NHS: Staffing Levels

Rachael Maskell Excerpts

Tuesday 11th December 2018 Westminster Hall

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

I congratulate my hon. Friend the Member for Batley and Spen (Tracy Brabin) on calling this vital debate.

I remember the challenging years of the mid-1990s, when I was working as a physio in the NHS. During that crisis time, I never knew when I would get home. Today’s scenario reminds me of the dying years of a Tory Government—the parallels are so strong.

In York, I read the Care Quality Commission reports in detail, and although the care given by our NHS staff is excellent, the real challenge that I pull out of the results of CQC reports is the staffing crisis. My local hospital currently has 59 doctor vacancies, and there are 580 nursing vacancies in bands 4 to 7, 312 of which are in bands 5 to 7. The trust has done everything it can to recruit. It went to Spain and recruited 40 Spanish nurses, 37 of whom left after a very short period. The reality is that NHS staffing is in crisis and that affects patient care.

Last year, the trust had to spend £8.5 million on agency staff. That pushed a trust that is already struggling because the funding formula does not work for York into further deficit, which has an impact on its control and on the resources it can get for the winter crisis—York had some of the highest levels of influenza last year. The Minister, therefore, must ensure that the money works, as well as addressing staffing.

I want briefly to look at primary care because, as we have heard, we need early intervention across all ages to keep people out of hospital. Rightly, the Government looked to increase the number of health visitors, and by 2015 the figure was up to 10,309, but since then we have seen a 23.8% fall, down to 7,852, meaning that young people are not getting the input they need. School nursing figures have also fallen by 25% since 2010. So we have a real crisis in our primary care workforce, and also in mental health, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said. Certainly we feel that in York, whether in the community or the hospital environment.

[Paula Sherriff]

Will my hon. Friend give way?

[Rachael Maskell]

I am going to continue.

The trust is doing everything it can to recruit, but it is impossible to recruit because the national pool of mental health staff is far too small. Therefore, it is vital that we consider the solution, which comes down, as has been said, to workforce planning. We need a partnership approach to planning the workforce. We need to understand the changing demographics and the increasing mental health challenges in order to put the right planning in place, but trusts will not be able to recruit unless the staffing framework is right. The removal of the bursary scheme has been seriously detrimental, particularly to the recruitment of mature students into nursing. People are giving up a job, but their staying in the profession for longer will pay dividends. Students have to pay to travel to placements, and I remember what that was like, so it is really important that they have bursaries.

Secondly on workforce planning, we need to look at how we educate healthcare professionals across the board. I remember discussions at a national level with the trade unions on that very issue, about needing to find a different way. In some countries they bring a real foundation into NHS training so that everyone works together in the first 18 months or two years of their training and has a breadth of understanding of medicine before going off to specialise. We, instead, train in traditional old silos of jobs that have clearly blended over the years, and we must look once again at how we structure that.

Thirdly, we need to look at the “Agenda for Change” package. There is no doubt that it is hard to recruit because people are poorly paid in the NHS and can be better paid elsewhere. Given the stress levels and the antisocial hours that people work, we need to look once again at the remuneration of our NHS workforce. Finally, the knowledge and skills framework has consistently been underutilised by the Government and NHS employers, and it is vital that we go back to that framework of professional development in the NHS.

Nursing: Higher Education Investment

Rachael Maskell Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

I do, and I will talk about that in my speech and touch on the lack of nursing students coming into those particular areas because of the bursary’s disappearance.

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

My hon. Friend is making a very sound speech. Does she agree that it is a completely false economy that, as a student nurse told me just today, of the 45 recruits to mental health nursing in his cohort, under the new financial regime only 18 remain on the course in its second year? We desperately need those nurses—what a price to pay!

[Eleanor Smith]

My hon. Friend is totally right. Again, I will address that point in my speech, but it is noted. I am glad that my hon. Friends are intervening, because it shows the importance of this debate on nursing and the lack of it. I am glad the nurses came to my hon. Friend and told her what it is like. The situation is beyond shocking. There are almost 42,000 vacant nursing posts in the national health service in England. Without policy and funding intervention, that will grow to almost 43,000 by 2023.

Prevention of Ill Health: Government Vision

Rachael Maskell Excerpts

Monday 5th November 2018 Commons Chamber

[Matt Hancock]

Yes, I absolutely will. I am a huge fan of social prescribing. I essentially think that because drugs companies have a big budget to try to market their drugs—and of course many drugs do wonders—there is not the equivalent level of organisation to drive up the use of social prescribing. Examples like the one that my hon. Friend mentions are incredibly important.

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

The half-a-million-pound cut in public health in York has had very serious consequences, while nationally, with regard to the Government’s flagship project of health visiting—the crucial profession in improving outcomes—the number of health visitors has plummeted by 23% from the previous figure of 10,309. Why?

[Matt Hancock]

We are increasing the budget in future and making sure that we target it more on community services and making sure that we get more prevention rather than cure. I can look at the case of York; I can look right across the country at what we need to do. Making sure that we get better prevention is all part of that.

Budget Resolutions

Rachael Maskell Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

As the hon. Lady knows, life expectancy is increasing, and we are forecast to see an increasing number of people live to a good old age. Indeed, the number of people aged 75 and over is set to double in the next 30 years. That is a brilliant achievement, which is in part down to the hard work of our NHS. Cancer survival rates are at a record high, strokes are down by a third and deaths from heart failure are down by a quarter. Of course, those successes have brought new challenges. The biggest health challenge we face is that people are living longer, often with multiple chronic conditions. The money is only one part of the plan to safeguard the NHS and ensure it is fit for the 21st century. The Budget delivers the funding, and later this year we will deliver the plan for how we will set the NHS fair for the future.

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

I have very little hope for the older people of our country given that the Government have cut £7 billion from the social care budget and replaced it with only £240 million. How is that safeguarding our old people for the future?

[Matt Hancock]

Of course, in Scotland social care is devolved, so—[Interruption.] And in York, the amount of money for social care is going up thanks to the decisions announced yesterday.

Social Care Funding

Rachael Maskell Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

I am grateful for my hon. Friend’s work in making the case for more support for adult social care in Solihull, and to support the NHS in Solihull through that. I hope the funding we have announced today will help in Solihull, and the people of Solihull should know they have an excellent champion who has helped them to get that funding.

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

To address delayed discharges, it is crucial that we have transitional care and extra care in place. Will the Secretary of State look at York’s proposal for building facilities on an adjacent site to make that happen?

[Matt Hancock]

That is an interesting proposal, and I have seen others similar to it. We are looking at the link with housing as part of the Green Paper, and I have been discussing that with the Department concerned. The point the hon. Lady raises is important. I note that £731,800 has been allocated today to improved adult social care in York, to take the pressure off the NHS in York this winter. I hope that she will acknowledge that fact.

Access to Orkambi

Rachael Maskell Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

I think that most people would accept that now is the time for a review of the criteria that are applied and the processes that are undertaken. Any organisation needs to be continually improving. We do not condemn NICE. In fact, we acknowledge that it has got many difficult decisions right, but it has also got some wrong. Time and again, the reason that it has got those decisions wrong—arguably—is that the criteria it is applying and the criteria it has been given by the Department of Health are out of date and flawed. I think we would all want to see a review of NICE’s remit and the way in which it carries out its work over a reasonable period of time. It would be helpful if the Minister would respond to that point when he concludes the debate.

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

My hon. Friend is making a very important speech. As I know from being a physio who worked with cystic fibrosis patients, when making an assessment of the cost of treating cystic fibrosis, we must look at the social cost, the economic cost and the immense cost of keeping somebody alive. Does he agree that Orkambi would be a solution to that, let alone addressing the human cost?

[Mr Lewis]

I entirely agree—my hon. Friend makes absolutely the right point. When there is an incomplete assessment in looking at value for money versus outcomes, that will lead to flawed decisions that are incredibly difficult to justify. We have a mismatch between the basis on which NICE is expected to make these decisions and appropriate processes. Instead of everybody hinting, “Yes, of course there’s a need to review NICE—of course that would be a good thing”, we would like to hear from the Minister a timescale as part of the response to the specific issue of Orkambi in terms of NICE’s roles and responsibilities.

Management of NHS Property

Rachael Maskell Excerpts

Wednesday 4th July 2018 Westminster Hall

[Karin Smyth]

I recognise that the management of NHS property is not the most enthralling subject, but many hon. Members from across the country will recognise that it is a growing problem in their constituencies. The problems are varied and many. My focus today will be on the community and primary care estate.

I will not talk about bricks and mortar or leaking pipes, or outline the detailed and manifold operational challenges posed by an NHS estate that in many parts of the country still relies on pre-1948 infrastructure. Instead, I want to talk about the places our constituents go to when they need care, where they welcome their children into the world and where they say a final goodbye to those they love. They are places where some of our most precious memories are forged, capable of delivering huge happiness and hosting unimaginable grief. They are hard-wired into our emotional DNA and the fabric of the communities in which they sit. They are places that are paid for by our constituents through their taxes, which our constituents feel ownership of and an enormous attachment to. It is in this difference that the notion of local or personal ownership is blown apart. The harsh reality is that our constituents do not own these properties. Moreover, they do not even have a say in how they are run or in their future.

Who owns them? Who runs them? How do they operate? How can users or stakeholders such as MPs influence change? Those questions are hard to answer as control of these special buildings is opaque to the point of absurdity. The lines of accountability are unfathomable and, as so many colleagues will know, incredibly frustrating to deal with. I have spoken to numerous colleagues across the House about these issues.

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

I am grateful to my hon. Friend for giving way, and grateful to the Minister for listening to my concerns about the Bootham Park Hospital site and intervening on that. A real programme of change for healthcare in York has now been put together. Does my hon. Friend agree that when looking at the estate it is important to develop plans that improve healthcare rather than seeing it just as buildings?

[Karin Smyth]

I agree. The building that my hon. Friend has been working on is iconic, and that case is a good illustration. My hon. Friend the Member for Bristol West (Thangam Debbonaire) has been dealing with a GP surgery in her constituency for a long time and can get no resolution. I have also spoken to my hon. Friends the Members for Stoke-on-Trent Central (Gareth Snell), for Stroud (Dr Drew), for Bishop Auckland (Helen Goodman) and for High Peak (Ruth George)—these problems are happening across the piece.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Speaker]

Order. I am sorry, but we have run out of time. However, the person whom I think has been standing the longest is Rachael Maskell.

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

Thank you, Mr Speaker. NHS Property Services intends to sell the Bootham Park Hospital site, but reinvesting in that site would make such a difference to the health needs of our city. Will the Minister ensure that that happens?

[Stephen Barclay]

I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.

NHS Outsourcing and Privatisation

Rachael Maskell Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

Will the hon. Gentleman give way?

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

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.

[Rachael Maskell]

I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?

[Jonathan Ashworth]

My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.

I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.

--- Later in debate ---

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

It is a pleasure to follow my hon. Friend the Member for Oxford East (Anneliese Dodds). I could not agree more with her astute analysis, which also—yet again—applied to what is happening in York.

I want to begin by thanking Pat Crowley, the chief executive of York Teaching Hospital NHS Trust, who has just announced his retirement. He has steered our hospital through unprecedented challenges. I have met the Minister to discuss so many of those challenges—the failed funding formula, the perverse financial incentives, the failed budget integration and the placing of the private profit motive at the heart of our NHS—but I am still waiting for his response to that meeting.

Let me turn to the issue of how money flows. We have talked about private finance in the NHS, but we should also bear in mind that money is not going into primary care and GP services. That is forcing people to use accident and emergency departments, which are the most expensive part of the NHS. Let us follow through the money that people are drawing down. People cannot get in through the front door of the NHS because people are not being cleared out of the back door as a result of the bed-blocking that has resulted from the Government’s cuts in local authority budgets. Those cuts have also caused public health services to be slashed so severely that a massive health crisis is being created. The shocking statistics relating to drug deaths in York are now the worst in the country. We desperately need more resources there. If we invest in people’s health, the health service will save money in the long term. Our teaching hospital is over £20 million in debt—it is the same with the clinical commissioning group—because of the failed funding formula set out under Lansley’s plans for the NHS and the ideology behind that.

I want to take on the argument that the private sector is helping the NHS. The private sector is offloading the low-risk, high-volume work from the NHS—that which under the tariff produces money and profit for the private sector. Formerly that money was invested in the most expensive parts of the NHS to stop the deficits in the NHS; the money went to the ITU, the A&E and the renal units which have a high demand for expensive drugs. The private sector sucking out resources from the NHS in this way is causing the financial failure of the NHS today. Therefore, it is incumbent upon the Minister to withdraw that failed model under the Health and Social Care Act 2012 and to ensure that instead we see real investment in the NHS, which will make a vast improvement to the health service as we move to its 70th anniversary.

NHS 70th Anniversary

Rachael Maskell Excerpts

Wednesday 16th May 2018 Westminster Hall

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

Thank you, Mr Hosie, for chairing this morning’s important debate, and I thank my hon. Friend the Member for Blaenau Gwent (Nick Smith) for introducing it in the way that he did.

The incredible tributes that we have heard this past week to Dame Tessa Jowell have reminded us what a formidable politician she was, and how she centred her work around the important agenda of public health, backed up by the epidemiological evidence. We have had so many fantastic evidence-based reports, not least the work done by Michael Marmot in identifying the importance of the social determinants of our health outcomes. We know that various agendas meet around public health—social, economic, health and education agendas, and many more. That is why it is really important that we put our focus on the whole person and the impact that life has on people.

We have seen severe cuts, not least to our Sure Start centres, hundreds of which have closed. From the evidence that they produce, we know about the real impact that they have, particularly on our young people. Health visitors are an initiative that the Government took up in 2010, following Labour’s urging that we must increase the number of health visitors. That number has now fallen, from the 4,200 additional health visitors that David Cameron put right at the heart of his Government, back to the numbers before that Government. There is a real crisis among that vital workforce, with ever-increasing workloads.

We have had workforce cuts, financial cuts and service cuts in public health. Public health is about long-term outcomes, and when we are dealing with austerity and cuts, we are looking at having to support tomorrow, not the future. Public health has been a very poor relative in the austerity programme, and I can witness that in my city. In Acomb in York, since 2011 I have seen childhood obesity more than double among my community. I have also seen health checks cut; those are vital at the age of 40 to ensure that we put people’s health back on track.

Long-term contraception has been cut, and smoking cessation services demolished—unless, of course, people pay for them. We have seen a 90% fall in the number of people able to access smoking cessation services, in an area where the number of people who smoke is higher than the national average. Those are the real consequences of cuts. In York, the clinical commissioning group denies surgery to people who have a high body mass index or who smoke, yet the support services to help people change their lifestyle and behaviours are not there any more—a complete nonsense. That is why it is really important to put the focus back on public health.

Over the past week, I was most shocked by a letter I received about substance misuse services in York. York is now 148th out of 148 authorities when it comes to drug-related deaths of people in treatment and across the community as a whole. Most people will be shocked to hear that about York, but when I look at what our local council have done in absolutely slashing funding to those vital services, I am not really surprised—and, of course, the most severe cuts are still to come. What will that mean to the people in my community whose life chances are being taken away from them?

Across mental health services, the sustained lack of investment over such a long period is having a real impact on health outcomes. People have been hurt by cuts and hurt by political decisions. It need not be that way. We all know it is the most vulnerable, the poorest, the people who really need the state’s help who fall down when the state stands back.

We have heard so much about young people in the debate, for whom interventions are even lower than for older people. For people in their latter years, public health virtually does not feature. Yet, in the health service that Bevan created, everyone from cradle to grave could access the necessary good public health services. Such interventions save the NHS so much money—it is a no-brainer—so why cut those services? That question comes not just from me, but from directors of public health I meet regularly in my constituency, and across the board. They want to understand what will happen when the public health grant is withdrawn. I hope the Minister can reassure them today that he will ensure that they will receive the funding needed to sustain services into the future. They also want to know how the Department of Health and Social Care will work with directors of public health to ensure that their long-term goals for improving the community’s public health will be funded.

We need to look seriously at the workforce in public health, which has been decimated. We have to look at funding to sustain that for the future health of our nation. We need to look at outcomes, not just inputs. Let me take the child measurement programme as an example. It is a nonsense that we know now how obese children are, but we cannot afford the interventions to change the trajectory of those children’s lives. That means that the programme does not work. We need to examine how we change the life chances of so many people across the country.

I want to touch on the 70th birthday of the NHS, which is so important for so many of us, and draw the Minister’s attention to what we are doing in York. When I heard what his Department was rolling out, I thought it quite lacklustre—it lacked ambition—so I pulled together the health leaders in York to drive forward a public health initiative to mark the 70th birthday. It includes the clinical commissioning group, the acute trust, the mental health trust and the local authority. We are working together to launch in July, as part of that fantastic celebration, a whole programme intended to transform the health of our whole community.

I have a meeting with businesses to talk about how employers can change the life chances of people who work for them. We are meeting faith and community groups to talk to them about people that they engage with. We are going to have a touring pop-up event across the city over the NHS birthday to provide advice, health checks and services, and simple programmes, because we do not have a lot of money. I know from Health questions that the Minister will meet with me, as the Secretary of State said, to talk about this initiative. We are going to have health walks at lunchtimes. We are going to have basic tests to understand health measures, as well as advice, information, encouragement and the promotion of better understanding, looking at diet, exercise, behaviour and the choices that people made. We are determined to touch the thousands of lives of people in York on this 70th birthday, because we want to celebrate the future with everyone.

We know that so many people are being failed, and the most vulnerable are being failed the most, but we can change things around. Public health does not actually cost a lot of money compared with acute services. So, I trust that from today, we will take the spirit of Nye Bevan and ensure that we invest in the very people who will depend on our NHS in the future.