Thursday 5 September 2019
[Ian Paisley in the Chair]
Artificial Intelligence in Healthcare
I beg to move,
That this House has considered involvement of patients in the use of artificial intelligence in healthcare.
It is a pleasure to serve under your chairmanship once again, Mr Paisley. I am delighted to have been granted this important debate, and I am pleased to see a number—particularly for a Thursday—of Members from all parts of the House present to take part. I declare at the outset that I am the chair of the all-party parliamentary group on heart and circulatory diseases. Earlier this year, the APPG conducted an inquiry, with the support of the British Heart Foundation, to better understand patient perspectives on artificial intelligence. It found huge potential for AI to transform the lives of those living with heart and circulatory diseases and a greater need for those affected to be included in discussions about the development and adoption of new technologies.
Before I go further, I want to speak briefly about what AI is. Put simply, AI is the term given to a set of computer actions that mimic human intelligence. Our report outlines that what separates modern AI, such as machine learning, from other types of computer program is that it can learn and improve at tasks. AI is particularly strong at finding patterns and trends in data that are not obvious through human analysis. I have mentioned machine learning, which is one type of AI. It is where algorithms—a set of rules that a computer uses to make a calculation—are used to look for patterns in data, and the computer then uses those patterns to make decisions. It looks for patterns in many different types of data, from scrutinising images to analysing genomic data.
Every day, we interact with something that uses AI. Whether it is entertainment, online shopping, wearable devices, virtual assistants, chat bots or advertising, the use of AI is ubiquitous. Whether it is through faster or more accurate diagnosis, more personalised treatment, better targeting of demand, improvements in service planning and delivery or better predictions, AI has the potential to touch all aspects of healthcare delivery and management.
Our APPG’s report, “Putting patients at the heart of artificial intelligence”, was launched in May this year. It warns that the spread of misinformation risks undermining public confidence in the use of AI in healthcare. The APPG has therefore recommended that policy makers, parliamentarians, the NHS, charities, healthcare professionals and the health technology industry should seek to engage and involve patients in the design, development and diffusion of AI. If they do not, developments in AI might not reflect the needs of the very people who could benefit from it.
It is important to ensure that fake news and the desire for a quick headline do not undermine the public’s trust and confidence in this important area of research and clinical practice. In a survey conducted for the inquiry, 91% of people with heart and circulatory diseases said that the public should be well-informed about how AI is used in healthcare. Some 90% believe it to be the responsibility of the NHS to inform the public about current and potential uses of AI in healthcare, and 48% of patients surveyed strongly support doctors using artificial intelligence technologies to assist them in diagnosing and treating heart and circulatory diseases.
Heart and circulatory diseases, including coronary heart disease, stroke and vascular dementia, affect millions of families across the UK. The halving of deaths from heart and circulatory diseases since the 1970s has been a major health success for the UK. However, such conditions still cause a quarter of all deaths in the UK and are the largest cause of premature mortality, particularly in deprived areas. Together, they make up the single biggest driver of health inequalities and cost the NHS in England at least £7.4 billion a year. As outlined in the long-term plan, it is the single biggest area where the NHS can save lives over the next 10 years.
In assessing the potential for AI, it is important to note the scale of heart and circulatory diseases in this country. The British Heart Foundation, which provides secretariat support to the APPG, reports that heart and circulatory diseases still cause a quarter of all deaths in the UK, on average killing one person every three minutes. The number of people living with heart and circulatory diseases also remains high, at 5.9 million in England. There are more than 42,000 premature deaths from cardiovascular disease each year in the UK. We must therefore utilise the enormous potential of AI across all areas to transform the way we prevent, diagnose, treat and support those living with or at risk from heart and circulatory diseases.
In my constituency of Crawley, 11,000 people were living with a heart and circulatory condition in 2017-18. Of those, 3,679 had coronary heart disease and 1,865 were living with stroke, 774 were living with heart failure and 1,985 were living with atrial fibrillation. In addition, 16,682 constituents have been diagnosed with high blood pressure, including me, and 7,555 with diabetes. While those numbers may seem high, the British Heart Foundation tells me that according to the quality outcomes framework data, Crawley is ranked 548th out of the 650 UK parliamentary constituencies for the prevalence of cardiovascular disease.
In communities around the country, including Crawley, one of the challenges of introducing AI into everyday practice in healthcare is its potential to exacerbate health inequalities. Age, ethnicity, and socioeconomic demographic factors can influence access to the best technologies. Access to new technologies is relevant because AI is currently being implemented in consumer-facing technologies, such as smartphones, which can help manage adherence to blood pressure medication, smart watches, which can track and analyse heart rates, and voice-activated assistants such as Alexa or Siri, which can act as useful reminders to take medications.
As I mentioned, the APPG on heart and circulatory diseases launched its report on AI earlier this year. Our group was grateful for the involvement and enthusiasm of the Secretary of State for Health and Social Care, who also took the time to speak at the report’s launch. Given the number of people in Crawley who have heart conditions, I wanted to keep local residents updated about my work chairing the group. Shortly after the report’s launch, I wrote in the Crawley & Horley Observer about the importance of tackling such conditions and reiterated the salience of the Department of Health and Social Care ensuring that some of this Government’s increased funding for our NHS is used to address the use of AI and its potential in the health service.
It was very much with that call in mind that, almost a month ago, I welcomed the Secretary of State’s announcement that £250 million is to be spent on the new national artificial intelligence lab to improve the health and lives of patients. The Department of Health and Social Care has said that the AI lab will bring together the industry’s best academics, specialists and technology companies. They will be working on some of the biggest challenges in health and care, identifying the patients most at risk of conditions such as heart disease. That will allow for earlier diagnosis and cheaper, more focused and personalised prevention.
The new national artificial intelligence lab will sit within NHSX, the new organisation that will oversee the digitisation of the health and care system in partnership with the accelerated access collaborative. One of the key recommendations of the APPG report is that NHSX should set up discussions with charities and the public to explore the views and concerns of patients about the use of AI in healthcare, and I would be grateful for the Minister’s assurances that through the development of the new lab, NHSX will be exploring the opinions of patients and thoroughly engaging them throughout that ongoing process.
In the past five years, we have seen AI go from struggling to identify images of cats to being able to identify skin cancer in histological sections of biopsies just as well as a team of specialist doctors with decades of combined experience. In debates on this topic, it is easy to discuss issues in what seem like abstract terms, but when patients go to see their GP, they want to see their GP. In such cases, AI could be used to create automatically the GP’s notes about their patient, reducing the time that the doctor will spend looking at their screen, for example.
There is also the issue of self-management. From dedicated apps that people use while going out for a run to the most basic step counters, more and more people use their own devices, on some level, to keep an eye on their health. AI can be used more and more in this area. Patients could use wearable devices and sensors to manage their condition at home and in the community instead of in hospital. AI systems could then monitor for unusual patient-specific patterns, such as a deterioration in a heart failure patient, and relay that information to a clinical team for further intervention. That also presents an opportunity to put patients in much better control of their care.
Our inquiry heard from experts from the University of Cambridge and the University of Oxford, who told us that NHS health checks could be better at distinguishing the risk of different types of heart condition, to ensure that the most suitable treatment can be received by the patient. On 16 August, the Department of Health and Social Care announced a review of the NHS health check service, which is offered to everyone between the ages of 40 and 74 to spot the early signs of major conditions that cause early death, including stroke, kidney disease, heart disease and type 2 diabetes.
Although the NHS health check programme has identified more than 700,000 people at high risk of cardiovascular disease over the last five years and has saved an estimated 500 lives each year, the Department of Health is right that there is potential for people to benefit even more from an enhanced tailored service. The APPG’s survey of patients with heart and circulatory diseases found that 64% had at least some awareness of the potential future uses of AI to diagnose and treat heart and circulatory diseases. However, only 17% of respondents were aware of any current uses. That represents a huge opportunity to inform patients about the opportunities of AI.
People are becoming more and more wary about the use of their personal data. From cold calls to unsubscribing from mass emails, there is increased caution from people about giving up personal information. When it came to the APPG’s inquiry, however, 86% of respondents were comfortable with their personal health data being used to help better to diagnose medical conditions. Policy makers should feel confident that patients support the use of AI in healthcare if it is done to improve health outcomes.
Trust works both ways of course, and it is important that those implementing policy and programmes are open with the public about how their information will be used. That is why patients, and the wider public, should feel involved with not only the details of what their data will be used for but the wider work of the NHS to use artificial intelligence to improve our health service. In June, when speaking on the use of AI, NHS England chief executive Simon Stevens said that
“from April next year we propose to change the way we fund care so that NHS organisations who invest in this world-leading technology will be properly rewarded for doing so.”
I would be grateful for an update from the Minister on what form that is due to take. I am sure that such an update would be welcome if colleagues are to make representations with their own health authorities and trusts.
Our report raised the issue of what patients need to know. Transparency is welcome, and it is important to specify what type of transparency, as well as its intended outcome, in addition to being clear about for whom the transparency is intended. Transparency can include outlining why an algorithm was developed, what types of data were used, and how the development was funded. Some experts have argued that the black box of AI—the difficulty in understanding how AI models reach their decisions—is not really a problem at all, as humans are equally opaque in how they arrive at decisions.
However, the ability to scrutinise, conduct quality assurance, and undertake due diligence are important parts of regulating the health system and ensuring patient safety. In November 2017, the national data guardian for health and care, Dame Fiona Caldicott, told the House of Lords Artificial Intelligence Committee about the challenges of using patient data in technology, saying:
“What we have not done is take the public with us in these discussions, and we really need their views.”
That needs to be addressed. If patients are to trust the use of AI in healthcare, they need to know they are a vital part of the journey.
Our report also looked at the regulatory framework, and how the development of such technological innovations means that health systems are becoming more complex environments to regulate. At the same time, it is important that the regulatory burden is not added to, so that the spread and adoption of new innovations is not stifled. Our inquiry found that a
“balancing act between managing expectations and encouraging hope and enthusiasm is always challenging but nevertheless important. When we say patients should be informed and clear on what AI can do for the NHS, it is not a tick-box measure. It is to provide the clarity that is needed for better diffusion of AI.”
NHS England and NICE, the National Institute for Health and Care Excellence, should encourage the development and use of reporting standards for AI research, in order to provide best practice for artificial intelligence researchers. That could also lead to greater recognition of quality in AI research, particularly among the media, policy makers, clinicians and the public.
With regard to my constituents, I mentioned the importance of Government, policy makers and NHS staff, all of whom have an important role to play in supporting patients. I am also grateful for the secretariat support provided to the APPG by the British Heart Foundation, and I pay tribute to the charity’s hardworking volunteers, including those whom I have been pleased to meet throughout Crawley, and those at the British Heart Foundation shops located on Queensway and on the Broadway in my constituency.
There is much to welcome in the NHS long-term plan. Indeed, NHS funding will grow on average by 3.4% in real terms each year from 2019-20 to 2023-24, which is of course welcome. The current funding increase will mean that the NHS can lay further foundations for service improvements. Thanks to our NHS staff, millions more people are being treated every year. Although services return to Crawley Hospital—and I continue to call for even greater provision—it remains the case that the worst decision in the history of Crawley as a new town was the removal of A&E in 2005. Our constituents expect to see improved GP provision, reduced waiting times and enhanced frontline services.
The APPG on heart and circulatory diseases welcomes the great strides made in recent years to speed up the development and diffusion of AI in the NHS. The Office for Artificial Intelligence and the AI Council have huge potential to bolster the UK’s position as a world leader in AI as part of the Government’s AI sector deal. The Centre for Data Ethics and Innovation can also cement the UK’s leadership in ethical AI and ensure that society can shape the direction of travel and reap the benefits of AI, and we hope that those initiatives will continue to be taken forward.
The chief executive of NHS England has called for this country to become a world leader in the use of AI and machine learning, stating that exploiting the boom in AI technology can help meet the target in the NHS long-term plan of making up to 30 million outpatient appointments unnecessary, in addition to saving more than £1 billion in what would have been increasing outpatient visits. The money can be reinvested in frontline care and save patients unnecessary journeys to hospitals. That reminds us that patients must be at the heart of today’s debate, and hopefully future debates in Parliament on this issue.
It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Crawley (Henry Smith) not only on securing the debate but on his thoughtful and comprehensive introduction to an extraordinarily complicated subject that I suspect will require much more debate in this place in future. I chair the all-party parliamentary group on data analytics and represent a constituency that is, of course, well known for its health services, innovation and tech cluster, not just in the city but around it.
The issue is therefore close to my heart. When I was elected as the Member of Parliament for Cambridge, I never imagined that I would spend quite so much time on such issues, but there are many jobs involved and huge opportunities available, exactly as the hon. Gentleman said. However, I suspect that I will be slightly less optimistic than him, because as I have begun to look at the issue more closely, it has struck me, as he said, that the only way that we will make it work is by maintaining the trust of patients, which is difficult—particularly given the behaviour of some of the major tech companies. It is not a lost cause, in my view, but we are going to need a qualitative change in regulation and protection if we are to secure some of the benefits that have already been referenced. Every day in Cambridge, I hear about new innovations and developments that convince me and, I think, many others that we really are on the cusp of a technological revolution across a range of sectors. Everywhere one goes in Cambridge, one sees people working on the most extraordinary things, and the gains are potentially huge, not just for our citizens but across the world.
It is hard to explain a lot of this to the public. I feel that I am in a privileged position going around Cambridge; I sometimes feel that I am the only person who is seeing all the various things that are going on, and one of my challenges is to try to spread the word about all the stuff that is happening. My worry is that often it is poorly communicated and poorly understood, and that misunderstanding can easily lead to a public backlash. I read with great interest the report from the all-party parliamentary group on heart and circulatory diseases; a very distinguished panel of people was behind it, and I will highlight some of the crucial points.
Ensuring that artificial intelligence really does enhance patient healthcare—and that it does not, as some of us fear could easily happen, get diverted on to a profit-seeking route—requires the following key elements: stakeholder engagement; an exact explanation of the risks and benefits; keeping researchers and academics involved; digital inclusion in general; proper development of policy, focusing on AI for public values; and the development of standards.
There are others, of course, working in a similar field. I am delighted to see present a fellow member of the APPG on data analytics, the hon. Member for North East Derbyshire (Lee Rowley). A few months ago he and my hon. Friend the Member for Bristol North West (Darren Jones) led a very good inquiry and produced, with a similarly illustrious panel of experts, an excellent report entitled “Trust, Transparency and Technology”. It is amazing how many people are working in this field at the moment. Part of that report—I suspect the hon. Gentleman will refer to it when he speaks—was focused on healthcare. He did the work, so I do not want to steal his thunder, but I will pick out a particular couple of things.
We drew on a 2018 survey by the Open Data Institute, whose statistics reflected those cited by the hon. Member for Crawley. Some 64% of consumers trusted the NHS and healthcare organisations with their personal data, which is more than the 57% who trusted their family and friends. Consumers also trusted the NHS more than they trusted their bank, the figure for which was also 57%; local government, for which it was 41%; and online retailers, for which it was 22%. I do not think they asked about the level of trust in politics; that is probably not recorded. Nearly half of respondents—47% of them—were prepared to share medical data about themselves. I have seen different figures, and I would also reflect on the fact that 53% were not prepared to share data. However, those people were prepared to share their data provided that it helped develop new medicines and treatments. In terms of the trade-offs for data sharing, they were most keen to participate when it was for medical research.
As we know in politics, however, trust is hard won and easily lost, and we have to be careful. A few months ago, I was asked to write a foreword to a report by the think-tank Polygeia, entitled “Technology in Healthcare: Advancing AI in the NHS”. The report is consistent with other work in this field and comes to broadly similar conclusions to those we have already heard. There is also a sense that NHS staff need to be closely involved in these developments, to ensure that they are not just kept informed but given a sense of understanding and confidence about how this can work. The black box algorithm to which the hon. Member for Crawley referred is still a little baffling and scary to a lot of people. If we are going to make this work, it is crucial that we consult, educate and take people with us. We must rely on the advice of medical and healthcare professionals, who are best placed to understand the concerns of both their patients and their colleagues.
We are constantly seeing new developments in the news. One of the joys of modern life is that when we go on holiday, we still watch our iPad. This summer I noticed the debate about DeepMind and its new ability to predict acute kidney failure; it wins an extra 48 hours by looking at huge volumes of data and doing the number crunching. That is bound to be a good thing but, typically, there were people who questioned the methodology and who raised concerns about unforeseen consequences. I also think there are some unforeseen consequences to these kinds of changes, and I will touch on one or two.
So far, I have been profoundly non-partisan and non-political, but I have to say that the new Secretary of State for Health and Social Care did rather wade in early on with his support for Babylon Health and GP at Hand. Those kinds of technologies provide tremendous opportunities but, as the hon. Member for Crawley said, such developments can be disruptive to the organisation of the national health service. There has been disruption to funding flows, particularly across London, and I hope the Minister will be able to reassure us about that. Simon Stevens made a commitment, but these changes are happening quickly and one of the things that we know about the NHS is that it is quite a tanker to turn around. Quick, unintended consequences are not always benign ones for the people on the receiving end.
The wider point, of course, is that some of us are worried that the NHS, which is free at the point of use, is being undermined by the creeping in of a potentially competitive system. That can be resolved in some ways: we can change the administrative structures, for example, and sort out the financial flows. My bigger fear relates to confidentiality and what is happening with patient data. It is frequently argued that the data will be anonymised, and this is where we get into the realm of the techies. Plenty of people have explained to me that it is possible to reverse that anonymisation process, because as clever as these machines are in terms of machine learning, they are also pretty clever at doing the reverse. I am now pretty much persuaded that there is no such thing as anonymity. We must face the fact that there are consequences to these tremendous gains, and think through how we should deal with some of them.
This does not necessarily matter. I remember years ago when, under the previous Labour Government, Alistair Darling unfortunately had to come to Parliament and explain that his Department had lost millions of people’s data. That week, everyone thought the world was going to come to an end, but it did not. An awful lot of data is out there already, which is not great because we do not know who knows what about us. That is not necessarily a disaster, but if data is being used for the wrong purposes, it could be very difficult. This is my key point, I suppose: I am afraid that the evidence from the big tech companies, as we see almost daily, is that they have been doing things with our data that we did not know about. That is a problem that we previously experienced with the Care.data failure in the NHS, which damaged public trust. It is absolutely essential that we do better in future if we are going to keep the public on board.
The report from the APPG on data analytics states:
“Key lessons from this failure are around data security and consent, and reinforce the need for proper public engagement in the development of data collection programmes, and gaining the right level of consent, if such consent is not subsequently to be withdrawn with major clinical and value for money implications. In the case of DeepMind, Dame Fiona Caldicott, the National Data Guardian at the Department of Health, concluded that she ‘did not believe that when the patient data was shared with Google DeepMind, implied consent for direct care was an appropriate legal basis’.”
There is a significant number of concerns and the issues are profound and difficult. We have a whole range of structures in place to try to deal with some of them, and I have huge respect for the Information Commissioner’s Office. The Information Commissioner frequently tells those of us who ask that that office does have the appropriate resources. Given the scale and difficulty of the task, I must say that I find that hard to believe, because it is a very big task indeed. The hon. Member for Crawley mentioned the Centre for Data Ethics and Innovation, which is at an early stage. Frankly, it, too, will struggle to find the resources to meet the scale of the task.
I sat on the Bill Committee for the Data Protection Act 2018, which introduced the general data protection regulations. Some parts could have been strengthened. I tabled amendments that would have tightened up the assurance that research institutions must process healthcare data ethically for patient gain, but sadly, the Government chose not to adopt them. I hope that they might look at the issue again. A feature of the lengthy discussions in Committee, particularly in the Opposition’s observations, was that although the legislation is worthy, it felt like it was for the previous period, rather than the future, given the pace of change that we are likely to encounter. We were not convinced that it would keep up.
We need a much more radical set of safeguards. To stray slightly into the technical areas, when my local paper asked what my summer reading was going to be, it was surprised to hear that it was Shoshana Zuboff’s magnum opus, “The Age of Surveillance Capitalism”. It is a thought-provoking work and astonishing in the way she untangles the range of uses to which our data is being put every time we pick up our smartphone—or, in some cases, when we do not even turn it on. Many people are surprised to find that, far from being a phone, it is a tracking device. As she says, the question is not just who knows about us, but who decides what data is used, and who decides who decides what that data is used for. She talks about a shadow text, effectively; there is the data that we put on there and then there are all the connections that are made.
Staggeringly, huge amounts of information are being held about all of us that we do not have any access to—that we do not know about. At the moment, those companies consider that it belongs to them. We have to change that, because I think if it is about us, it belongs to us. That is a huge challenge, because if it were to happen, it would fundamentally challenge the business model of those hugely fabulously wealthy tech giants, which are hardly likely to give it up easily. The only way to tackle it, however, is through Governments and regulation. I hate to mention the issue of the hour, but that is one reason, of course, why those companies dislike the European Union—because we need large organisations to counter the giant power that we face.
We have a fantastic opportunity, particularly with our national health service, which, as is often observed, has access to huge amounts of data that no other health system in the world has. In this country, we have the fantastic raw material and a fantastic data science industry. We have the expertise and the knowledge. We also, just about, have the good will of our citizens. We have a great opportunity, but we will need much tougher regulatory frameworks to unlock that potential in the right way. I fear that, so far, compared with what we have to do, we have merely been tinkering.
There are huge opportunities. I have raised a range of issues that go beyond the immediate ones. I hope that Parliament will find an opportunity to have those discussions in the period ahead. If I were asked whether we are in a position to meet the challenge, I would say, “Not yet.” I do not think it is impossible, but it will be difficult, so it is vital to start the discussion. I thank the hon. Member for Crawley for giving us the opportunity to do that today.
It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate my hon. Friend the Member for Crawley (Henry Smith) on securing the debate. He is a doughty champion and campaigner for this area of public health policy. It is great to have the opportunity to talk about it and the innovations and where it can go in the long term.
I congratulate the all-party parliamentary group on data analytics for its sterling work on this important report, which brings together a substantial amount of work and demonstrates the possibilities for the country and the sector to make progress in the coming years. I also welcome the Minister to her new role and I look forward to the work that she will be doing in this and many other areas—hopefully for longer than the coming days. I hope to see her in her place for many years to come.
I welcome the debate because it is a massively important subject for our country and the health of our citizens. It is a pleasure to follow the hon. Member for Cambridge (Daniel Zeichner), who highlighted some of the work that I have been involved in, in a tiny way, over the last few months. I thank the APPG for its kindness in allowing me and the hon. Member for Bristol North West (Darren Jones) to do that. The commission that we co-chair, which looked into the importance of ethics in the aggregation of data and the use of technology, brought it home to me that we need to have more discussions such as this and that it is important for public policy to focus on these things.
I also welcome the debate because, for once, we are not talking about Brexit. It is a fantastic opportunity not to do that. I slightly regret bringing it up, but I will do it anyway. For me, this is the kind of debate that will be transformative for the people in our society and communities over the next 30 years. It will transform the royal hospital that serves my constituents in north-east Derbyshire and the hospitals in Sheffield, in the same way that automation, artificial intelligence, big data and machine learning will transform my local economy and the skills we need to teach in my local schools. If there had been more such debates, instead of the ones we have seen in the last few days, Parliament would have been in a healthier place in the last few months.
AI has the potential to be hugely transformative, as I saw as part of the commission. We need to look at it more, not just in healthcare but in education and elsewhere. Again, I congratulate the APPG on the report, which is a great start in the area of healthcare, but that is an area about which we have to be incredibly careful, as the hon. Member for Cambridge has eloquently outlined—much more eloquently that I can. Our population has trust in our healthcare systems and is willing, at the moment, to innovate in those areas, but those things are hard-won, are not particularly guaranteed and will be easily lost if we are not careful. The worst situation that we could end up with is one where there is huge potential in the area but we are unable to do anything because people do not wish it to be utilised or do not have confidence in it being utilised in the way they want.
I am pleased by some of the statistics in the report, particularly the level of confidence that is already there. Some 85% of people support in principle the use of artificial intelligence to move that area forward and 86% of people are willing to have their anonymised data shared. The hon. Member for Cambridge has already outlined, however, the challenge with that, because we may all like the idea of our data being shared as long as it is anonymous, but it is almost impossible to anonymise it. There are numerous reports that say that it takes only a few data attributes in the same area, even with a population dataset that is not particularly large, to retrofit them and work out where the data has come from and, ultimately, who the data points in it are. That is a challenge that we have to get over if we are to innovate, develop and utilise the technology.
Other aspects of AI’s use concern me greatly, such as security. We have to make sure that we consider security, whatever we are using AI technology for, whether in operations or additions to people. There is also a question about the development of the technology. We have a trade-off to make in which, as the hon. Member for Cambridge rightly said, the development will be judged and accelerated or decelerated by our appetite in this country for how we use data, what we do with it, what consent we have behind it and what the population are willing to do.
Countries elsewhere in the world do not have the same structures, rules, morals and ethics that we do in relation to the usage of data. We see that already in other areas. In China in particular the Government use personal data for the control of their citizens and people are incredibly uncomfortable with how that data is used. We have to create a framework around that. I am a small-state Conservative who believes in as little regulation as possible—not no regulation, as I believe in regulation where it is appropriate, but not in significant amounts. This is one area where, while I am not necessarily convinced that we need lots of regulation, we need to talk about what the regulation is and where we ultimately want to get to. The creation of the Centre for Data Ethics and Innovation is positive. I know the Government, the Secretary of State and the Minister are working hard on this subject, but we need to have more conversations about it. This is a great start. I really welcome the debate and the report.
I have a personal interest, too. My father had a double heart bypass a number of years ago, after a heart attack. Luckily, he came through that. He is now busy doing whatever he is doing today—decorating or whatever. He would not be here today without the innovations of the last 40 or 50 years. I want to make sure that other people’s dads and mums are here in the next 50 years, because of this kind of technology, so long as it is used properly. The APPG is doing sterling work in ensuring that that is the case.
Finally—not to go back to Brexit!—my last point is that we need more of this sort of debate, please, and less of what we have had in the last few days in the other Chamber.
I apologise to the Minister and all hon. Members for not being here on time. I was in the main Chamber, as I had a business question that I wanted to ask the Leader of the House. I apologise for my late arrival. I hope that everyone will be happy with me speaking, having arrived more than 10 minutes late.
It is a pleasure to speak on this matter. I thank the hon. Member for Crawley (Henry Smith) for bringing forward an issue on which he and I are much in tandem in thought, deed and speech, as so often; today is another one of those occasions. It is also nice to see the Minister in her place. I promise not to ask any questions that will throw her off guard, as I did yesterday. That was not intentional, by the way; I just wanted to add to the debate. I hope to get a response on that question at some time in the future. No doubt, if we have the opportunity to have debates in Westminster Hall, the Minister will be in a position to answer many of my questions. I also thank the hon. Members for Cambridge (Daniel Zeichner) and for North East Derbyshire (Lee Rowley), as well as those who will follow me, for their contributions.
Mr Paisley, you know that I am not au fait with computer technology. I honestly cannot use a computer. My children can, and my grandchildren can, but this auld boy cannot. It is one of those things. When someone relies on the staff in their office to do all the computer work, perhaps they do not have to. It is only in the last few years that my colleague and hon. Friend the Member for Belfast East (Gavin Robinson), in this very Chamber, taught me how to text; I learned to text just over two years ago. So I have advanced greatly in my aspirations, although I suspect that others will say that if that is all I have done, I have not done very much!
I am not all that au fait with computers, but the presence of modern technology in science and medicine has saved billions of lives and can only be lauded, especially when it is matched with the brilliance of the human mind and human hands—the skill of the surgeon, the knowledge of the doctor and the care of the nurses. All those things coming together are a very important combination. Putting patients at the heart of artificial intelligence is what we are discussing.
The background information on the debate we received pointed out in its news section various articles in the media where the NHS and all those with health problems can see the benefits of artificial intelligence and healthcare. As the hon. Member for Cambridge mentioned, it can be used to tackle staff shortages. We can also use it to address and help those with kidney problems. That is an issue very close to my heart: my nephew had a kidney transplant, so the issue of kidney problems is real for me and my family.
Other articles note that artificial intelligence could “restore the care” in healthcare, that scientists claim to have developed the world’s first AI vaccine, and that smart tech can help people with dementia. How real that issue is in my constituency. Over this last period of time, I have noticed that many more people with issues with dementia and Alzheimer’s are coming forward to make me aware of their problems. It is a terrible disease to watch, as it greatly changes lives.
The role of technology is ongoing and vital to a vibrant NHS, but we can never be in the position whereby it overtakes a doctor who can act on experience hand in hand with their medical knowledge. We need to have both the human element and the artificial intelligence aspect working together as we move forward.
I welcomed the Government’s announcement of 8 August 2019, in which they outlined some £250 million of investment to help establish a national AI laboratory, which would sit within NHSX. That money is incredible. They also purposefully set aside money within that; the Office for Life Sciences has established five centres of excellence in digital pathology and radiology with artificial intelligence, supported by an initial £50 million industrial strategy challenge fund investment and a further £50 million to scale up funding from the Department of Health and Social Care.
The centres are working with NHS and industry partners. We cannot do anything if we do not have partnerships, one of which I will give as an example later on. Those partners include innovative small and medium-sized enterprises, and they are working to develop pioneering artificial intelligence-enabled pathology and radiology tools. We need the NHS and partnerships with universities and business to ensure that we can move forward and that we can all benefit.
I read an interesting article that highlighted the fact that medical imaging—where AI can be trained on thousands of scans—has led the charge. This is marvellous technology; clinical trials have proven that it is as good as leading doctors at spotting lung cancer, skin cancer, and more than 50 eye conditions from scans.
If we can advance medical expertise and knowledge, let us do that and encourage it. It has the potential to allow doctors to focus on the most urgent cases and rule out those who do not need treatment immediately, or identify where a minor treatment would do. Other tools have been developed that can predict ovarian cancer survival rates and help to choose which treatment could and should be given.
Diagnosis is, of course, important. Artificial intelligence has the potential to transform the delivery of healthcare in the NHS, from streamlining workflow processes to improving the accuracy of diagnosis and personalising treatment, as well as helping staff to work more efficiently and effectively. With modern AI, a mix of human and artificial intelligences can be developed across discipline boundaries to generate a greater collective intelligence.
I laid an early-day motion this week—I am not sure whether hon. Members have had a chance to look at it; I would encourage them to sign it. Mr Paisley, hailing from Northern Ireland, as I do, will understand its importance. It is about Queen’s University in Belfast, which is doing some fantastic work addressing cancer issues. The EDM says:
“That this House congratulates all of those involved at Queens University, Belfast for its breakthrough early research findings on discovering a biomarker panel for ovarian cancer that may be able to detect epithelial ovarian cancer two years earlier than existing testing methods; thanks those who work so tirelessly to bring about such a difference to lives of people throughout the globe; and expresses pride in one of the foremost medical research universities in the world.”
Queen’s University is doing tremendous work, as are other universities. A number of my friends over the years have had ovarian cancer—I am sure others here will have also had that experience. Unfortunately, the diagnosis of ovarian cancer is often, “Go home and get your affairs in order.” There is a limited time to live. That work will hopefully predict ovarian cancer two years in advance of what we are able to do now, and is a fantastic, tremendous breakthrough. We welcome it. It shows that partnerships between the health service, universities and big business can make things happen.
As I said, I want to ensure that there is hands-on, human co-operation with AI methods of diagnosis, and another concern I have is safeguarding information. It is important that we protect people in the process. There are people who pride themselves on hacking information from Government services, just for the joy of knowing they have outsmarted them. There are also those who do it to garner information for nefarious use. We had a breach of information in this place that led to my staff’s home details being leaked, which we took very seriously. How much more serious would that be for vulnerable, ill people?
Any investment in AI within the NHS can go hand in hand only with top-level data protection and cyber-security, especially when we bear in mind that in May 2017—it will be real to many of us in the House, and indeed to almost everyone in Westminster Hall—the NHS was hit by a large-scale cyber-attack that disrupted hospital and GP appointments. It was high level, very disruptive and clearly down to someone intentionally disrupting what took place. It is a tight rope that we walk, and I believe that it can be walked. I ask the Minister to assure us that security is a priority in any use and sharing of patient data that is essential to the use of artificial intelligence in the NHS.
I believe we must move with the times and use all tools at our disposal to diagnose early, which allows more effective treatment, and we also need to ensure that our medically trained professionals are on hand and using the tools, and that they are not being replaced by such tools. In some of the futuristic films that we see—I am not sure whether anyone watches them—the robots take over. Everything happens. That is not a society that I particularly want to see. I want to see us working hand in hand with AI, and I want to see the human input into that. Finally, we need to ensure that all information is safely shared.
We recognise the investment by the Government. Let us not be churlish—the Government have made significant progress on this issue, which I welcome, but I also want to ensure that some of the things that hon. Members and I have brought to the Minister’s attention are responded to. I believe the investment by the Government will be money well spent, if we safeguard each aspect of it.
It is an absolute pleasure to serve under your chairmanship, Mr Paisley—I believe it is the first time I have done so in Westminster Hall, which is particularly pleasing to me. I thank everyone who has taken part in this excellent debate, and I particularly thank the hon. Member for Crawley (Henry Smith) for securing it. I think the one thing on which we can have cross-party agreement is that the more debates we have in which Brexit is not the focus, the better. I am sure we could all go through the Lobbies to agree on that.
This is such an important debate, and I think the public and many of ourselves as MPs are just beginning to catch up with how important it is, which is why I am particularly pleased that the hon. Member for Crawley secured it. He linked technology, the NHS and artificial intelligence in such a detailed speech, and he chairs an important all-party parliamentary group. We can see that technological advances are saving lives on the frontline, which is tremendously important to people right across the United Kingdom. That is why we cannot over-focus on this issue. More and more debates will be about it in so many different domains, particularly in health.
The hon. Gentleman brought up an important issue: education of the public, which will be absolutely key going forward. It is such a crucial issue for us all to consider, because it is not just about medical and healthcare professionals becoming educated, and perhaps their training changing over time to incorporate all these new techniques and procedures, and about how the world is becoming much more digitalised, with 5G and so on coming on stream; it is also about public understanding and ensuring that the public are involved in their healthcare going forward, and that they are absolutely able to engage with it.
Like the hon. Member for Strangford (Jim Shannon), I am a real technophobe. It took me over a year to try to pay for things by tapping a debit card on machines in stores. Now, I love it. I probably do not even carry any money now, but at first I was so anxious that I would be walking about and having money removed from my bank account that I avoided using it. That is one of the concerns about the technology. It is about bringing the public and those of us who, unlike my own kids, have not grown up with such technology as the norm.
We have to get people on board and ensure that, across the lifespan, people can really benefit from the digital revolution that is happening, and that people do not become more isolated and left out of society because they are left behind. That is important for their physical health—monitoring prevention and so on—and for their mental health, in terms of feeling really engaged and involved in society. We have to integrate all this with the professionals in our healthcare settings, with the public being a key focus.
As has been said, artificial intelligence will be so crucial at every step of the patient’s journey. It will include prevention—we have already heard about some of the developments. There is some amazing work being done at Queen’s University Belfast on early prevention, detection of ovarian cancer—my goodness, how life-saving will that be?—and early interventions, not just for physical health, but for mental health. I am very keen for us to look at how we can engage more with AI and digital technology, perhaps in relation to depression, anxiety and how patients can monitor their mood, and at how technological advances can promote what we want to do: achieve parity of esteem for mental health services and physical health services. There is also treatment and recovery. It will be about prevention, early intervention, treatment and recovery, and the technology will be crucial at every step of the way.
I was pleased to hear the hon. Member for Cambridge (Daniel Zeichner) talk about developing standards, because everything in healthcare is about developing standards, best practice and guidelines, and that is what fosters the public’s faith in the work that we do. Our NHS is so loved right across the United Kingdom. When private companies bring their expertise in research and technology into such a beloved institution as the NHS, it is extremely important that the public have a sense of those companies’ remit and the sensitive nature of the data, that protection and security issues are addressed, and that standards are of the utmost importance for maintaining that.
The hon. Member for North East Derbyshire (Lee Rowley), too, spoke of the importance of security and international collaboration and research. Again, we have to think about other countries and how they manage data. We take part in lots of clinical trials—I am going to mention the EU, then move on to talk about, more broadly, the situation internationally. We have to look at developing standards commensurate with those of other countries, and we must at least know the limitations of the collaboration that can be undertaken when it involves our NHS and is about our patients’ data. He also mentioned his personal family circumstances and how important the advances have been for his own family and their healthcare. It is always very poignant to have that personal experience to bring to debates, and to speak about the impact that has made.
I looked around a few times just as I sat down, and I thought, “Why is the chair behind me empty, and where is the hon. Member for Strangford?” Then I turned round again a third time, and there he was. He never fails to take part in as many debates as possible in the House of Commons, and to ensure that his constituents are so well supported and their issues addressed at every step of the way. I am pleased that he recently learned to text, because it sounds like he is similar to me in being trepidatious about technology. Both our examples show why we have to educate the public and try to ensure that we all become up to speed with the technology. I mentioned the wonderful facilities at Queen’s University Belfast, where I was going to go and study before deciding to stay at Glasgow University; when I was training as a clinical psychologist, I had also applied to Queen’s. I could have gone to Queen’s if I had not gone to Glasgow, so I have always had a soft spot for it. I am delighted that its research is formative and will make such a difference.
From my experience of working in health, I know that computer programs managing data are very important, but the systems do not link up. For instance, health boards pay millions of pounds for systems that work for child services and for adult services, but the data cannot be transferred between the two. Children become adults, so how do we merge the data across their lifespan? Will the Minister look at that issue? For most people, transferring data seems commonsensical, but it is not happening in practice. Aligning it better would save a lot of money; we should not have to change systems that have already cost the taxpayer millions of pounds.
I was pleased to secure a debate on smart cities just before the recess, in which we talked about 5G. Driverless technology will enable ambulances to get to incidents much quicker when we have 5G technology and the next industrial revolution—this technological revolution—happens. I would be interested to hear from the Minister how 5G fits in with the issues we are debating and the advances that are being made. Where does she see the future lying?
I have spoken about this issue with some international delegations, particularly from Japan and China. We talked about the fact that technology and artificial intelligence have had an impact on social care. Robotics is being used in care homes—for example, robots can remind patients to take their medication. I would be interested to know a bit more about how we are linking to our international partners. We must collaborate safely in a way that enables patients in social care and the NHS to benefit from technological advances.
We have talked about how important this technology will be for surgical procedures. That was described very well. I agree wholeheartedly that there must be a partnership between robotic techniques and skilled clinicians. That is what the public wants, and that will always be the safeguard as we take these issues forward.
On the issue of prevention, smartphones and smart watches, technology has had a massive impact on reducing missed appointments in the NHS. Sending patients a text to remind them to come to appointments saves money and clinicians’ valuable appointment time.
Social media must be responsible when it comes to health. Through its technological advances, it is already playing a huge part, but young people in particular often get inappropriate information from websites that are not properly regulated. The large companies must take much more ownership of those issues. I have discussed these issues with Facebook and Twitter recently. There are sites that tell people how to develop an eating disorder or harm themselves. We must look at regulating them further. Will the Minister address their impact on mental health? Will she think about not just mental health treatments that we can develop through technology, but about how we ensure appropriate regulation is in place for sites that are not managed by our NHS or professionals and are causing harm to the public?
I am pleased to say that Scotland is to have its own £15.8 million AI health research centre based at the University of Glasgow. It will be a genuine collaboration between NHS research and other industries. We are keen to ensure that all partners are involved and that we can generate the very best practice in technology and healthcare.
It is a pleasure to serve under your chairmanship, Mr Paisley. I thank the hon. Member for Crawley (Henry Smith) for securing this debate on a very important subject. I welcome the Minister to her place. I, too, am very pleased to be talking about something other than Brexit. I thank all hon. Members for their informed contributions, and I pay tribute to the hon. Members for North East Derbyshire (Lee Rowley) and for Strangford (Jim Shannon) for sharing their personal family experiences. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) said, that always adds poignancy to debates and keeps us rooted in reality. I thank the APPG on heart and circulatory diseases for its excellent report, “Putting patients at the heart of artificial intelligence”, which I thoroughly enjoyed reading. I learned a great deal from it.
This is a fascinating debate. When Charles Babbage created the difference engine in the 19th century, he could not have envisaged where modern computing would take us. We are living in a brave new world. We are in the midst of a technological revolution that is already massively transforming our lives. Artificial intelligence is already widely used at our airports and in our homes. Virtual care assistants are being trialled, and driverless cars will soon be a common sight on our roads. It would be strange therefore if we did not take full advantage of the contribution that AI can make to healthcare.
There are many different types of AI. I am not a scientist and do not understand all the complexities of AI—although I can text—but I do understand that it involves a computer equipped with a sophisticated algorithm capable of analysing thousands of sets of data. A computer learns patterns from the data and is able to make predictions based on it. The more data the computer has, the smarter it gets. Tasks that require extraordinary attention to detail, such as radiography, diagnosis, robot-assisted surgery, administration and many others, can be transformed using AI. The prospects are exciting. The ability to deliver early and speedy diagnosis and to develop personalised treatment plans is welcome in a health service besieged by unprecedented demand, long waiting lists and staff shortages.
AI is a game changer for the NHS and healthcare in general. The UK has the potential to be the world leader in digital-assisted healthcare. In our lifetimes, there will come a point when conditions like cancers and strokes can be pre-detected instantly from simple scans, enabling the patient to get the very best early intervention treatment. Only this week, researchers at Oxford University reported that they have developed artificial intelligence that will be able to detect, from a scan of an apparently healthy individual, heart attacks that are 10 years away.
We must be careful, however, in enabling this revolution. Technology is a double-edged sword, and for every monster it destroys, it has the potential to create one in its place, as my hon. Friend the Member for Cambridge (Daniel Zeichner) reminded us. We must be grounded in reality. It is easy to get excited about a vision, but we must keep bringing ourselves back to what it means to real people, and what the potential dangers are. We must proceed with caution. Above all, we must ensure that AI is not something that is done to patients. We must proceed with an engaged and well-informed population. Legislation and regulation must keep pace with scientific innovation. No one wants to see unnecessary regulation. I note the points made by the hon. Member for North East Derbyshire.
It is absolutely vital, however, that the regulation is adequate and keeps pace. Above all, we must protect patient safety. We must act sensibly and legislate robustly, with proper scientific input to ensure that changes are to the benefit and not the detriment of patients. Patients must be kept at the heart of the changes and we must retain their trust, which, as other hon. Members have said, is hard to gain but easily lost.
If patients are to trust and fully embrace this revolutionary transformation of care, they need full explanations and to understand what is involved. People need to understand, for example, that artificial intelligence will not replace their GP with a robot, but will mean that a GP session may be recorded and transcribed by computer, which then produces a diagnosis. We need to pay special attention to the needs of the vulnerable, elderly and, in particular, the mentally ill. We must make it plain to patients that AI is not and never will be a replacement for human health professionals. It should always be clear that AI is not a means of providing health services on the cheap, but a way of enhancing diagnosis and treatments to assist, not replace, well-qualified health professionals.
There are obvious implications for data protection and the misuse of data. Although ideas such as allowing Amazon’s Alexa to use NHS 111 information to guide patients to the most effective non-emergency treatment are beneficial, the idea of inadvertently letting such companies have unfettered access to patient records, which they could use for other unconnected purposes, is clearly unacceptable.
We must ensure that patients know that our laws protect them from predatory companies. All data used in the NHS—even if through third-party contractors—must stay within the NHS. If we are to embrace this revolution, it must be patient-focused and not a market-centred approach. AI must improve life outcomes and not be used to sell diet pills in the name of healthcare. Patients and medical professionals must be properly educated in what AI will mean for them, and both should be involved as much as possible in the design process.
Artificial intelligence can bring many benefits, but its use in healthcare brings significant challenges. We have nothing to fear from embracing it, as long as all provision is properly regulated in a way that protects patients without stifling continued innovation—there is a fine balance. The key is to ensure that health professionals are involved in every stage of development and, most importantly of all, that the NHS ensures that patients are fully informed and engaged.
The APPG concluded:
“Meaningful, early and proactive engagement on how AI is used in healthcare is essential for effective implementation and sustainability.”
That is well put and I agree. Unless patients are fully engaged, AI will just not progress in the way that it could and opportunities will be lost. I hope that the Minister will outline the Government’s plans for implementing the report’s recommendations. Will she reassure us that the NHS will lead on this with all its resources, ensuring that patients are at the heart of this exciting new technology, and that all patients, irrespective of their socioeconomic background or personal ability to access technology, will be able to benefit?
It is a great pleasure to serve under your chairmanship, Mr Paisley. The debate has been really interesting, particularly in the light of the number of Members who stood up and admitted that, although they could not send emails, only recently learned how to text and do not use contactless payment cards, they were very much in support of the potential of AI technology and what it can offer patients, healthcare settings and the public at large.
AI is exciting and innovative. I have been in my Department only a few days and I have learned some more from this debate. I hope to have some answers for hon. Members, every one of whom gave an example of the exciting breakthroughs and areas of application of AI, as well as of what it can deliver for patients. That is incredibly exciting.
I thank my hon. Friend the Member for Crawley (Henry Smith) for securing this debate. He made the point about misinformation and fake news. We need more of these debates because Westminster Hall, and this place as a whole, is a good forum to knock down those myths, get rid of fake news and stop fearmongering about the use of AI, because journalists who are interested in AI will follow these debates and quote what hon. Members say. We should have more debates on this subject in future.
Artificial intelligence has the potential to make a massive difference to health and care. There are significant opportunities to save money, improve care and save lives. AI technology could help personalise NHS screening and treatments for cancer, eye diseases and a range of other conditions, as well as free up staff time.
Almost all health and care services can benefit from AI in some way, but realising its potential for our health and care system depends on the involvement of patients. We are committed to working with patients to ensure that they understand and are involved in the decision making about how we use AI to deliver the impact that we both want and need.
I will give a few examples of how AI is working. Some patients have already benefited from it, as hon. Members have highlighted. John Radcliffe Hospital in Oxford has developed a system that uses AI to improve detection of heart disease and lung cancer, as the shadow Minister mentioned. Currently, 20% of heart scans result in a false positive diagnosis, and the subsequent 12,000 unnecessary operations cost the NHS about £600 million a year. The potential financial savings are huge.
Another fantastic example of the use of AI is that of Moorfields Eye Hospital’s implementation of the DeepMind AI algorithm for retina scans. The AI can correctly recommend patient treatment referrals, to the same or better standard as world-leading doctors, for more than 50 sight-threatening eye diseases. Tens of thousands of scans were taken of people with both healthy and diseased retinas, and DeepMind developed software that could detect—long before a doctor could—sight-threatening diseases and the patterns that lead to them. That is just one example.
The use of AI goes further than just diagnostics. NHS 111 online, once fully implemented, will automatically triage patients by using AI technology. The system sends patients to the most appropriate care setting and reduces unnecessary A&E visits, meaning that patients can access the care that they need faster.
We must make best use of the available resources within the NHS to harness the full potential of AI, which relies heavily on enormous amounts of data to learn and become effective at its task. That data must be shared safely, however. Health data that is shared fairly, ethically and transparently has the potential to improve outcomes for patients, improve the efficiency and efficacy of the NHS, and underpin the next wave of innovative research taking place in the UK.
To help the NHS and researchers share health data in a safe, secure and lawful way, the Government have committed to developing a policy framework that sets out our expectations for how the NHS should engage with researchers and innovators when entering data-sharing partnerships. That builds on the work of the code of conduct for data-driven health and care technology. We are committed to involving patients and the public in the development of that policy. That is key and comes back to the point made by the hon. Member for Cambridge (Daniel Zeichner). Patients must be at the heart of and engaged in projects, understanding how their data will be used in future and reassured of its safety.
To support the NHS in embedding the framework in practice, we will also set up a national centre of expertise. The centre will sit in NHSX and provide hands-on commercial and legal expertise to NHS organisations to support them in reaching fair, ethical and transparent agreements for data. Although AI has been the subject of much speculative reporting, on both benefits and risks, we know that it will bring big changes to the way in which care is developed and experienced.
While we promote the latest data-driven scientific advances in healthcare, we must always ensure that patient data is respected and properly protected. Data is vital to the delivery of safe and high-quality care, but we need to ensure that an understandable and trusted system is in place, which patients can be confident will protect their data. The Government are clear that patient data will only ever be used and/or shared when anonymised, or with the consent of the individual, unless for direct patient care. That is an important point and one that almost everyone made.
We have therefore put in place several safeguards, including legislation such as the Data Protection Act 2018, enacting GDPR; data and cyber-security standards applicable across the health and care system; and legislation that is under way to put the National Data Guardian on a statutory footing to provide an independent and authoritative voice on how data is used across the health and care system. We have also launched the national data opt-out, which gives individuals choice of how their data is used beyond their individual care. That gives patients choice, which is important.
In some instances, it will be appropriate for patient data to be shared for secondary purposes, such as when consent has been given on behalf of the patient, or there is an overwhelming public interest in sharing. The National Data Guardian is supporting work with NHSX to clarify and update guidance on the lawful use of patient data to support the understanding of the public, clinicians and industry. We do not want to hinder the progression of innovations, but all patient data should be handled with the respect and care that the public rightly expect.
We are also very aware of the ethical issues that can be raised by artificial intelligence at a personal, group and system level. Bias is a current common issue with the use of AI, and we must curtail any bias within algorithms by ensuring that the data feeding them reflects our diverse population and range of health economies. Initiatives such as DeepMind’s ethics and society research group and the Partnership on AI, which counts IBM, Microsoft, Facebook and Amazon among its members, show that industry is alive to the issues. We are already taking steps to ensure the safe development, deployment and use of AI, and the published code of conduct for data-driven health and care technology that I mentioned earlier encourages technology companies to meet a gold-standard set of principles to protect patient data to the highest standards.
NHSX announced that it would set up an “AI lab” to bring together the industry’s best academics, specialists and technology companies to build groundbreaking diagnostic tools and treatments in line with the NHS’s priorities. NHSX is delivering the Prime Minister’s grand challenge mission to use data, artificial intelligence and innovation to transform the prevention, early diagnosis and treatment of chronic diseases by 2030.
The NHS AI lab will harness the power of data science and AI to continue the UK’s great tradition of using evidence-based decisions in health, public health and social care, and to position the NHS as a world leader in artificial intelligence and machine learning. It will collaborate widely to identify impactful ways to improve the NHS through more sophisticated use of its data. Once identified, the lab will develop, test and deploy early-stage software solutions to be handed over to the NHS to implement at scale.
The operations of the AI lab will align to the core values of the NHS. Most relevant to this debate, the AI lab will protect patient privacy—to go back to the substantive concern expressed by the hon. Member for Cambridge in his speech. The AI lab will sit within the NHS and will protect patient data. It will also guarantee that the value of the healthcare data is retained by the UK public.
As well as ensuring that the technology meets the highest standards and sufficiently stringent regulation, we must ensure that the public are aware of that technology. The public must understand the principles well enough to be confident in a particular technology’s capabilities, irrespective of the statistical evidence supporting it. For the NHS to maintain the confidence that the UK public place in its brand, it must ensure that the apps and data-driven technologies that it recommends are examples of the best practice, not simply in transparency but in what they do and where the personal data goes.
There is now an opportunity for the UK to do that well, making the UK’s standards for MedTech an international benchmark, strengthening the position of digital health in the UK and enabling it to make great leaps forward. As I mentioned, the National Data Guardian and NHSX will work together to produce clarifications on the circumstances in which it is appropriate to share data. We recognise the findings of the “Putting patients at the heart of Artificial Intelligence” report produced by the all-party parliamentary group on heart and circulatory diseases and its calls for greater public engagement to avoid a souring of opinion on AI. We will continue to engage patients in the design and development of AI, where appropriate, and to raise the profile of the effectiveness and efficacy of using AI to provide health and care.
I will now go on to the points made by Members and their requests for reassurance. My hon. Friend the Member for Crawley asked how an NHS organisation investing in the new technologies would be rewarded. We are investigating how best to do that by engaging with commissioners, clinicians, business and academics. We will announce more detail in due course.
The hon. Member for Cambridge asked for an assurance that the additional NHS funding that has been announced will go ahead. Yes, the additional funding will go ahead, but we are still investigating how best to distribute it. My assurance to him is that, yes, the funding will be distributed. He himself highlighted the complexity of ensuring the fair distribution of such funding.
My hon. Friend the Member for North East Derbyshire (Lee Rowley) mentioned mitigating the risks. I hope that I covered that in my speech. A huge amount is going into mitigating such risks. For example, the Information Commissioner provides anonymisation guidance. I also refer to the points I have already made about NHSX.
The Scottish National party spokesman, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about mental health and patients. This morning, I heard about a great example of AI helping a patient suffering with dementia. It is being used to track normal movement and behaviours. When something different or unusual happens in the home to cause concern, an alert is sent out to a first carer who can be on the scene immediately. That is another great use.
The hon. Lady also asked what we were doing about 5G. I will not try to wing this one, but will simply repeat the answer that my officials gave me word for word: we are working closely with the Department for Digital, Culture, Media and Sport, which is leading test beds—is that right?—for 5G in Liverpool and Birmingham, showing how it can improve access to services and exchange of information between patients and clinicians.
The hon. Lady also asked about international collaboration. NHSX will engage with the World Health Organisation through the Global Digital Health Partnership, and the Medicines and Healthcare Products Regulatory Agency has a strong tradition of international engagement with both the US’s Food and Drug Administration and the European Union, which is key to solving difficult regulatory questions.
In conclusion, I reiterate that AI’s potential to transform the way in which we deliver health and care in the UK is huge. Advancements in diagnosis, treatments and prevention facilitated by AI will provide frontline NHS staff with more time to spend providing care to those who need it most. Through our involvement in the Prime Minister’s grand challenge, the AI lab and our work with the National Data Guardian, we will raise the profile of AI as a health and care project, and ensure that the public are fully aware of both its benefits and the expectations they should place on the NHS.
In the last few seconds, would my hon. Friend the Member for Crawley like to wind up?
Thank you very much again for your chairmanship, Mr Paisley.
I sincerely thank the hon. Members for Cambridge (Daniel Zeichner), for Strangford (Jim Shannon), and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), my hon. Friend the Member for North East Derbyshire (Lee Rowley), and the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), for their contributions to this important debate. I congratulate the Minister, and I welcome her to her well-deserved position.
The key word I heard was “trust”, and as we go forward with AI, we need to instil that for patients.
Motion lapsed (Standing Order No. 10(6)).
Hernia Mesh in Men
[David Hanson in the Chair]
I beg to move,
That this House has considered hernia mesh in men.
I have brought this issue to the House because, to be truthful, I was not aware of this problem among men. I am well aware of the hernia mesh issue for women, and have represented their viewpoint for a number of years in this House and back home, where the Northern Ireland health service has responsibility. I asked for this debate after a number of gentlemen came to see me some months ago—I will give a little background on that in a few minutes.
I thank the Backbench Business Committee for selecting this topic for debate. Back in July I accepted its offer of this first Thursday back, even though I know it is the graveyard shift, unless there is a three-line Whip in the main Chamber. Given today’s one-line Whip, many Members have returned home after everything that has happened in the last two days. None the less, I am very pleased to bring this matter to Westminster Hall. I am also pleased to see the Minister in her place. This will be a hat-trick of debates for her—one yesterday and two today. I look forward to her response.
I raised this issue after a meeting I had with some men in Northern Ireland. My party colleague and health spokesperson in the Northern Ireland Assembly, Paula Bradley, who represents North Belfast, initially made me aware of the issue. My hon. Friend the Member for Upper Bann (David Simpson) also brought it to my attention, as he had met constituents to discuss the matter. It is only over the past nine months that I have been aware of it. The men I met that day were aged between 30 and about 55. I understand that in Northern Ireland some 400 men have had problems, and the number across Great Britain will be even higher. They outlined their experiences and the difficulties that they attributed to hernia mesh. I thought that their problems should be considered in this place, as those problems have been replicated throughout the United Kingdom.
The matter has been brought to the attention of the Department of Health and Social Care. The hon. Member for Linlithgow and East Falkirk (Martyn Day), the Scots nats spokesperson, is aware of the issue and will offer his experience. I will not steal his speech, but I understand he will tell us a wee bit about what he has experienced personally and about the health service in Scotland. I am also pleased to see the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), in her place.
I urge that serious consideration be given to an investigation, on the same scale as the Australian investigation, and that action be taken after the findings are collated. Australia took action, and I hope the Minister will assure me that the Government will do the same. I promised my constituents and those 400 men across Northern Ireland who have had problems with hernia mesh that I would raise awareness in this House because, unfortunately, we do not have a functioning Northern Ireland Assembly so cannot raise the issue there.
In November 2018, the Health Issues Centre undertook social research to investigate adverse health experiences among Australian men and women who had undergone a medical device implant. The research was product non-specific, to identify any devices that demonstrated a pattern of failure. Many hernia operations are successful. In our job as elective representatives, people do not tell us how good things are; they tell us their complaints. Therefore, we do not always hear about the successful hernia mesh implants, but we certainly hear about the problems.
The issue was highlighted on the “Victoria Derbyshire” programme on 26 December 2018. A spokesperson from the Royal College of Surgeons said that hernia mesh complications “affect more than 100,000” people. They went on to say:
“It is clearly tragic if even a single patient suffers horrible complications from any type of surgery, not just hernia operations. Unfortunately the nature of surgery in general, not just mesh surgery, carries with it an inherent risk of complications which surgeons will always seek to assess, and will discuss with patients according to their individual clinical circumstances before surgery takes place.
It is important to make a distinction between groin hernia, the most commonly carried out repair and other forms of abdominal wall repair where a hernia has arisen, for example, in an incision or scar after a previous operation. These are more difficult and the complications rates are much higher.
A recent 2018 study found that both mesh and non-mesh hernia repairs were effective for patients and are not associated with different rates of chronic pain. The Victoria Derbyshire programme is right to point out how a minority of hernia mesh operations are associated with complications. However, it is also important to stress that such complications range dramatically from minor and correctable irritations to the more serious complications highlighted in its programme. Complications can also occur with non-mesh hernia repairs, and by not operating on a hernia at all. It is extremely important that patients are given the full picture by surgeons, regulators, and the media.”
A large number of studies have looked at the available treatments, but unfortunately we do not have all the appropriate information. The spokesperson continued:
“There have already been a number of scientific studies looking at the use of different types of mesh in hernia and we should continue to review the evidence and patients’ experiences to make sure the right advice is given and the right action is taken. Along with the regulatory authorities, we will continue to listen to patients’ experiences. Patients suffering complications or pain need help, not silence.”
That is very important and we must underline that point. They continued:
“There must also be an ongoing review of the data to make sure that previous studies have not missed any serious, widespread issue. It remains vital that surgeons continue to make patients aware of all the possible side effects associated with performing a hernia repair.”
Those gentlemen who came to see me earlier this year to ld me that they were not aware of the complications. I will give an example a little later. I do not want to criticise surgeons because they are under incredible pressure, but people have told me that they were not aware of the ins and outs and relevant information, so I believe there is a case to answer.
The Health Issues Centre inquiry specifically focused on people who had suffered a hernia, to better understand the nature and the impact of adverse outcomes. Over a period of four weeks, 183 respondents reported hernia mesh-related injury across a range of brands and of categories of hernia. Several serious problems with hernia mesh implants arose, too. It is hard sometimes to explain the physical, emotional and mental effect. The people I met were very clear that in the vast numbers of cases that they knew of, there were several serious problems. The vast majority of respondents—87% of them—did not feel that they were given enough information before their treatment to give informed consent. Indeed, they were never told about the risks and the impacts. They were not aware of any problems.
A senior member of the Conservative party—I will not mention his name—told me yesterday, “I have had a hernia mesh implant, but mine was successful.” Many are successful, but we should highlight those that are not. Some 91% of respondents suffer ongoing post-operative chronic pain as well as other health impacts. For example, some of the men who spoke to me have had serious bouts of depression and allergic reactions. Only 8.7% of respondents said that they had had successful treatment to address the problematic outcome of the operation.
Past cases of mine have involved women who have had mesh operations, which are intimate operations. I have had cases of ladies who have been unable to work or keep relationships going. They have been unable to cope with life, so the impacts of hernia mesh when it goes wrong are very real.
Men represented some 70% of the respondents to the survey. Those figures are from Australia, of course, but I just want to illustrate the matter. I will move on to the United Kingdom, but those figures are relevant.
Years ago in Northern Ireland a man developed a limp four years after surgery. People told him, “We have experienced pain as a result of similar surgery.” Damien Murtagh, who lives in Banbridge and has given me permission to tell his story, has been left with a limp as a result of his operation six years ago. He said:
“For years no one could tell me what is causing this pain. I can no longer ride my bike, go fishing, I work part-time”,
because of the chronic pain and the effect it has had on his lifestyle. He continued:
“The pain in the lower stomach and groin area makes me feel physically sick. I have no private life.”
It has been difficult for him to maintain relationships with other people. The issues caused off the back of the surgery are genuine and life changing.
I find it odd that this surgery can create such problems. I am not a medical professional. I can make no judgment about the operations, but I can ask whether they should continue without the assurance that every possible investigation has been carried out into the prolonged side effects. The patients should know, at every stage, the potential implications if the operation does not go as planned.
Figures specific to the United Kingdom also outline the problem. In a survey of 653 people, 18.8% said that they had developed antibiotic-resistant infections as a result of mesh complications. A person’s general health can go down dramatically. Some 40% of respondents described their pain levels at worst to be 10 out of 10. Usually, 10 out of 10 means someone is doing well, but in this case it means they are not and that they are in severe pain. In addition, 85.6% of respondents said that they could not sleep because of the pain. The men told me that their sleep patterns had been destroyed. They are in constant, nagging pain that never leaves them. When it gets to that stage and someone’s personal life is so affected, we have to look very seriously at the issue.
The problems of lack of information are not specific to Australia. Some 91.7% of respondents were not even told that they would be getting a mesh implant. Some did not even know what was happening. They went for the operation and knew there would be a repair job; they accepted that, but they were not aware of the implications. Some 96.2% said they were not shown the mesh implant that they were about to be given, while 91.7% were not told that the mesh implant was made of plastic, and 98% said they were not told the size of the mesh implant. When it comes to serious operations—in most cases it is probably a minor operation, but it has the potential to change lives—we need to make sure that patients are aware of such things.
Patients feel that they are not being told the risks of the surgery and the potential issues. We understand that that is partly because a decision is made when the patient is open and the need dictates the method; sometimes a decision has to be taken when the operation is at an advanced stage and it might not be possible to let the person know. I understand the pressures that surgeons and their staff are under, but I feel that an essential part of the care is an understanding of what to expect, and that can make a difference to the outcome. It would certainly have made a difference to the 400 men in Northern Ireland who have experienced problems. It would certainly have changed their lives if they had known about the implications for them. None the less, we find ourselves in a very difficult position, and they find themselves physically, mentally and emotionally changed. For some of them, their relationships have broken down as well.
Informed consent is fundamental to any surgery. I had three minor operations in 2017 and, to be honest, I would have signed any paper just to get the operations over because the pain was so extreme. At the end of the day, you sign the paper and you understand. In my case, it was a straightforward operation on the three occasions.
I mentioned Damien from Banbridge earlier. Outlining his case could help people make the all-important decision to go ahead with surgery, knowing that there could possibly be some serious downsides, although not in every case. That would be a more ideal situation for the patients, rather than being struck with post-operation issues without having been aware of the risks. At least they would know that they had taken the risk, not the surgeon, who they might feel had hidden the risk from them. It is a natural reaction. It is not pointing the finger or judgmental. I stress again that in no way can I ever accuse surgical teams of deliberately withholding information from their patients.
In an ideal world, post-operative problems would not exist and the NHS and private hospitals, which some patients are transferred to, would be able to shape the surgery in such a way that the pain that many patients cite would not occur. Problems created by surgery have knock-on effects. Physical problems quickly become mental problems. If Members had heard the stories of the gentlemen I met, they would understand where the mental problems come from. The pain is absolutely unbearable. Many experience depression as a result of surgery. They all cite anxiety, panic attacks and nightmares, and—this is serious—some people hear things that are not there. It clearly affects them mentally.
I congratulate and thank the men for making their information and backgrounds known. I also thank my colleagues from my own party who took the time to let me know about their individual cases. When we hear their stories, we clearly see how their lives have been changed.
In the United Kingdom study, 27.6% of respondents had been formally diagnosed with a mental health condition such as PTSD, which can affect people in many different ways, and 4.7% said that they had self-harmed because of mesh complications. That is probably off the back of the depression and the pain that becomes almost unbearable. I never realised just how much pain can affect people. I met a lady who had a problem following an operation—it was nothing to do with hernia mesh. The pain was so bad that she asked for her right knee to be taken off to remove the pain. Doing that removed the pain, because that is where the pain was, but it was a dramatic step to take, so when people start to self-harm, as some have said they have, because of the mesh complications, we must take serious cognizance of what has happened.
Some 24.3% of respondents had psychotherapy or counselling as a result of mesh complications. Again, the counselling was to try to stop them self-harming, and to help them to deal with a physical, surgical problem that would be long-term. Almost half of respondents—43.6%—revealed that they had suicidal thoughts, which underlines their clear anxiety and the importance of doing something; and 4.7% had tried to take their own lives. Unfortunately, nearly every day of the week we elected representatives deal, in our offices, with people suffering depression and anxiety, whatever the reasons may be. We understand what drives people to the brink of despair. It can be money issues, marital problems, family issues or a physical problem, as in the case we are considering. The figures reveal the dark reality of post-operation life for many of the respondents, and reinforce the urgency of the issue, which needs to be addressed as soon as possible. That is why I have brought the matter to the House for consideration, and it is why the Backbench Business Committee was pleased to provide an opportunity to highlight it. Many complications surround the issue of hernia mesh surgery, and there is a need to give urgent attention to solving them. The figures more than reinforce that point.
I mentioned the effect on families. The gentlemen who came to see me and my colleague, Paula Bradley MLA, on the occasion I spoke of, were able to tell me something about that. More often than not, when someone is sick or ill or having problems they are not the only one travelling that road; their wife or partner and family travel it with them, so there are also family issues. Post-operation care is prevalent among the issues, and 33.1% of respondents in the UK survey said that their partner was now their carer. When we get married we know it is for better or for worse—and sometimes a partner becomes a carer. Clearly that is a great responsibility for them. Three per cent. of respondents said that they had to put their parents into a retirement home as a result of mesh complications and problems with the surgery. People would obviously have loyalty and feel a duty to try to look after them, so that tells me, and should tell everyone present in the Chamber, that clearly the problem affects all the family. If one suffers, all suffer.
I have been told that there are clear problems associated with mesh implants that need to be addressed. We are dealing with issues, following the surgery, that people believe are related to it. They include adverse mental health issues and the fact that 78.4% of people experience depression—more than three quarters of the people in question. For the people I met, depression was clearly now a part of life. Some had stopped work altogether. Family relationships had broken down; they were no longer able to hold them together. Some 40.7% of respondents said that their child acted as a temporary carer. I know the good things that many children do for parents and perhaps siblings, but whenever a child, growing up, who should be enjoying childhood and focusing on their education, must be a temporary carer, there are clearly issues to address. Some men cannot have children after surgery, as some of the men I met told me. That is another issue that means we need to hasten an investigation.
There is also a need to address the issue of post-operative pain that lasts many years. I understand that what I have said is perhaps topical and anecdotal. The hon. Member for Linlithgow and East Falkirk will tell the House about some of the cases, but it is clear to me from meeting the men I have mentioned, and from the evidence that I have seen, that some hernia mesh operations in men have led to serious physical problems. That is why I have brought the matter forward today for consideration. It is the reason for this debate in Westminster Hall today.
We need a governmental investigation, and there must be a directive to do that, and funding to enable it to happen. That is why I look to the Minister. I hope that we will get a helpful response. I hope that in the future all the post-operation issues with hernia mesh surgery can be resolved. I hope that the NHS will receive appropriate funding to tackle mental health issues caused by the surgery. I am very pleased that in the Chancellor’s statement yesterday he reaffirmed the commitment to spending on health—I think it was £34 billion. Is the Minister in a position to suggest that some of that money could be focused on enabling the investigation to happen, and getting the data to try to address the issue? The mental health issues can never be ignored, any more than the physical ones. Perhaps the NHS will be able to improve the surgery process so that patients will not have to cope with being left in serious pain for years and perhaps for ever afterwards.
Now that the issue has been raised it is important that it gets the attention that it deserves and that the problems are tackled. I again ask the Minister—and she knows I do so respectfully and sincerely—whether we can start the process of answering the questions and providing empirical data on the side effects of hernia mesh in the United Kingdom. I know that her responsibility is to the mainland, but the inquiry will have to start somewhere, and I hope that it starts here.
It is a pleasure to serve under your chairmanship today, Mr Hanson. I am grateful to the hon. Member for Strangford (Jim Shannon) for introducing the debate. He has a brought a number of debates to the House over the years, and I have learned an immense amount about issues that I did not know about. This, however, is one of which I have had some personal experience. Indeed, in my personal life since I have been in Parliament I have had two such hernia mesh operations—in my case, both successful. However, 2015 and 2018 are well within the timeframe that the hon. Gentleman highlighted, in which people have developed complications. So far, touch wood, everything has gone fine.
Hernias are fairly common operations. They usually go without any problem, but not everyone has the same experience, and I am grateful to the hon. Gentleman for highlighting the issue as it affects men. Health issues are, of course, devolved in Scotland, and the Scottish National party Scottish Government have a strong record of ensuring that no one suffers unduly from mesh. In 2014, the SNP Government requested a suspension of the use of medical mesh by the NHS in Scotland, pending safety investigations, and in 2015 the Cabinet Secretary for Health and Sport, Shona Robison, apologised to women who had been left in severe pain by such operations. Between 2009 and 2016, the number of women receiving mesh surgery in Scotland fell from 2,267 to just 135.
An independent review published in March last year in Scotland made eight recommendations—notably that surgical mesh implants should be used only after all other appropriate alternatives have been exhausted. Scotland’s chief medical officer accepted those recommendations in full.
The hon. Member for Strangford mentioned people not being told adequately about the potential complications. I have to be honest: having been through the process myself, I probably agree. We were told some things, but a patient suffering from a hernia is more concerned about when they will get their operation and be able to get back on with their life, so they probably do not pay appropriate attention to what is a fairly minor risk. Perhaps that risk needs to be emphasised to people, or they need to be reminded at a later stage in the process; as I know from experience, it can take a while after having seen the consultant to get the operation.
Although health is devolved, the regulation of mesh is a reserved matter. We therefore call on the UK Government urgently to review its effects and to legislate accordingly. Although regulation of these devices is reserved, we really need a UK-wide clinical audit database for recording device identifiers. We were pleased with the review of the guidelines for mesh following the finding by the National Institute for Health and Care Excellence that the evidence for the long-term efficacy of vaginal mesh implants was inadequate in quantity and quality, but we would like to see a review of the use of mesh to repair hernias.
Scottish Government officials are working with UK colleagues to consider the possibility of an automated implant registry, which would allow unique device identifiers to be entered on the patient’s electronic record. The SNP hopes that Ministers will be willing to work with their counterparts in the devolved Administrations and consider a UK-wide summit on that issue.
It is imperative that the highest possible standards for mesh are maintained. EU regulation 2017/745 on medical devices will change mesh implants for long-term or permanent use from class IIb to class III devices, meaning they are generally regarded as high risk. Those regulations will not take effect until 2020, after the date on which the Government desire to leave the EU. How will important EU regulations to monitor the use of devices across EU territories be implemented or reflected in UK law and regulation after Brexit? I reiterate that it is important that we maintain the highest possible standards, and I look forward to the Minister’s comments on that.
When I saw the title of the debate, I knew my Whips would be in touch because I had personal experience; having missed various other engagements while waiting for my operations, I knew I could not get out of doing this. In some parts I feel more mesh than man, but as I say, so far, so very successful.
It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate and for his characteristically passionate, thought-provoking and knowledgeable speech. Although, for all the reasons he gave, the debate is not heavily subscribed, it is an extremely important debate about an issue we have not yet addressed in this place. I know that all the men and, indeed, women watching—be they wives, partners, family members or mesh sufferers themselves—will thank him for bringing this issue before the House too. I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for his remarks on behalf of the SNP.
I welcome the Minister to her new role. We were both elected in 2005—I remember seeing her at the induction on my first day—but I think this is the first time we have faced each other speaking from our respective Front Benches in this capacity. I look forward to shadowing her on some of her policy areas and to holding her Government to account on all things public health and patient safety, which tends to be the area I cover. I also look forward to her response to the debate, but first I have some questions of my own for her.
As the hon. Member for Strangford said, we have had a number of debates in this Chamber and the main Chamber about the impact of vaginal mesh on women—including, sadly, as I am sure Members have heard, my own mam. She is a sufferer of vaginal mesh, which I have spoken about at length in other debates. Although this debate is about hernia mesh in men, it is clear, as the hon. Gentleman said, that there are similarities between the two that need to be addressed. First, the devices are made of the same material—usually polypropylene plastic, which is also used for plastic bottles. It is hard to believe that it is being inserted inside people; obviously, we are now hearing about the damage that causes. The other similarities are a lack of data and a lack of information about the risks for patients, both of which cause harm to patients.
As we heard, the majority of hernia mesh operations are successful, and the Royal College of Surgeons states that the implants remain “the most effective way” to treat a hernia. However, that does not mean we should ignore the patients who tell us that the operation caused them extreme pain and discomfort. The surgery might be successful in the sense that it repairs the hernia, but if it causes extreme pain and life-changing symptoms for some patients, it cannot be right to call it successful.
As I have said in debates about vaginal mesh, if a car, a washing machine or a drier failed in such numbers, there would be a full recall and sales would cease immediately, no ifs or buts. Research shows that between 10% and 15% of people who have hernia mesh surgery suffer from chronic pain and complications after the surgery. That is just not acceptable. That is not a tiny number of people—it is not just the odd one—and it is devastating for the lives of every one of them.
According to NHS data, 10% of people who have hernia mesh fitted go back to their clinician at some point after their surgery. Some surgical experts claim that complications occur in as many as 30% of hernia mesh surgeries, and that those can be every bit as harmful as with vaginal mesh. Until today, hernia mesh patients have not had their voices heard, because the extent of the problem is just not measured. What assessment has the Minister made of the number of complications following hernia mesh surgery, and what consideration has she given to establishing a hernia mesh database to audit the number of surgeries and any associated complications?
The lack of data collection means patients cannot adequately be informed about the risks before surgery. I hope that changes as a result of the debate. Hon. Members may have heard of Dai Greene, a world-class hurdler who captained the Great Britain athletics team at the 2012 Olympic games and was subsequently treated with hernia mesh. He says he cannot remember being warned about any associated risks but was told he would be back training after a few weeks. That was not to be the case: Greene lost five years of his career due to complications after the surgery.
We all trust that surgery will be safe for patients and will improve their quality of life. Patients trust that they will be informed of any associated risks. With vaginal and hernia mesh, that has not been the case for thousands of patients. How will the Minister address these serious concerns? Patient safety and trust must not be compromised in favour of a cheap or quick procedure. My mam was told, “Oh, it’ll be 15 minutes that will change your life.” My word, it changed her life—but not for the better.
I understand that the independent medicines and medical devices safety review is due to report its findings soon. I attended one of its sessions in Newcastle with my mam. It was very well attended, as I believe they all were. Baroness Cumberlege was there, and she was very attentive and compassionate to all the women in attendance. I look forward to her report. Hernia mesh is not included in the review, but given the parallels between vaginal and hernia mesh, which have been highlighted not just today but consistently— the hon. Member for Strangford cited Victoria Derbyshire, who has also done great work on this issue—the Minister should consider the review’s findings in the light of this debate and treat hernia mesh with the same seriousness as vaginal mesh.
Will the Minister work with NICE and NHS England to ensure that patients are clearly informed in good time before surgery about the risks associated with their treatment so that they can make properly informed decisions, with updates on risks as research develops? This is about patient safety and confidence, which is paramount to our NHS.
In closing, I welcome again the Minister to her role. I appreciate that this week must have been a baptism of fire, trying to get on top of so many issues. I understand that she has had to respond to three debates—as the hon. Gentleman said, she has got a hat-trick. Nevertheless, I hope she will address these concerns today and take away any that she cannot. No doubt, we will revisit this issue for debate at a later date.
It is a pleasure to serve under your chairmanship, Mr Hanson. I was alarmed when you walked in, because I think you have held more ministerial posts than anyone else in the House of Commons—or you are pretty close to holding the record, anyway. So to have you in the Chair, judging me as a Minister, is quite daunting.
I thank the hon. Member for Strangford (Jim Shannon) for bringing up this important debate. You always bring debates to the Chamber that you are heartfelt and passionate about. That is so important. It is a delight to be opposite the hon. Member for Washington and Sunderland West (Mrs Hodgson). We have both been in this place for 15 years, and I know that you also bring the same passion and commitment. You always speak from your heart. We might be a bit similar in that way.
Of course, Mr Hanson. I am amazed that after 10 years in the Chair I make these mistakes—it is because I am nervous. I am delighted to serve opposite the hon. Lady; it will be great.
This is a serious subject. It is incredibly important to hear the voices of patients who have suffered as a result of inguinal hernia mesh repair operations, because without allowing those patients to be heard, we cannot move forward to find solutions to deal with this issue. I will go off-piste from my speech, because there has been some conflation during the debate of vaginal mesh repair for the purpose of urinary incontinence and inguinal mesh repair for an inguinal hernia. The two operations are entirely different and have completely different outcomes. Vaginal mesh repair is for urinary incontinence. Inguinal mesh repair is for hernia, and without repair, there is a possibility of death. That is because of the pattern of development of an inguinal hernia. It is due to a break in the muscle wall. The hernia is a part of the bowel that comes through the muscle wall, and it can quickly strangulate and develop into peritonitis. The result of that can be death.
I join the debate late on, but perhaps I can be the example the Minister is looking for. I had a double hernia just a few months ago that was treated at Queen’s Hospital in my constituency, where I received fantastic care. Mesh was used to repair a double hernia, which I got as a result of doing too much exercise—I am not as fit or strong as I thought I was. I was nervous about having mesh because I had heard all the rumours about how damaging it could be, so I questioned the consultant and surgeon. For me, it was brilliant: it meant keyhole surgery and a quicker recovery. I say to all those men out there who might be going in for a hernia operation: do not dismiss mesh, because it makes the operation simpler and the recovery time quicker. I recommend it.
I thank my hon. Friend for his absolute honesty and openness in bringing forward his own case.
The bowel can come through the opening in the muscle wall, strangulate and develop into peritonitis, with dire consequences. The fact is that the alternative method of repair—just to stitch the muscle wall—is nowhere near as effective, and the same dangers can present. There can be a rupture, and the hernia will present again with the same complications.
The Minister, with her medical knowledge, can give the details on hernia repairs in men that otherwise would have been missing from the debate. The hon. Member for Burton (Andrew Griffiths) speaks from his experience. Although I do not want to be a harbinger of doom, for him it is very early days; often the pain that comes in 10% to 15% of cases appears a few years later, as the hon. Member for Strangford said in his speech. The Minister rightly points out that it is a good operation for what is a life-threatening condition in men, as opposed to stress incontinence in women, but still in 10% to 15% of cases we are talking about real pain. I would like her to elaborate on what we should do about that.
The hon. Lady is absolutely right. No one should suffer with chronic pain. There is a difference between acute and chronic pain, with acute pain happening immediately post operation and the chronic pain continuing afterwards. In inguinal mesh repair operations, the chronic pain is due to the mesh—like a small piece of net curtain—rubbing up against nerve endings and causing inflammation. For many men, the pain is quickly cured by an injection of local anaesthetic such as lignocaine with a steroid, which reduces the inflammation and takes away the pain completely. For many men who present back in out-patients, their pain is quickly sorted.
I do not want it to sound as though I am trivialising in any way the problems of those who continue to suffer pain. I believe that the Cumberlege report covers mesh as a wider issue, as well as issues related to the use of mesh, so we may gather more information from the report that will inform the debate on inguinal hernia mesh repair.
There are, however, other options. The best practice is shared decision making between the patient and the clinician, with the clinician fully explaining the operation to the patient, what is involved and what the options are. One option for patients who present with a hernia is for the clinician to reduce it in the clinic back in through the muscle wall. At that point, the patient may know how to handle it and manage it by not over-exercising and being careful when they cough. The patient will be registered as having had a hernia reduced and, if they want it operated on, they just ring up and go straight on to the operating list. That is a good option for many men if they think they can carefully and responsibly manage the hernia and come back to hospital only if it gets worse, if it pops again or if they need immediate attention. Whatever happens, they will be registered as having had an inguinal hernia and seen a clinician and therefore in need of treatment should it reoccur.
We are encouraging clinicians to have that conversation with patients. I do not know whether the clinicians treating my hon. Friend the Member for Burton (Andrew Griffiths) did, but clinicians should do so that patients can decide whether they want to go ahead with an operation.
I had exactly that conversation: it was my choice whether I had an operation and how I managed it. Also, it was just four months between seeing my GP and having the keyhole surgery at my local hospital, which took an afternoon. The service at the hospital was brilliant; I cannot praise it enough.
I am delighted to hear that.
I am pleased to say that shared decision making is set out in the NHS long-term plan and I hope we will see more of it in other areas. As the hon. Member for Strangford mentioned, it has the full backing of the Royal College of Surgeons and the Royal College of Anaesthetists. I know from my own experiences in the health service that the role of patient voices is critical at every stage along the treatment pathway. Indeed, as we have said, the Government have asked Baroness Cumberlege to lead a review on the theme of patients’ voices. I will say more about that later.
All of us, including Ministers, regulators and clinicians, must listen to patients, such as the constituent mentioned by the hon. Member for Strangford who has had an ongoing problem, when they raise concerns. Only by listening to those patients’ voices and understanding the issues they have after hernia repair can we learn and develop what we need to do to ensure that it does not happen to people in the future. We must strike a fine balance as we steer through innovation, emerging science, clinical advice and the voices of a multitude of patients.
Hernias are relatively common. One in five men will get an inguinal hernia in their lifetime and it is worthwhile briefly outlining why men are mostly affected. Inguinal hernias are a type of groin hernia, which are the most common type of hernia. Some 98% of them are found in men, as the male anatomy is particularly vulnerable in this region. The main reason to operate on a hernia is to reduce the risk of bowel obstruction or necrosis, which is tissue death. Both of these conditions require major emergency surgery, where there is a risk of death.
Hernia surgery is therefore often a necessity. I have been advised by clinicians that when an individual’s condition indicates surgery, mesh repair is the standard operation for adults with inguinal hernias. It is safer than non-mesh repair in the first instance and is less likely to lead to pain post operation. It is also less likely to lead to hernia recurrence. To address the point made by the hon. Member for Strangford, I hope he understands not only that this treatment is the most effective but that the alternative is more likely to result in complications. Mesh is therefore used in approximately 97% of all surgical inguinal hernia repairs in England.
All the expert scientific advice that Ministers have received does not support a ban. It is important to emphasise that internationally no other country has banned the use of mesh to treat hernias. According to the National Institute for Health and Care Excellence, approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. These mesh repairs are performed by either open surgery or laparoscopic surgery, as my hon. Friend the Member for Burton described.
NICE has developed guidance which recommends laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. The guidance states that it should only be performed by appropriately trained surgeons who regularly carry out the procedure. This evidence was reviewed by NICE in February 2016 and the recommendations have remained in place since then. The Medicines and Healthcare Products Regulatory Agency and others will continue to review the situation as further evidence and analysis emerges, and will take any appropriate action on that basis. That is why this debate and the recounting of the experiences of constituents is important. They have ensured and will continue to ensure the safety of patients who need treatment.
Unfortunately, no type of surgery is without risk, both during and post surgery. The right balance between risks and benefits for individual patients must be achieved, which places patient autonomy and consent at its heart. I stress that I am deeply concerned to hear about instances where these conversations may not have happened, or have not been conducted in a manner that sufficiently informs the patient. Every patient should expect to receive safe and effective care, and to have an opportunity to raise concerns and feel confident that they will be listened to.
I will talk about the pain and suffering experienced by some men after mesh surgery. The vast majority of patients who undergo surgery using mesh to treat hernias go on to live normal, independent lives. While we do not know the exact number of complications, we believe it is low. However, I understand that those who experience the most adverse outcomes are those who suffer chronic pain or long-term discomfort.
I have been advised that 10% to 12% of men experience moderate to severe chronic pain post surgery. While that number is high, it is lower than for those who have non-mesh repair. I have been advised that acute pain is normal during healing, but chronic pain is not normal. As I said, one example of pain management is to treat chronic pain by injecting local anaesthetic and steroid. Long-term discomfort or pain is fortunately rare, but can still occur in one in 20 inguinal hernia repairs. While this number is still concerning, and, I believe, too high, the risk is dependent on the circumstances of each case. For example, there is an increased likelihood of it where patients have small hernias and where the predominant symptom before the operation is pain. Patients present at the clinic with pain and continue to have the pain after the operation. Both these adverse outcomes—the severity and the longevity of pain—remind us that regrettably complications can arise when any person undergoes surgery.
What we are establishing is that there are still many unknowns with regard to the numbers and when the pain occurs. That is what we need to drill down on. The hon. Member for Burton said that his surgery has been totally successful, however many months it is since it took place. However, the problem is not just post-surgery. Often, as we have heard, people are fine for two or three years and then suddenly, “Boom!”—they are hit with whole host of pain and autoimmune reactions. We need to drill down on that when we are looking at the problem. Will the Minister commit to trying to use the data to do that?
I am hopeful that the Cumberlege report will touch on that area to some degree. I will study the report in some detail, as will officials in the Department, and we will decide where we go from it, but I emphasise that the alternative of not having the mesh repair is more dangerous and has more complications, as we know from the data, than having it.
To follow on from the shadow spokesperson’s question, has it been possible within the investigation and review to understand why the vast majority of people can have the operation without any side effects, while a large number of people do? There were 400 such people in Northern Ireland. If we take that population across the whole country, that means about 24,000 people across the rest of the United Kingdom, so the figures show a large number of people who have had problems. Is it possible to say why, or to investigate and ascertain why those problems take place, as they did in Australia?
We will take that question away. I will come back to the hon. Gentleman, because that is a detailed question with more complexity in it than I could answer today. For those people who suffer from pain, is it alleviated by the steroid and local anaesthetic injection? Are those numbers just people who present back once with pain, or do they go on to have chronic long-term pain, and, as the hon. Member for Washington and Sunderland West says, come back three or four years later? Some drilling down into that data is needed.
Work is under way both within and independent of Government to improve safety and how we listen to patients, in order to gather the information to work with. In July, we launched the patient safety strategy, which sets out the direction of travel for future patient safety. It was developed through speaking to not just staff and senior leaders but, importantly, patients from across the country. As much as it looks at system improvements, such as digital developments and new technologies, it also looks at culture, so that the NHS becomes ever more an organisation with a just culture of openness to concerns, whether they are raised by patients, family members or staff. Concerns of all kinds should be welcomed, valued and acted on appropriately.
We are also waiting to hear back from the independent medicines and medical devices safety review, which is led by Baroness Cumberlege. The review examines how the healthcare system has responded to concerns raised by patients and families around three medical interventions, one of which is vaginal mesh. To do so, the review has focused on meetings with a broad range of stakeholder groups; I think the hon. Member for Washington and Sunderland West may have attended one of those with her mother.
I close by acknowledging just how difficult the subject matter is. No one should suffer from chronic long-term pain without every effort being made to reduce it and find out why it occurs in the first place. This is not an easy subject for men who are suffering from ongoing pain to speak about. We know that men are always very reluctant to come forward and go to the doctors about anything. I pay tribute to the many impassioned contributions of the brave men who have allowed their stories to be told, who have visited their MPs and contributed, because men are not good at sharing information when it comes to their health.
As I mentioned earlier, however, it is vital that the use of mesh to treat hernias continues. It remains the best course of action for patients where the appropriate treatment pathway leads to surgery. As with all treatment, shared decision making should be central to this process. It is vital that we continually examine the evidence together on the best means of treatment. Decisions in healthcare are often about weighing potential benefits against risks, and I thank those in our healthcare system who strive always to offer us the best treatment possible.
Thank you very much, Mr Hanson. I will certainly take no longer than three minutes. I had that advantage earlier on—I may have taken advantage of it, but there we are. Three minutes is more than enough.
First, I thank the hon. Member for Linlithgow and East Falkirk for his contribution. If we wanted a headline for the hon. Gentleman, it would be “More mesh than man” because of the number of operations he has had, if he does not mind me saying so.
It was the hon. Gentleman’s quotation, so I am just quoting him again. He has personal knowledge of what has taken place. Again, to be fair, his operation has been successful. The shadow spokesperson, the hon. Member for Washington and Sunderland West, brought a lot of information to the debate. The problems are really real.
We set out two subjects in this debate: No. 1 was awareness, which is important, but No. 2 was that everyone should understand, before they have the operation, what the implications could be. That does not mean that they will not go ahead with the operation, but it ensures that they understand it. The hon. Lady referred to the “devastating” effect that this can have on lives. It is not a quick or cheap procedure, either, and patient safety is critical.
I thank the Minister for her response. She first confirmed in her contribution that we are raising awareness, and secondly referred to a safety review. I appreciate that and understand why. That does not in any way dismiss—no one can dismiss—those problems that have arisen out of the hernia mesh operations in men as not real. I ask her, if she has the opportunity, to perhaps look at the Australian investigation, although maybe she has already done so.
There we are; the Minister is ahead of me there. Well done. That investigation might give us some ideas for what we could do here as well.
I also thank the hon. Member for Burton (Andrew Griffiths), as always when he turns up, for his contribution. I know many people who have had the operation successfully, but my job here is to bring to the attention of the Minister and this House the many others who live with the mental, physical and emotional problems. That is what this debate is about. I thank everyone for their contributions, and I thank you, Mr Hanson, for chairing the meeting admirably, as you always do.
Question put and agreed to.
That this House has considered hernia mesh in men.