Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 29th October 2019 Commons Chamber

[Matt Hancock]

My predecessor, my right hon. Friend, is an assiduous campaigner for South West Surrey. There is no better spokesman for South West Surrey than my right hon. Friend. He has raised this issue with me in private over recent weeks since these concerns were raised. I have in turn raised it with the chief executive of the NHS, and I can confirm that the walk-in centre will stay open.

[Rachael Maskell (York Central) (Lab/Co-op)]

The primary care mental health service in York is not being cut; it is being scrapped. Will the Secretary of State urgently meet me to save this service?

[Ms Dorries]

I am happy to help and to meet the hon. Lady to talk about that. No primary care mental health services should be cutting given the amount of funding we are putting in, but I am happy to meet and discuss it with her.

Health Visitors (England)

Rachael Maskell Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for introducing this important debate. The Labour Government recognised the decline in the number of health visitors and therefore put in train a health visitor implementation plan. As head of health at Unite—I refer Members to my declaration in the Register of Members’ Financial Interests—I was delighted to see that plan come to fruition during my time there. The ambition to raise the number of health visitors by 4,200 was a steep challenge, but a necessary one. We have heard the reasons why. Health visitors are the backbone of early intervention by health services. They are the pioneers of public health, and are instrumental in addressing health inequality. At a time when there are real challenges on children’s health, it is so important that a workforce is there to deliver that service.

Unfortunately, as we have heard, the numbers have fallen by 31% to date, from a peak of 12,292. That is having a serious impact not only on young people and their opportunities but on staff. We know from the work that the Community Practitioners and Health Visitors Association has carried out that 85.3% of health visitors are experiencing stress. They have case loads that are unsafe. It is therefore vital that the Minister put a statutory caseload figure on the books. It is important that health visitors work to criteria under which they can cover their caseloads. In York, we have only 29 health visitors to cover our city, which has a population of nearly 10,000 children. That clearly is not safe at all.

The health visitor implementation plan was good, though very rushed. Often mentoring was being stretched from a one-to-one relationship, which is the norm, to one-to-six. That is what I heard from some health visitors in training. No sustainability was put into the plan after its implementation. Therefore, with an ageing workforce, we saw rapid decline and people moving elsewhere in the health service—partly because they were placed in local authorities that, under the austerity measures, decided to cut back not only on opportunities for training and development but on pay.

Such cutbacks had a significant impact, and downgrading was part of it. For people who went to work in outsourced services, for which we obviously cannot get hold of information about true numbers through freedom of information requests, we know that conditions were even worse, and that people have left the service after their training period. That is a massive loss to our service as a whole.

I will rapidly move on to what needs to be introduced—a new, and properly resourced, health visitor information plan. There was a promise in the report on young people by the right hon. Member for South Northamptonshire (Andrea Leadsom) that the comprehensive spending review would resource the future programme, but of course we have not had the comprehensive spending review. It is therefore urgent that the Government put money on the table to deliver that.

We also need to ensure that we bring services back into health that have been outsourced, so that there is proper monitoring of the service and it is seen as a statutory service to be delivered. I am very interested in the ideas that have been proposed in today’s debate that it either be moved back into the NHS or into a proper partnership between health and local government. The reality is that the right relationships need to be built for health visitors to deliver the programme.

Finally, we need to ensure that the right stakeholders are brought around the table. It has been brought to my attention that some consultation has taken place on how we should move forward on such issues as the number of mandated contacts and so on, but not all the stakeholders are there. I urge the Minister to meet the CPHVA, which is the lead organisation representing health visitors, and to ensure that included in that cohort are people working in the profession who can really reflect what it is like on the frontline today.

Community Pharmacies

Rachael Maskell Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to see you in the Chair, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing today’s debate.

A couple of weeks ago, I went to visit a local community pharmacy in my constituency, and the superintendent pharmacist sat me down to tell me his tale of woe, which has been echoed across the Chamber this morning. He runs seven pharmacies across the city, serving 20% of the population, but he has seriously struggled over the past three years and is wondering whether he will be there next year. He has ploughed in tens of thousands of his own money just to keep the business afloat. That certainly highlights how many single-handed pharmacies have closed in the city.

Part of this is about the Government funding cuts, not least to the establishment payment, which covered things such as rent, regulatory registration and insurance. Part of it has also been about the loopholes for the clinical commissioning group and how it is now buying branded generics and not giving the headroom that pharmacies used to have. For instance, if people were purchasing a drug at, say, 60p and it had a value of 90p on tariff, there would be headroom of about 30p. That money was then ploughed back into the business to run other essential health services and to ensure that there could be free deliveries of pharmaceutical products to the community. Pharmacies just do not have that headroom any more.

The situation is made far worse by the multinational companies—we have heard about Boots, Lloyds and the others—which have the buying capacity and the space to be able to drive up the price at the wholesalers, which in turn means that the independents pay more when they go to purchase their pharmaceuticals. I have always called it the Walmart model, because that is how many of these companies operate. They try to push out the competition by making it impossible for the independents to participate in the market. That is certainly what we see here.

There is a toxic combination of cuts, CCGs facing tough financial lines—the CCG in York is always struggling—and, on top of that, the wider market pressures. Of course, the multinationals can spread their risk. They sell other products, and they are owned by multinational corporates, which gives them a further cushion in their operations. The impact is that, where some of those big companies have bought up independents, they are then closing them in crucial communities.

Clifton in my constituency is an area of high deprivation, with one of the lowest ages of mortality in the city and a real need for a community pharmacist, but Lloyds has pulled out of that community. That means that while people are waiting, say, three weeks to go and see their GP, they cannot just pop down the road to their community pharmacy as an alternative, because it is simply not there.

That is building more pressure on the independents, because people go to them to get the free delivery now that, as we have heard, the big companies have seen a gap in the market—surprise, surprise—and are charging their drug delivery tax to get more resource. That means that the independents, which are trying to provide that community service, are delivering further and further afield, which is costing them more, and they have less resource to do that with. We need to address the drug delivery tax to ensure that, as my hon. Friend the Member for Halifax set out, we get these products to those people in our communities who are incredibly vulnerable.

I draw the Minister’s attention to one other scandal in the industry, which is that companies such as Boots are paying only 9% corporation tax. As a result, the Government are losing out on £1 billion a year. If we think about the scale of the cuts and the £200 million that has been removed, it does not take long to realise that, if Boots was forced to pay its corporation tax, we would not see pharmacies struggling and going to the wall, or communities suffering and losing those essential community services.

I ask the Minister to go back to the Treasury and make sure that those tax loopholes are closed. Boots moved into a multinational company, which I believe is 49% American-owned, and it is now registered in Switzerland, so it does not have to pay the same overheads. That is another inequality built into the market that must be addressed. The pressure cannot continue, or we will lose our community pharmacies. As I said, one pharmacist, who oversees seven pharmacies, does not think he will be there next year. That is seven communities across my constituency and York Outer that will not have a community pharmacy on the street corner.

It is vital, therefore, that the new Minister gets to grips with this issue. She must make sure that the right investment goes into our communities, that those loopholes are closed for the CCGs and for tax, and that the drug delivery tax is not put on pharmaceutical products.

--- Later in debate ---

[Jo Churchill]

If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.

As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.

First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.

Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.

[Rachael Maskell]

How will the Minister measure the impact of the settlement, particularly on independent pharmacists? If more of them close or are struggling financially, what other interventions does she plan to make?

[Jo Churchill]

As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.

We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.

We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.

Social Care Funding

Rachael Maskell Excerpts

Tuesday 1st October 2019 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

We hold this debate against the severe cuts we have seen in local authorities, with £7.7 billion taken out of the budget. Of course, we had the Dilnot report in 2011 and the promise of a social care Bill in 2012. In 2015, we had a manifesto promise; in 2017, we had the promise of a paper and then a disgraceful offer in the manifesto. In 2018, we were promised a Green Paper before the summer, before the autumn, by Christmas, in the new year and then “soon”, and then it was summer again in 2019, and of course this Green Paper has not seen the light of day. Meanwhile, 1.4 million people are not getting the care they need and 87 people each day die before they get the care they desperately need.

I want to tell the story of Mr Stewart, in my constituency. The love of his life, Nancy—they have been married for more than 60 years—was taken into hospital and then discharged to a care home. He wanted her home, and it was refused and refused, and then an inadequate trial was done without the right care support in place. He longed to have her back at home, but she was permanently moved to a care home outside Harrogate, which is over 20 miles away, and each visit costs £88. City of York Council will pay for him to visit his wife once a week, but he wants to spend his whole life with her. He pays for two additional visits despite not having the means, but the visits are all too short. He cannot afford to go every day; he cannot afford to live with her; and he cannot afford to have her cared for at home. The system is broken, and poor Mr Stewart has been broken by the system. Hope came last week when Labour announced that it will pay for the personal care that people need, which would enable Mr Stewart to live with his wife. It is right that we reform our care system and turn it into a therapeutic system as we do so.

I praise our diligent careworkers, but we must end the pressure placed on them by zero-hours contracts and short visits. They need time to care and to apply their expertise. Training should be put in their hands, so that they can be at the frontline of delivering care with confidence. I worked as a carer, so I know what it is like to work under that pressure. I then moved on to be a physiotherapist, and trying to discharge people into the system was a massive challenge. We need to respect our careworkers and pay them well. No more talking; we will make it happen. It is the right thing to do. It is the Labour thing to do.

--- Later in debate ---

[Caroline Dinenage]

My hon. Friend is right to say there were teething problems, but in the most recent reporting cycle, 93% of local areas agreed that joint working had improved as a result of the better care fund. We want to use it to drive much better integration and to look at how we undertake more joint commissioning in future.

We are committed to working alongside all partners in adult social care to attract and support a growing workforce with the right skills and the right values to deliver quality and compassionate care. Earlier this year, we launched the “Every Day Is Different” national adult social care recruitment campaign to raise the profile of the sector. We have secured a further £3.8 million for the next wave of that campaign, which will start later this month. We fund Skills for Care to support the sector in recruitment and retention.

[Rachael Maskell]

Will the Minister give way?

[Caroline Dinenage]

I do not have time. We also fund the workforce development fund, and social care employers can bid for this funding to pay for their staff to gain training qualifications at all levels.

There were lots of questions raised across the Chamber, and I want to deal with them all. The hon. Member for Totnes spoke about the impact of Brexit. As the Prime Minister has said, he wants our immigration system to help to attract the brightest and best talent from across the world. This includes delivering an Australian-style points-based immigration system as a first step. The Home Secretary has commissioned an independent migration advisory committee to review this and the appropriate salary threshold. Clearly, we want to attract people to work in adult social care.

We are aware that the system is already under pressure and recognise that EU exit could add to this. We have been working on this for a long time alongside partners, including ADASS, the Local Government Association and local authorities, to ensure robust contingency plans are in place. [Interruption.] I am going to have to make progress as I will have to sit down in a second.

There is still much more to do. The funding announced in the spending round is a down payment on much more fundamental reforms to social care that we need to introduce. As the Prime Minister said on the steps of Downing Street, the Government will set out plans to fix the crisis in social care once and for all, to give every older person the dignity and security they deserve. We want to ensure that nobody has to sell their home to pay for care. The Government will not shy away from the long-term challenges that face social care. Our proactive approach to funding and reform means that we will ensure that our social care system can respond to the challenges that lie ahead with confidence that the most vulnerable in our society will be able to live with dignity and respect and receive the care they deserve.

Health Infrastructure Plan

Rachael Maskell Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

My right hon. and learned Friend makes an important point that is close to my heart, as a former co-chair of the all-party parliamentary group on dementia. I recently, or relatively recently, had the opportunity to visit Leicester Royal Infirmary, which has done exactly that and worked with the Alzheimer’s Society and others to create a dementia-friendly ward. He is right that that sort of thing should be hardwired into our designs as we upgrade hospitals.

[Rachael Maskell (York Central) (Lab/Co-op)]

Had the Minister conducted an appraisal of the full NHS estate, he would have realised that mental health hospitals are not on his list. In the light of the urgent need for a new child and adolescent mental health services unit in York, how did he miss CAMHS from his list? This will have a real impact on clinical services.

[Edward Argar]

The hon. Lady makes an important point about mental health and the services for those with mental health needs. This announcement is very much focused on acute hospitals, and investment was recently announced for mental health services in, for example, Mersey Care and Manchester. Indeed, my own county recently invested in a new unit.

The hon. Lady raises a specific point, and it would be wrong to suggest that this Government are not investing in mental health services. However, if she wishes to discuss the specifics of her constituency and of the needs in Yorkshire, I would be happy to meet her.

Spinal Muscular Atrophy

Rachael Maskell Excerpts

Thursday 25th July 2019 Commons Chamber

[Sir John Hayes]

Exactly. That is why, in the exciting conclusion to this speech, I shall make demanding suggestions. I think they are demanding because of the demands of those who need this drug, not because of any particular interest I might have in this matter beyond a passion to ensure that my constituent and others like her get what they need so desperately.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to the right hon. Gentleman for introducing today’s debate. We have had many debates in the House on the procurement of drugs. I have been working with health economists at the University of York who are leading in this field. They very much recommend the model now being adopted by Canada around a national rebate scheme, which takes away some of the tension over cost that we seem to return to time and again. Is not that a way forward that the Government should at least explore?

[Sir John Hayes]

The hon. Lady had the great pleasure of shadowing me when I was at the Department for Transport, and I have had the greater pleasure of listening to her on so many subjects. She speaks with such knowledge, understanding and wisdom. Once again, she has shown all those things today.

The Government and the new Prime Minister must do as much as they can to ensure that those with rare diseases have every chance possible to live the very best lives they can. So, here is exactly what to do: first, as Spinraza has been shown to be both safe and effective, the NHS should provide the treatment for all those who would benefit from it; secondly, in addition to making Spinraza available for all, the Minister should set up a rare drugs fund, similar to the successful cancer fund, to ensure that those battling debilitating degenerative diseases are supported at every stage of their journey; and thirdly, I ask the Minister to implement an immediate review of the criteria used by NICE to determine access to new medicines.

We all want to do the right thing. I described earlier what I said was a crude approach. These things develop; they metamorphose. This is a chance to look again at how we can administer treatment to have the best effect on those in the greatest need. Hegel said:

“Life has a value only when it has something valuable as its object.”

Chamberlain said:

“In great deeds something abides.”

There is no better great deed, no more noble object, no more abiding purpose than the care for those in the greatest need. I ask this Minister to make her abiding object a war on want, a campaign against suffering, a crusade for those in pain—Madam Deputy Speaker, nothing less will do.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

A year on, NHS Property Services is now having to remarket the site of Bootham Park Hospital. In the light of this complete failure and the failure to listen to health professionals locally, will the Minister ensure that the One Public Estate bid is seriously considered as the sale moves forward?

[Stephen Hammond]

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

Children and Mental Health Services

Rachael Maskell Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths]

I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.

[Rachael Maskell (York Central) (Lab/Co-op)]

The hon. Gentleman is giving an excellent speech. In York, we have seen a 26% increase in referrals into CAMHS over the past five years. As a result of such high demand, one referral in four is turned away from the service, including children who are self-harming and have experienced abuse. Surely we need to focus on investment in the workforce, as well as on funding.

NHS Long-Term Plan: Implementation

Rachael Maskell Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

Few people make the case for their constituencies better than my right hon. Friend, and nobody makes the case for Harlow better than him. He invited me around Harlow hospital. I went into the basement to see some of the work that is needed, and the basement of Harlow hospital is in a worse state of disrepair than the basement of this building. That means that it needs work, so I am considering his proposal. The future NHS capital budget will be settled in the spending review, so I suggest that he has a conversation with Treasury Ministers as well. I look forward to seeing the case progress.

My right hon. Friend is also right about how important degree apprenticeships are. Both of us are former Skills Ministers and have heralded the arrival of degree apprenticeships as a route for people into high-paid, high-quality jobs without them having to go to university.

[Rachael Maskell (York Central) (Lab/Co-op)]

Delayed discharge has a knock-on effect on the whole NHS. The fact that the Secretary of State has said today that all he will do is review the better care fund and that he will not publish a White Paper on social care shows what a low priority this is. When will we see the White Paper on social care for which we have been waiting not just months, but years?

[Matt Hancock]

The statement was about the implementation of the NHS long-term plan, to which of course the future of social care is vital, which is one reason why the spending power available within social care has risen by more than 10% over the past three years. We continue to work on the long-term future of social care. We will have to wait for a new Prime Minister before publishing the Green Paper—I think that is fairly obvious—but it would also be good to get a bit of cross-party collaboration. When my right hon. Friend the Member for Ashford (Damian Green) made some proposals that were in line with the cross-party work of two Select Committees of this House, within half an hour the shadow Secretary of State’s friend, the shadow Chancellor, had rubbished the idea—I do not think he took the time even to read it. We could do with a bit of cross-party work on the future of social care in this country.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is quite right to celebrate the development of the NHS app. More than 80% of people are now able to use the NHS app to link to their GP practice. Our plans for the year ahead include API-based connections to a number of third-party products, including the NHS app. More importantly, I want the opening of this system to allow other innovators to be able to develop products for patients to use in a way that we have not imagined before. I want a load of innovations so that people can get the best possible access to their NHS.

[Rachael Maskell (York Central) (Lab/Co-op)]

T6. In York, it has taken 46 weeks for children and young people to commence the diagnosis process for autism—and demand and the number of referrals is going up. It takes a further 12 months, once there is a positive diagnosis, for parents even to access the SEND—special educational needs and disability—course. Precisely what service improvements can families expect to see in the next 12 months, and how will they be achieved?

[Caroline Dinenage]

The hon. Lady is absolutely right to draw attention to this issue. We are very concerned about the diagnosis times, which is why we are reviewing our autism strategy this year and are extending it to include children, whereas before it catered only for adults. We want to ensure it remains fit for purpose. We have launched a national call for evidence and have already received in excess of 1,000 responses.