthma that is difficult to control. They can reduce asthma attacks in severe asthma, reduce the need for steroids and improve symptoms. At present, they are only offered to patients through the specialist asthma clinics. There was strong support in our report last year for the appropriate use of biologic treatments and we supported the extension of prescribing to secondary care clinicians for severe asthma patients. Many clinicians viewed the use of biologics as a better alternative to traditional oral corticosteroid treatment for severe asthma and we received evidence that a large majority of patients who are eligible still do not have access to them.

Asthma UK suggests that

“82% of difficult and severe asthma patients are often not being referred at the right time, or sometimes, not at all.”

That is hard to believe. Asthma UK and BLF also told us that the current NHS asthma care pathway does not take full account of the availability of the new treatments. So most people with severe asthma are still reliant on OCS. According to Asthma UK, three in four people eligible for biologic treatment are still not accessing it and thousands of patients are having to endure treatments that are considered inadequate and suffer unnecessary side effects.

That is linked to the Government’s five highest health gains programme, which introduced a commitment by the UK to match or surpass comparative nations in the access to new and innovative medicines in five clinical areas, one of which is severe asthma biologics. The scheme committed to the objective of

“reaching the upper quartile of uptake for 5 highest health gain categories”

during the course of the first half of the scheme, by mid-2021. We applaud the Government’s initiative and action on that to date, but the deadline has clearly been missed. New data commissioned by NHS England has shown that the UK is far from the upper quartile and confirms that we are currently ninth out of 10 with regard to comparator countries. We must improve that. We must get better and do that for our patients. We also recommended extending the Accelerated Access Collaborative’s severe asthma programme, and increasing resources to increase capacity for prescribing biologics will be important for achieving that. Will the Minister give a renewed commitment to achieving upper quartile access and set a new, clearly defined target for when and how that will be achieved?

In October 2021 the Government announced 40 new community diagnostic centres, which are set to open across England in a range of settings, from local shopping centres to football stadiums, to offer new and earlier diagnostic tests closer to patients’ homes. I want to put on record my thanks to the Government and the Minister for that commitment. It is clearly there and we thank him for that. However, we cannot make it a postcode lottery. If it can happen here in London, it should happen in Cardiff, Newcastle, Liverpool and everywhere else. Nowhere should be any different, so I would like to see that happening.

The Government have stated that the new centres will be backed by a substantial amount of money—a £350 million investment—and will provide around 2.8 million scans in the first full year of operation. They are designed to assist with earlier diagnosis through faster and easier access to diagnostic tests for symptoms in areas including breathlessness, cancer and ophthalmology. In the Budget, the Chancellor announced an additional £5.9 billion to tackle the backlog of general diagnostic tests to deliver more checks, more scans and more treatment. The intention is to increase the number of diagnostic centres to at least 100 and I understand that each one will include a multidisciplinary team of staff, including nurses and radiographers, and will be open seven days a week. The Government and the Minister are to be commended for that, and I warmly welcome it and the funding that will be allocated. I hope they can help address the covid-imposed inequalities that we have seen across the country in asthma care and treatment. Will the centres be fully staffed, will they have trained staff and will they be in place?

I also welcome the breathlessness diagnostics, which will be included in the centres. It is essential that they should be equipped to diagnose any cause of breathlessness, whether cardiovascular, lung cancer, asthma or chronic obstructive pulmonary disease, which my hon. Friend the Member for East Londonderry (Mr Campbell) mentioned. It is also important to establish an appropriate referral system from the centres, should further investigation be warranted. Will the Minister confirm that the FeNO and spirometry tests will be included in all centres, to allow for fuller asthma assessments?

I look forward to the contributions from other Members, and I thank those who intervened on my speech. I very much look forward to the Front-Bench contributions, particularly from the Minister.

Access to Salbutamol Inhalers

Margaret Ferrier Excerpts

Monday 29th November 2021 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

It is a pleasure to serve under your chairship, Mr Hosie, and to follow the hon. Member for Don Valley (Nick Fletcher)—we keep meeting each other in Westminster Hall.

Today’s debate is of huge importance, and I am grateful to the almost 2,000 of my constituents who took the time to sign e-petition 578676. My constituency had the second highest number of signatories in the UK, clearly showing how strongly the community in and around Glasgow feel about the petition’s aims.

The events that prompted this petition are devastating. We have heard how Lauren Reid, who was just 19 years old, suffered a severe asthma attack at work. Tragically, she did not have her inhaler with her at the time and she passed away later that week in hospital after becoming starved of oxygen during the attack. Nineteen is no age to pass, and I cannot imagine how difficult it has been for Lauren’s family and friends in the time since. It is horrible to think of this as preventable, but I do hope that today’s debate can serve as a step forward to ensuring that these events are not repeated in the future. The hon. Member for Strangford (Jim Shannon) has a debate next week on asthma outcomes, which I hope will further contribute to recognition of the seriousness of this illness and what can be done to protect sufferers.

Before moving on to more general points, I would like to commend Lauren’s mum, Elaine, who has pursued Lauren’s law tirelessly throughout what will undoubtedly have been an exceptionally painful and difficult year. Her loss is unimaginable and her commitment is admirable. She has my full support in her campaign for salbutamol inhaler provision in commercial kitchens.

Asthma is a common chronic condition. It is more common in Scotland and the UK than in most other places in the world. More than 8 million people, or 12% of the population, have been diagnosed with asthma. According to the National Institute for Health and Care Excellence, it accounts for 2% to 3% of all primary care consultations, 60,000 hospital admissions and 200,000 bed days per year. Interestingly, although it is more common in boys in childhood, it is actually most prevalent in adult women, such as Lauren. As we have heard, one in 14 people in Scotland is currently being treated for asthma. It is also estimated that occupational asthma accounts for 9% to 10% of adult onset asthma.

It is widely accepted that commercial kitchens can both aggravate existing asthma and trigger it in people who have previously never had any symptoms. That is because commercial kitchens have a number of irritants. The use of powder substances such as flour, which is in daily use in most kitchens, is one of the biggest triggers. Current advice for people who develop occupational asthma is to consider a change in role or career. That might seem like reasonable advice: why would someone continue to put themselves at risk once they know the triggers? Realistically, however, it is not—not when there are other options that could help people manage the problem and stay in the job they love. When reading about Lauren, her passion for her work shines through. Nobody should have to choose between their passion and their health; the two do not have to be mutually exclusive.

I said earlier that asthma is a common condition, and kitchens are not the only workplaces where occupational asthma is prevalent. It is also triggered by allergens that affect hairdressers, agricultural workers, mechanics and healthcare workers. If something can be done to mitigate the impact of occupational asthma or to ensure better outcomes when someone suffers an attack, it should be. Making sure that salbutamol inhalers are available in high-risk environments is an easy thing to do. We already know that it can be done, because we allow non-prescription inhalers to be kept in schools.

In conclusion, I am sure the Minister and her Government colleagues support these measures but they have to abide by the human medicines regulations. I urge her to commit to a review and ask the relevant bodies to explore whether inhalers can be provided to commercial kitchens.

Automated External Defibrillators: Public Access

Margaret Ferrier Excerpts

Thursday 18th November 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered public access to Automatic External Defibrillators.

I am pleased to see many hon. Members from all political parties in the Chamber. I will also say, because I mean it, that I am especially pleased to see the Minister in her place and I look forward to her response. She understands the importance of the debate. Each hon. Member who speaks will illustrate the strength of the need for the Government and—dare I say it—civil servants to understand the importance of the debate. If they understand it, and if the Government press the issue, the general public will be glad to see it happening.

It is a pleasure to have this debate before the Second Reading of the Automated External Defibrillators (Public Access) Bill on 10 December. I thank the Backbench Business Committee for granting my application. The intention is to deliver public access to AEDs across the whole United Kingdom. All MPs will have at least one person in their constituency who has been saved by an AED.

I am grateful to the hon. Member for Sedgefield (Paul Howell) who co-sponsored the debate and supported me in making it happen. I appreciate his co-operation, partnership and friendship. He made representations to the Committee alongside me and shared his own experience, which he will tell us about shortly. He has referred to the dedicated work of his constituent Councillor David Sutton-Lloyd, who advocates and lobbies with him about the importance of awareness and public availability of these lifesaving devices.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

In my constituency, Councillor Mo Razzaq has been championing the cause and has fought hard to improve provision, which has led to a community defibrillator installation outside Strachan Craft Butchers in Blantyre. Does the hon. Gentleman agree that locally elected representatives can be instrumental to the cause?

--- Later in debate ---

[Jim Shannon]

I do agree, and I think there would be a positive consensus in the House on that. I will give an example later of how an AED in a school saved a life in my constituency. I have two examples to illustrate the point.

I have seen over the past year how we have begun to address the importance of CPR training, to which the hon. Lady referred, and AED availability. I agree with her. The AED in Newtownards is in the street, but it could have been in the shop, which closes at six o’clock, so from 6 pm to 9 the next morning it would not have been available. The hon. Lady is right about what should be done.

The right hon. Member for South Staffordshire (Gavin Williamson) backed the campaign, in his former role as Secretary of State for Education, to see all schools equipped with defibrillators. I believe that has been accomplished. I was encouraged by that, as we are trying to do it back home as well. However, it is not just about primary schools; it is about having AEDs available in streets, shopping centres, Government and local government buildings, and leisure centres. The Bill says that they should be available, but it does not put a cost factor on it. To make this happen is a win-win for the Minister and the Government.

I will explain where the campaign came from. The Minister will remember that we met with Mark King, of the Oliver King Foundation, whose 12-year-old son Oliver died of cardiac arrest during a school swimming lesson in 2011. I was incredibly moved, as I know the Minister was, by Mark’s experience. I was motivated too by his commitment to installing AEDs as far and wide across the community as possible. I know that he will be watching the debate today, and it will be a poignant one for him. Throughout this journey, I have stayed in touch with the foundation. I want to remind Members that this Bill was inspired by a young fella called Oliver King—a 12-year-old—and that we bring this debate to the Chamber in the hope of ensuring that Oliver’s legacy continues.

I am encouraged that in Northern Ireland, the Education (Curriculum) (CPR and AED) Bill has reached its second stage. This is not about politics; it is about the issue. That is the way I see things. I am a political person, of course, but what drives me is asking what is the right way to do things—that is important. One of my colleagues who is not of my party, Colin McGrath MLA, has brought the Bill to the Northern Ireland Assembly. We have worked together; he was keen to know what I was doing and I was keen to assist him back home in the Assembly. He has expressed his best wishes for the Bill, because it is just as important for children to acquire the CPR and AED skills that the hon. Member for Mid Derbyshire referred to, as it is for adults. It is good to see a devolved Administration talking, taking this on and encouraging others to follow suit.

I believe in acts and not just words. Very shortly, the hon. Member for High Peak (Robert Largan) and I will be doing an AED instruction session in the House, when we are able to. I am not sure when that will be, but we are hoping to do it this side of Christmas—the idea is to have a date that coincides with the Bill’s Second Reading on 10 December. It will be with David Higginbottom of Driver First Assist. My staff and I back home will also be taking part in a CPR and AED training session in the office in Newtownards led by Mrs Pauline Waring, superintendent of the St John Ambulance Dufferin Cadet Unit in Bangor. She, along with many other volunteer leaders, does incredible work with St John cadets by training them in first aid and lifesaving skills. It is always good to remember that the St John Ambulance is voluntarily staffed and funded by its own efforts; I encourage Members to engage with their local St John Ambulance if they can.

The hon. Member for Sedgefield, in his representation to the Committee for this debate, raised the very important point that many people are afraid of AEDs. They should not be, and that is why the training is important. Right away, people ask, “Will I know what to do?”. They will know what to do, because it is quite simple. I am not being smart by saying that; the instructions are really easy—they are easy for children to use as well, if that is necessary. People will learn that AEDs and CPR cannot do any harm; they can only do good. That is the motivation. I refer again to my message of hope for this debate, because anything that equips and inspires our young—anyone, in fact—to do good for the community carries the spirit of hope.

I want to raise some important facts about AEDs and CPR because they are two of the links in the “chain of survival” referred to in the UK Resuscitation Council’s updated guidelines. The third link is targeted temperature management. I want to touch on TTM here because I have been made aware of how this impacts on the recovery process. While the focus of this debate is on promoting the prevalence and availability of AEDs in public spaces and buildings, it remains essential that we consider the whole “chain of survival” once a person has experienced a cardiac arrest and been resuscitated.

In my constituency of Strangford one Saturday afternoon at a football match, one of the supporters collapsed at the side of the pitch. I spoke about this at the debate on the ten-minute rule Bill in February. What saved that man was the fact that the club had a defibrillator at all its matches. That is characteristic of all football matches in my region. People were able to resuscitate that man and he is alive today because the Portavogie football team and one of its staff members were able to get him back. He is alive today and can still attend football matches.

I want to give another example, but I am conscious of the time and other Members want to speak. A father was outside a school after leaving his children there. Unfortunately, he then had a heart attack. The children were inside and did not know what was happening to their daddy. The school had a defibrillator and, again, access to an AED saved that man’s life—he is alive today. Not only is he alive; he is able to continue taking his children to school.

I have given two examples, and I know that other Members will have lots of their own. It is hard not to get enthused about this issue, because of the clear benefits. I have referred to Christian Eriksen who collapsed at the football match. I acknowledge and praise the hard work and unfailing efforts of the Minister, who brought forward legislation in 2016 and 2019. Her support is needed if we are to get this done.

In May 2021, the Italian Government passed legislation requiring all offices open to the public with more than 15 employees, transport hubs, railway stations, airports, sports centres and educational establishments—schools, universities and all those places—to have public access to AEDs. In France, a Bill was passed in 2018 requiring almost all buildings where people gather to have access to an AED, including restaurants and shopping centres. It went a stage further by including holiday centres, places of worship, covered car parks and even mountain refuges. In Singapore, AEDs are carried in taxis.

In this House, we are at an important stage. We have more AEDs per head than across the whole of the country—that is not a criticism, Mr Hollobone. I am not saying we should not have them, but I would like to see that replicated everywhere else.

[Margaret Ferrier]

Following cardiac arrest, for each minute that passes the chances of survival fall by a massive 20%. Outside urban areas, and certainly in very rural locations, ambulance call-out times are often much longer than a matter than minutes. Does the hon. Member agree that provision needs to be prioritised in rural areas?

[Jim Shannon]

I certainly do. Living in a rural area as I do, I know the hon. Lady is absolutely right. I would hope and expect that to be the case. I want to give others the opportunity to speak and will make my closing comments now.

Let us remember why we are here today. We are here because there are currently over 30,000 out-of-hospital cardiac arrests in the United Kingdom each year. Of those people, only one out of 10 will survive. I put it to the Minister, the Government and civil servants that I want—indeed, I think we all want—the other nine to survive as well. How can they survive? They can survive if we have access to AEDs in the places where people are, including in rural places. That is why we must push this forward.

What value do we put on a life? A typical defibrillator for the community can cost £800. The Library notes refer to the cost being between £600 and £2,500. However, across Northern Ireland, with the efforts of all the charities and groups I have mentioned, the defibrillators are already in place. I have also mentioned the efforts of organisations such as the Premier League and the Education Ministers here in Westminster and back home in Northern Ireland, and I suspect the same is true in Scotland and Wales as well. That is why, when the legislation is introduced, it will be to encourage those who have not yet gone to that extra stage to make sure that there are defibrillators. That is why this debate is incredibly important. If the cost is £600 or, as it is in Northern Ireland, £800, that is a small price for the Government and the private sector to pay potentially to save lives.

Is it not right that every leisure centre should have a defibrillator? Is it not right that there should be one in the centre of every town? Is it not right that defibrillators should be available and accessible in restaurants, and outside buildings for times when people are out and about, including to visit pubs and restaurants at night time?

There is a campaign called The Circuit, which registers all community AEDs. The sale of AEDs rose significantly after the Euros incident, and when AEDs are registered on a central database, emergency call handlers can direct callers to the nearest AED. The objective of this Bill is to have an AED within three minutes of everyone. That is what the hon. Member for Rutherglen and Hamilton West wants to have; indeed, I think it is what we all want to have.

The Bill does not cost the Government anything. I have said it three times now; forgive me for saying it three times, but I want to emphasise it and say why it is important. Here is a Bill that delivers across the whole of the United Kingdom of Great Britain and Northern Ireland. This Bill will save lives, which is why it is important.

I say to my hon. Friends—all the Members here are my hon. Friends; to be truthful, on this issue all Members are probably hon. Friends whether they are in the Chamber or outside it—that this proposed legislation is neither to the left nor the right of politics. It is about what is right and what is wrong. It is about our whole society and equipping it with the means to save lives. Can there be a more civilised or caring thing to do? If words could make the difference—I will use a quotation, but before I do so I will say one other thing.

Today, this House can support the campaign to deliver AEDs, at no cost to the Government. AEDs save lives. That is the purpose of the Bill—it is to save lives. It is about those nine out of 10 who die every year because the AEDs were not available. It is as simple as that. It is about saving lives. For me, that is the crux of it.

I say that life and death are in the hands of the Minister and her Government, and they would seem to be in the hands of civil servants too. So what action will those hands—the hands of Ministers, the Government and civil servants—take in the coming days when the Bill comes back to the House on 10 December?

I will close with very poignant words. I know that the Minister knows that they refer to wee Oliver King. His dad said, and I have never forgotten it:

“Had the swimming pool had an AED, my son, Oliver, would still be here today.”

That is what we are here for.

Endometriosis and Polycystic Ovary Syndrome

Margaret Ferrier Excerpts

Monday 1st November 2021 Westminster Hall

[Taiwo Owatemi]

I thank my hon. Friend for making that important point. I agree, and I will come on to that issue in my speech.

To add insult to injury, funding for symptoms such as excess facial hair and chronic acne has decreased over the years. Endometriosis can cause chronic bowel and bladder-related symptoms and depression, yet I have heard from countless women that, after finally being diagnosed with endometriosis or PCOS, they are told by their GP to come back when they want to get pregnant and are then sent on their way, without targeted treatments.

It is extraordinary to think that there are the same number of women in the UK who have endometriosis as there are people diagnosed with type 2 diabetes. Nobody would suggest that a person suffering from diabetes come back when they decide to get married, so that they can manage swelling in their fingers before buying a wedding ring—that would be absurd. One in 10 people in the UK suffers from asthma, yet it would be completely unthinkable to tell someone with asthma to come back when they decide they want to run a marathon. Endometriosis and PCOS are about so much more than having difficulty conceiving.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Both endometriosis and PCOS can have a massive impact on mental health for a variety of reasons, whether related to pain or fertility. Mental health services have been chronically underfunded for years. Does the hon. Lady agree that the psychological symptoms of the conditions should be prioritised as much as the physical ones?

[Taiwo Owatemi]

I thank the hon. Lady for raising an important point. We absolutely need funding for holistic care for both endometriosis and PCOS, especially for mental health support.

Cervical Screening

Margaret Ferrier Excerpts

Monday 19th July 2021 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

It is a pleasure to serve under your chairmanship, Mr Pritchard, and an honour to speak in this important debate. It is an absolute pleasure to follow the hon. Member for Pontypridd (Alex Davies-Jones) and hear her personal story. I am sure we are all glad to see her today.

The petition is a proposal to introduce yearly cervical screenings for all women. As we have heard, the campaign for Fiona’s law was launched after the untimely death of 30-year-old mum Fiona from Kelso in the Scottish borders. Cervical screening is unequivocally the best method of protection against cervical cancer, and I think I speak for us all when I say that I hope to see greater uptake of screening. Unfortunately, prior to the pandemic one in four women across the UK did not accept their invitation for screening. The figure is higher in areas such as London and Glasgow, among women under 30 years of age, and among groups who face additional systemic barriers to their attendance—for example, this issue disproportionately affects LGBTQ people, with 40% of lesbian and bisexual women in the UK having been told that they do not require cervical screening. Experience of trauma or violence can also deter women from attending, with 72% of women who have experienced sexual violence delaying or cancelling their appointments.

Most clinicians would largely disagree with the proposal to make cervical screening annual. The UK National Screening Committee sets the eligibility criteria for screening programmes and makes recommendations about changes in order to maximise the benefits and minimise harm. Cervical screening starts at the age of 25, not 18, as HPV is very rare in younger women, with fewer than four cases per 100,000, due to the high uptake of the HPV vaccine. Around 90% of HPV infections are cleared naturally by the body in two years, and many cell changes return to normal without the need for treatment. Research generally suggests that a lower screening age does not substantially reduce cases and can in fact lead to over-treatment, which can have serious implications on physical and mental health, including on the ability to carry a child to term.

A more viable option for increasing the uptake of cervical screening would be to roll out widespread HPV self-sampling, which would allow women to enjoy the comfort and convenience of performing the test in their own homes. Research by Jo’s Cervical Cancer Trust suggests this would greatly increase uptake, with 47% of women who rarely or never book a test preferring self-sampling to clinician-led screening. Only 9% preferred clinician-led screening, while 50% of women who are overdue for an appointment and 34% of women from black, Asian and minority ethnic backgrounds also preferred self-sampling. Some 63% of those living with a physical disability have noted that their disability made it impossible for them to attend screening. Making self-sampling possible would put the screening process into women’s own hands.

For that to be recommended by the UK National Screening Committee, far more research into this procedure is required. At the moment, only a few pilot schemes are being run: one in Scotland, in Dumfries and Galloway, and another in London. It is essential that progress on these vital studies continues. It would be helpful to know whether the UK Government plan to increase support for such schemes, to accelerate studies into the viability of HPV self-sampling nationwide, and to give an estimate of when the necessary research will be collected by NHS England.

While annual cervical screening may not be realistically viable or desirable, we can take concrete steps to ensure that access is widened, risk is adequately assessed and appointments are not missed. I hope the Department of Health and Social Care will take on some of these considerations, especially with regard to advancing the research into, and roll out of, home HPV self-sampling.

Oral Answers to Questions

Margaret Ferrier Excerpts

Tuesday 13th July 2021 Commons Chamber

[Nadhim Zahawi]

I am very happy for myself and the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), to meet with others about that. Of course, I cannot comment on specific cases, and I would recommend that the services in question take up their concerns with Her Majesty’s Revenue and Customs as well.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

What discussions he has had with his (a) European and (b) US counterparts on progressing (i) mutual quarantine-free travel for people who are fully vaccinated against covid-19 and (ii) international covid-19 vaccine pass recognition.

[The Minister for Covid Vaccine Deployment (Nadhim Zahawi)]

I thank the hon. Lady for her question. We are working with the United States authorities, with the EU and with other international partners to ensure a safe return to international travel while managing public health risks. We support a global consistent minimum technical standard for covid status notification. Of course, the NHS app with the NHS covid pass is now accepted in 33 countries around the world.

[Margaret Ferrier]

The continued lack of recognition of vaccination status between the UK and the EU is putting the UK at a competitive disadvantage, according to the Association of British Travel Agents, especially when compared with the steps taken by the EU and the US. Both the US and the EU now have standardised digital ways to prove vaccination status, so will the Minister clarify why there is an ongoing delay in resolving this matter?

[Nadhim Zahawi]

The European Medicines Agency and our regulator, the Medicines and Healthcare Products Regulatory Agency, work incredibly closely together, and the EMA has authorised the vaccines that are approved by the MHRA. All vaccines that are authorised and deployed in the UK have been subjected to rigorous checks, including individual batch testing and site inspection. Our two regulators work incredibly closely together and I am confident that we will continue to do so and ensure that any issues are resolved as quickly as possible, working with the manufacturers as well.