Oral Health and Dentistry: England

Rachael Maskell Excerpts

Tuesday 25th May 2021 Westminster Hall

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

Thank you, Ms Bardell, for the opportunity to speak in today’s debate with you in the Chair. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for putting the debate into context. Here I am again debating dental services with the Minister and, yet again, championing the needs of my constituents and the dentists who have worked relentlessly throughout this pandemic in extremely difficult circumstances.

York had a dental crisis before the pandemic. Constituents now tell me that they have to wait at least three years to receive NHS treatment and that those trying to register struggle or simply search for treatment outside the area. We have serious problems in York, as the Minister knows. NHS treatment needs to be available for all and, tragically, it is not. Many are now turning to accident and emergency services to get pain relief or a course of antibiotics. Private care is not an option, nor should it ever be.

Successive Ministers have failed to address this crisis. This month, the Minister was unable to tell me, as my hon. Friend the Member for Stockport (Navendu Mishra) has said, how many NHS dentists there are in my city. The fact that she does not have that basic data gives me little hope that the Government have really got a grip on the scale of this crisis and the needs that must be addressed.

It is perplexing that oral health is seen to be different from other areas of healthcare, and that we have to pay for things that are done to our mouths but not to the rest of our bodies. It did not start that way. When Nye Bevan established the NHS, dentistry was free at the point of need and everyone was entitled to have their check-ups and treatment on the NHS. It was transformative. In 1951, the first assault on our NHS occurred when charges were introduced. That caused Bevan to resign in disgust, and sadly since then the divorcing of oral health from the rest of medical care has failed to serve us well.

Evidence from the BDA—I thank it for the work it does—shows that the pattern of health inequalities in other areas of healthcare is reflected in dentistry and oral healthcare, so it is time for integration, not segregation. Although I understand the point that the hon. Member for Mole Valley (Sir Paul Beresford) made, he did not suggest a solution. Of course, we need to ensure that good-quality, healthy food is available for all, particularly those living in deprivation, but it is wrong to blame those individuals for their lack of choice due to their financial circumstances.

This patchwork of failed contracts has courted privatisation and created a dependency on labour from other countries which, simultaneously, this Government are spurning. In the past year, I have been on a journey with many of York’s dentists to learn why, unless we see radical change to the delivery of dental services, the system will collapse. Dentists will burn out or leave—indeed, they are doing so as we speak—and the nation’s oral hygiene will deteriorate further. Even during the pandemic, dentists have been told that they will be penalised if they fail to deliver unrealistic contractual targets while practising in a covid-risk environment.

The NHS dental contract fails to pay. The Minister sets unrealistic targets—units of dental activity—without consideration of the scale of the barriers that dentistry is facing, and without providing mitigation. Ministers in Wales, Scotland and Northern Ireland seem to have understood that, but this Minister has not. In a post-covid world, and against a backlog of more than 20 million appointments—think about the scale of that; we are rightly exercised by the 5 million outstanding secondary-care appointments that we are having to grapple with at the moment—it is baffling that the Government have failed to grip the scale of this deepening crisis and have not instituted an emergency service.

The tightening of the thumbscrews on dentists through their contracts shows no mercy, despite their call for ventilation equipment funding, high-grade PPE and an understanding that requiring treatment rooms to lay fallow before a deep clean can commence due to the aerosol- generating procedures eats into dentists’ ability to deliver their contract obligations. The arbitrary, unevidenced targets require dentists to work round the clock, cancel leave and often their whole lives. They force dentists to focus on high-volume, low-risk work such as check-ups, while patients requiring treatment, not least complex treatment, are made to wait. It is unethical and wrong.

To top it all, the Government’s net spend on dental services, as we have heard, has been cut by more than a third in the past decade. Evidence shows that every pound invested can save over three, as well as teeth. This is the moment to start again, and I am glad the Minister is in listening mode. We have the diagnosis. We know the problems and the scale of the challenge. It is not time to tweak locum contracts or drive our dental staff harder. It is time to get a real, pragmatic solution in place. There is an opportunity to legislate for a national dental service in the forthcoming health and care Bill to solve this problem.

Oral health should be seen as a public health matter. It should attract the planning and preventive approach that any other public health emergency would. Fluoridation, as we have heard, is a no-brainer and brings universal benefits. I urge the Minister to introduce that without delay and end the postcode lottery. A principle needs to be made that everyone should be able to receive free oral health at the point of need—no barriers, and no excuses. Good oral health has to be accessible for all—nationally determined on the what, and locally determined on the how. We need to increase significantly the number of training places for dentists in the UK and ensure that the benefit they gain from training is tied in with their commitment to serve in a national dental service under NHS terms. Training bonds are not unique, and they ensure reciprocity. Therefore, they will bring real benefit to the service. What plans has the Minister executed in order to train more dental staff and ensure that we have sufficient numbers in our dental schools? What discussions are taking place? We would like to know.

Delivery is something that this pandemic has taught us all about. We need a collaborative approach—a place-based system approach—to ensure that we address the scale of the issues. The vaccine programme has settled the debate about emergency provision once and for all, and we are in that space now with dental care. Every child and young person should be able to access dental inspections in school each year, and this should be routine from when children start school. Early prevention would not only save the NHS a lot of money; it would also save children a lot of trauma.

Similar plans could be put in place for care homes. For adults, an accessible check-up service would clear the backlog and enable cases to be triaged, population-wide, into treatment. For some people, light treatment could be provided simultaneously, with more complex cases referred to a booking system.

As we have seen with this pandemic, there are collaborative ways to address health crises. A place-based approach, whereby barriers can be removed, can be enabled to provide the solutions. Rather than struggling to design ever-more challenging contracts and systems to serve a fair model, the Minister could create a national dental service and use this framework to work with local delivery partners. In a matter of months, she could start turning this vital service around for all.

[Hannah Bardell (in the Chair)]

Before I call the next speaker, may I gently and politely remind Members to turn off their phones or put them on silent during the debate?

A Plan for the NHS and Social Care

Rachael Maskell Excerpts

Wednesday 19th May 2021 Commons Chamber

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

A house without foundations will subside. The decennial reorganisation of the NHS has neither sure foundations nor structure. It will struggle to withstand the complex health challenges raining down on it. The one chance to meet the next decade’s health and care needs still awaits the foundational pillars of public health, mental wellbeing and social care White Papers. The Secretary of State’s proposal for yet another mass reorganisation is structurally unsound without those vital foundations.

With 5 million people queuing for operations and appointments, old and disabled people stripped of their money and dignity in a broken care market, mental health challenges enduring and deepening, embedded inequality and complex comorbidities, it is only the love and care of the staff that is holding the whole NHS together, while they are robbed of pay and respect and battling their own mental exhaustion.



I have four points to make. First, for years, Professor Michael Marmot has called for a focus on tackling health inequalities to improve health and wellbeing. This reorganisation will not see such a shift in health outcomes. Secondly, absent of a funding framework and with the national prescription of NHS provision ripped out of the NHS in 2012 by the coalition, the postcode lottery will entrench. In places such as York, rationing denies people vital healthcare.

Thirdly, I know that this Government hate scrutiny, but without it, wrong decisions are made and people suffer. Better accountability, not less, nationally and locally is needed. There is too much blame shift under this teflon Tory Administration. Strong governance and accountability leads to transparency and better outcomes. Fourthly, tragically, this past year has seen the most vulnerable exposed to the greatest risks. Of the 128,000 who have died, a third were in care homes, many alone.

Since 2010, this Government’s annual pronouncements of imminent social care White Papers have been worn like the emperor’s new clothes, laying the Government bare with no resolve. Unless there is a fully integrated public health and care service free at the point of need, we will never build the caring and compassionate society that we need.

The Government’s proposals drive the market through the centre of our NHS. While stripping out section 75 regulations is a must, their purchaser-provider approach conflicts with the planned collaboration necessary to fix the scale of challenge. These reforms provide neither remedy nor cure. There are no foundations, no strong structure. The Minister needs to go back to his architect—in my book, it should be the Labour architect of our NHS—and redraw his plans.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. There have been some withdrawals from colleagues wishing to speak, so I will put the time limit back up to four minutes.

Covid-19 Update

Rachael Maskell Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

The best understanding that we have is that five of the 18 who were in hospital yesterday had been vaccinated once, and one had been vaccinated twice but it is not clear how recently. Therefore, the majority have not been vaccinated, but most of them could have been vaccinated. That is frustrating to see, but it is also a message to everyone. We monitor this closely and the latest information on those who have been admitted to hospital in Bolton over the weekend is similar: the majority are unvaccinated. It reinforces the message that people should come forward and get vaccinated, because that is best way to protect everybody.

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

Before Christmas, it was the mutation—the Kent variant—mixed with the opening of the economy in York that caused a rapid spike of covid-19 infection, as people came to visit our city en masse and spread the virus through the hospitality sector, where still many workers are yet to be vaccinated. Here we are again, and who knows what will come next? A different variant—the Indian variant—with high transmissibility is about to be spread in a city that many people are already visiting, with more to come. We feel vulnerable. What proactive, preventive steps will the Secretary of State take so that we do not pay that heavy price again for the Government not acting fast enough?

[Matt Hancock]

The most important difference between now and then is, of course, that the vast majority of those who are vulnerable to ending up in hospital or dying of covid have had two vaccines. The vaccination uptake rates have been spectacularly high and the uptake rate of the second vaccine has also been incredibly high. That means that the protection afforded to those who have chosen to take up the vaccine is very high. The latest estimates show that having two jabs and waiting a fortnight or so after the second jab leads to around a 97% reduction in mortality. Of course, we will continue to drive and to open up access in order to find the final few per cent. of people, but the lesson of the last few days is that people who have not taken up the opportunity to be vaccinated should do so, because it is those people who have sadly ended up in hospital, and we do not want that.

Public Health

Rachael Maskell Excerpts

Monday 26th April 2021 Commons Chamber

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

It is late and I will be brief. Over the Easter weekend, I walked through a tragic situation concerning a constituent that reflects the insufficiency of the regulations before the House this evening. I certainly echo many of the concerns that have already been expressed in the debate.

My constituent could not travel back to the UK to see her mother because her mother was in a care home. However, her mother’s condition suddenly deteriorated, so she raced back to see her. As she had taken the two vaccines and had already tested negative, she travelled through hub airports. In the first, she was completely isolated from other passengers; in the second, she mingled with red and green passengers. She then touched down in the UK.

Sadly, my constituent’s mother passed away. My constituent had to go to a quarantine hotel, whereas many of the people she had been mingling with just hours before were free to travel wherever they wanted. When she arrived—obviously, she paid an extortionate amount for it—she was put in a poorly ventilated room and allowed out for only 20 minutes a day. She was in deep grief. She wanted to be at home with her father—isolating, absolutely—but that was denied. Over the Easter weekend, she had two appeals and private transport was arranged, but she could not leave that quarantine situation.

With regard to my constituent’s wellbeing, she felt imprisoned, with no support. When I raised the issue of support, all I was told was that she could be assessed for suicide. She was in deep grief. She needed to be with family, isolating as she was. The only concession I was given was that her father, who was also mourning, could travel to Birmingham from York and, at the full cost of £1,750, stay at the hotel for the full quarantine period. He had legal matters to deal with besides his grief. Other constituents have highlighted the lack of support around mental health.

My constituent is not a criminal, and she would follow all public health guidance required of her, including testing and whatever was needed by a local public health team. Her mother had just died, she was broken with grief, and no one had the capacity to find a solution, while others she met on her journey were free to go anywhere in the UK. That is why these regulations are not fit for purpose.

Further to that, my constituent was told that she would be able to go to the funeral, but if she was to do so, her father would have to drive for more than 12 hours to collect her and then return her, in the midst of his grief. That is not only dispassionate but dangerous—and she would be among 29 other people at the funeral, but she was not allowed to stay at home with just her father. Schedule B1A, paragraph 13, needs significant amendment. It is time to understand humanity and infection control. Both can be achieved, but that is not found in these regulations. So I urge the Government to get a grip of these really important issues and to get a heart.

Stroke: Aftercare

Rachael Maskell Excerpts

Wednesday 21st April 2021 Westminster Hall

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

Thank you for calling me, Sir Edward. I extend my gratitude to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) and wish his wife well on her stroke journey. I was a physio in the NHS for 20 years and worked in stroke rehabilitation, so I obviously know this issue well from a practitioner’s point of view. I echo much of what I have heard in the debate as the reality of clinical practice. During the course of the debate, about 12 more people in the UK will have had a stroke, which is why urgency in getting things right is so important.

Public health measures are absolutely crucial, because smoking and poor diet and exercise contribute extensively to the risk of having stroke. Above and beyond that, once somebody has entered that journey, we need to make sure that they get the optimum care. In acute care, thrombectomy processes are improving people’s chances of good recovery, which is fantastic, but a significant postcode lottery still loiters around that, which we have to address.

My first question to the Minister is therefore whether, as the NHS goes through significant change over the next couple of years, integrated care systems will be charged to set up their own clinical networks for strokes and to ensure that they have the specialism for that acute phase of stroke placed in each one and also spread through the network. It is really important that we bring this to the fore, and that, as the NHS changes, we make sure that the right services are in place.

All too often, as patients were discharged from my care, I would fret about where they went. If they went to a specialist rehabilitation centre, I knew that all would be well, but if they went to a more generalist step-down facility, or were discharged into the community, without that specialist input—speech and language therapists, occupational therapists, clinical psychology as well as neuro physio—I would worry. It is a specialism in and of itself; indeed, neuro physio diverts into stroke rehab. Making sure that people have the up-to-date specialist skills makes all the difference. They take a long time to train, but they change the way somebody with a stroke is approached.

One challenge I always found was the pressure to get people out the hospital door and discharged quickly. To actually re-educate somebody’s mind and body to synchronise and work together in a new way takes time, and therefore ensuring that there is that investment in time is really important. We also cannot push somebody because they become tired, so we have this really delicate balancing act of timing.

It is different for absolutely every patient, but as they go through that journey, they need that specialist support. I will give an example. They may be discharged home, but we know that so many people, once they go home, will just sit in a chair, as opposed to carrying on their rehabilitation. Or perhaps, even when getting up from the chair, they will take the short cut of pulling themselves up, increasing their muscle tone, which is detrimental, as opposed to, say, using a proper Bobath method of facilitating their muscles. That makes a real difference how this issue is approached, and therefore the paucity of stroke rehab specialists must be addressed, making sure that that skill mix is there, but also with the right level of training. That is crucial.

I ask for more training around stroke rehab for GPs and in the community in particular. A community physio may deal with respiratory patients, musculoskeletal patients, neuro patients. We want neuro physios in the community through an extension of specialist rehab centres moving into the community while keeping that clinical case load. We also want the same clinicians along a patient’s rehab journey. It is not easy for clinicians to relay information about a patient simply, so following them into the community could be a different way of doing that as opposed to the silos of our institutions that we currently see.

One other thing is really important. We know that stroke is for life, and therefore we need to ensure that the services are there for a substantial amount of time. I have raised the issue of the six-month review, which is far too long to wait—an individual may plateau or even regress in their care. Regular intervention is really needed and, if someone has plateaued or regressed when they could have been progressing, they should be brought back into more specialist care, even if that is residential care, to help them take that step forward again and get that continuity that is needed. If we do not put in those interventions, clearly the impairments experienced by someone will deepen, which will create pressures that will show themselves elsewhere in the NHS or the social care system. Therefore, that investment is so important for people as they are recovering from stroke.

There is clearly so much to be done. I really welcome the call for an APPG and would be happy to serve on such a group should it arise, but as we are currently reimagining healthcare, this is a real opportunity to put the patient’s need at the centre of a stroke service and ensure that we sustain that for the rest of their life.

Elective Surgical Operations: Waiting Lists

Rachael Maskell Excerpts

Tuesday 20th April 2021 Westminster Hall

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

It is a pleasure to speak with you in the Chair this afternoon, Ms McVey. I extend my thanks to my hon. Friend the Member for Bootle (Peter Dowd), who opened the debate so well.

Once more the NHS has been pushed to its limits these past few months, and once more it has delivered an unprecedented response. Every single person working for the NHS has strained every sinew at every hour of every day and night to support as many people and save as many lives as they could. I know how staff in York’s NHS services have stretched their known capability, skill and knowledge, have extended their capacity to care and support, and have served our community without complaint or restraint. For that reason, I echo hon. Members who have said that those staff need to be justly rewarded with a well-overdue pay rise.

At York Teaching Hospital, 1,974 covid-19-positive patients were treated between September 2020 and the end of March 2021, in a very challenging clinical environment, where infection control measures tested staff and the system. The hospital is already a challenged site, and that experience indicates that conversations must commence on the future of the hospital estate in the city. It serves a growing population, and I hope that the Minister would clock that and be open to early discussions about how, over the next decade, we can develop plans to meet the health needs of our city. Already, year in, year out, over the winter crisis it is challenged, but covid-19 has really pushed it to its limits.

As the latest phase of the crisis abates, the next mountain must be conquered. The pressure it causes is relentless. Elective surgery, which was stood down at the beginning of the pandemic, continued through the rest of the period. However, we know that the number of cases has built up.

In York, the independent sector is used to provide some of the cancer care. Good cancer networks were built with the local establishment. It would be good if the Government would publish the amount they have spent on contracts with the independent sector throughout the pandemic. Has it been at cost or at an escalated cost to the state? We need that information so that we can understand the extent of the use of the independent sector and so that lessons can be learnt about the need for national contingency in public health facilities, and about how the private sector is drawn on and whether there are better models out there for procuring services.

While staff have had to be redeployed to respond to covid-19 and address clinical priorities, which is absolutely right, York managed to continue with its planned surgery through the national phase 3 elective services restoration period up until March 2021. It has done really well: it has delivered 96% of the planned elective in-patient activity—ordinary elective and day cases—and 108% of the planned out-patient activity. That equates to the delivery of nearly 3,000 ordinary electives, 36,000 day cases and nearly 400,000 out-patient appointments over the six-month period. That is an incredible feat, because of the constraints—indeed, due to the sharp rise in covid cases in York, particularly following the Christmas period, 564 elective procedures were delayed—but those figures dwarf into insignificance compared with the scale of what is needed now. Nationally, there is a reckoning that it could take about five years to clear the list. And of course the Minister is planning a reorganisation of health services in the midst of all that, which may have some implications. I trust that, in his response to the debate, he can say how that will be bridged.

As we went into the pandemic there were already significant backlogs in elective care, as a result of austerity measures—cuts—being applied to services. That has had its implications in York. We have a high level of recruitment and retention in York—the vacancy rate is just 6%—but clearly there are implications due to the rationing that was applied. As a result, our clinical commissioning group, Vale of York, has applied rationing to services, and I want to dwell on that for a moment, because many procedures are no longer available in the city, but also many involve restricted access for those with a BMI over 30—in the case of hip and knee replacement surgery, it has now been lifted to between 30 and 35—and for those who smoke. We know that that discriminates disproportionately against those who experience socioeconomic disadvantage.

I have debated the issue many times in the House, but to this day I hold, as does the Royal College of Surgeons, that these should be clinical decisions, and should not be based on algorithms to weigh the clinical risks. Of course we all understand that smoking and obesity lead to significantly higher risks in surgery, but far more needs to be done to support people with weight loss and smoking cessation. With surgery already significantly delayed because of the pandemic, to deny people access to a waiting list removes the clinical support that they need. They also need additional support to address the risk factors, not least because we know that, for many people who smoke or are overweight, that is the case because they are dealing with the presentation of their illness. For instance, they may not be able to exercise and mobilise because of pain, which makes them more susceptible to putting on weight—or perhaps because of stress and depression.

We need to see those issues addressed. We need to see far more intervention in the form of prevention at these points, but also it needs to be understood that people should not have to wait even longer for the elective surgery that they need. We know that, over the last 13 months, there has been a serious drop in the number of people accessing diagnostic tests, out-patient appointments and other clinical services, so they are set back even further. And of course it is not just those cohorts of patients who are affected; we know that the effects have gone to so many other areas. As we have heard, the impact on cancer diagnosis has been significant as well. We know that today there are many people living with undiagnosed conditions who will, when they present, have greater risk and poorer outcomes unless this situation is attended to urgently.

Altogether, the waiting lists could double—none of us knows exactly what will happen—for clinical procedures once community referrals catch up. That would just break the system and therefore we need to see more reparation being put in place. I know that the Minister is looking at those issues, but by the time someone receives surgery they are likely to have more complexities, more underlying health conditions and a poorer prognosis. As we have heard in the debate, approximately 18,000 people could also see premature mortality as a result of this. Of course, there is a significant loss to the economy, loss of jobs, loss of income, loss of lifestyle and loss of social connections, leading to mental health challenges as well. We need to make sure that during this period people have access to social prescribing and support for wider needs as well as their clinical needs.

Bearing that in mind, I want to dwell on the issue of diagnostic testing and the fact that attendance in some areas was already low. Will the Minister look at how specialist clinics and testing centres could be set up to screen the population? Just imagine if everyone who had their covid-19 vaccine had a thorough health MOT at the same time. That would have been transformative. I ask the Minister: what can be learned from the vaccine roll-out to be applied to screening programmes and out-patient backlogs, to ensure that the NHS gets back on track with the provision of services as they are needed, and perhaps as a model for the future, too?

I want to raise one more point before I return to elective surgery; that is the issue of research. Research has been significantly shelved over the last year. We know that surgical advances will assist by cutting waiting lists, reducing the risk of procedures and reducing the need for surgery in the first place. I urge the Minister to ensure that there is significant investment in clinical research, and that it is stepped up, not cut back.

To return to elective surgery directly, first, on staffing, we know that we have an ageing workforce and many of those who have stepped up this year are now stepping back. Other staff members are exhausted and, frankly, shattered by their experience over the past year, so we need to ensure that we see that growth in the workforce. I trust that NHS planning and commissioning of training will increase, and not just to ensure that we address the current crisis; that could be extended into the future shape of healthcare. We need to get those figures right and not see the famine and feast that we have often seen in the past—although I cannot quite remember a period of feast. However, we certainly need to see proper provision of staffing.

As for facilities, we cannot dismiss the fact that over the past decade, about 12,500 beds have disappeared from our NHS. Cuts do have consequences and we have paid heavily for that. This is an opportunity to look again at how we configure our services, both on the acute side and in rehabilitation, to ensure that facilities meet needs. All surgery carries risk, so critical care support must be available, but we also need to ensure that more is done to support rehabilitation centres of excellence. Often we see patients being discharged far too prematurely, only to bounce back into the system or not fare as well as they could have done, had they had more rehab before going home. I speak as a former physiotherapist, so obviously I am passionate about that, but it really does make a difference.

In the past, patients undergoing hip, knee and other orthopaedic procedures have often gone to rehabilitation centres. Some of those centres no longer exist. For us in our profession to put people through their paces and gain the confidence they need, we need to make sure that they have those skillsets before they are discharged home. That is because we know that when people get home, the biggest risk from those procedures is that they just sit in a chair and do not mobilise at the level that they could, which of course undoes all that has been achieved. What a waste of money, but also what a waste of opportunity in somebody’s life.

Community provision is still patchy and we know that the sufficiency is not there to give people the time and investment that they need in a domiciliary setting. Following elective surgery we need to optimise not just acute care but the rehabilitation process, and make sure that post-operative care is at an optimum.

Just before I close: as many have said, the numbers are significant, they have risen sharply and the situation requires significant investment. We are moving into a new model of health provision over the next period. It is really important that we get it right and that we ensure that, before the legislation comes to the House later this year, we have the levers in place to address this form of care, locally as well as nationally. It cannot be business as usual. The next crisis is here and needs as much attention as the Minister and his team have given to the last.

Social Care Reform

Rachael Maskell Excerpts

Thursday 18th March 2021 Westminster Hall

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

It is a pleasure to see you in the Chair, Dr Huq. The arguments are well rehearsed, the need well understood, the unfairness deeply felt and the failure exposed in countless reports, but nothing changes. Like an annual custom, the Government announce a social care White Paper to be published later in the year, but nothing ever emerges. Meanwhile, the most vulnerable families have to pay out tens of thousands of pounds, and one in 10 over £100,000, for care by underpaid, undervalued and overworked care staff, either at home or in some institution. This year, they have even been denied seeing familiar faces—imprisoned for the crime of growing old or disabled as their lives have faded into a so-called care industry that largely seeks profit out of frailty.

We must establish the core principle that the state recognises its responsibility to care with parity of esteem with the NHS. My report into care homes in York exposed the failure of governance of funded care, with a business model that protects commissioners and providers, but not residents. We cannot continue to sell the lives of our most vulnerable in the marketplace of social care. Instead, we must make a pact with people who just want to be safe and not exploited. Principle one is that the state has the duty to care. Principle two is simple: social care must be a universal benefit. None of us knows the twists and turns of life that will lead us to need help. A caring society will reach out and meet that need.

Principle three is funding—public not private insurance. As we see in healthcare and care systems around the world, the private insurance industry’s lucrative revenue has driven the sick and the frail out of health and care. Every penny must be reinvested in enhancing care. If we are ever to bring funding together, we need to have one system. We have to be honest—high-quality care costs. And a Government will pay for what they value.

Principle four is quality. First, the care must be safe. My report into care homes showed that the larger care home companies provided some of the worst care. Secondly, the care must be person-focused and meet aspiration; it should not just meet basic need or be based on ability to pay. These are our mums and dads. We need a high-quality care standard, driving up quality.

Principle five is robust accountability. Although the Care Quality Commission has its role, I have to say that it seriously needs to beef up its whistleblowing processes; commissioners of care hide under layers of contract confidentiality. We need transparency. The sequencing of the Department’s White Papers has meant that the governance White Paper has been published before we know what the social care White Paper will say. So, can the Minister give assurances that the social care White Paper will be published before the Health and Care Bill comes to the House?

Principle six is about staffing. Care professionals must be paid a professional wage, but 1.6 million of them earn less than the real living wage and a quarter of them are on zero-hours contracts. They need associated registration to keep them and the public safe. As for insecure jobs—every person needs to know that they will be loved, cared for and kept safe when they need care.

Covid-19 Vaccine Update

Rachael Maskell Excerpts

Thursday 4th February 2021 Commons Chamber

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

Pharmacies cannot contribute in the vaccine programme unless they commit to deliver at least 1,000 vaccines a week. That precludes many community pharmacies embedded within those communities where some residents cannot access the vaccination centres. So will the Minister allow local pharmacies to work together to deliver smaller volumes, so that they can reach more residents who would not otherwise get a vaccine?

[Nadhim Zahawi]

I am grateful for the hon. Lady’s question. Community and independent pharmacies have a significant role to play; she may have heard me refer earlier to the hundreds that are already in the programme, delivering vaccines. The reason for the 1,000 vaccinations a week minimum is that, when vaccine supply is finite and every dose matters, we cannot afford for vaccines to just sit in a fridge in a smaller pharmacy. As vaccine supply begins to improve, we can look at bringing in more pharmacies. At the moment, 98% of the country is within 10 miles of a vaccination site; for the 2%, we will go to them with a pop-up site. I want us to get to a stage, once we have done phase 1, where we are maybe able to be more convenient and where people can pop into their local pharmacy once supply allows.

Vaccine Roll-out

Rachael Maskell Excerpts

Thursday 21st January 2021 Commons Chamber

[Matt Hancock]

[Inaudible.] the date when it will open. There is a huge amount of investment going into Harwell to make sure that we have cutting-edge vaccination manufacturing facilities for the future. The project is being led by my right hon. Friend the Secretary of State for Business, Energy and Industrial Strategy, so I will write to my hon. Friend with all the details.

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

I have serious concerns that, after people have had their first and, indeed, second vaccines, they will have a false sense of security about their level of immunity; we know that the efficacy even after two vaccines is not 100%. Will the Secretary of State ensure that it is communicated clearly that people will still need to follow the public health guidance of hands, face and space of at least 2 metres, even after two vaccines and until it is safe to do otherwise?

[Matt Hancock]

The hon. Lady raises an incredibly important point: someone who has been vaccinated can still catch coronavirus for several weeks. It is really important that people know that. When people are vaccinated, they are told the time that it takes and the limit of the effectiveness, especially in that early period, and they are told very clearly that they still have to follow the rules. That is an important part, especially until we can measure the effectiveness of the vaccination programme on transmission. Only yesterday, I reviewed the communications that go to people when they have been vaccinated, and they are very clear and robust, but it is important that everybody, post-vaccination, continues to follow those rules, both to bring the number of cases down because of the impact on transmission and to protect themselves. The vaccine is the way out, but it does not work immediately, and people still need to be cautious.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 12th January 2021 Commons Chamber

[Edward Argar]

I reiterate, as I did earlier, my thanks to the hon. Lady and all her colleagues in the NHS for everything they are doing. I reassure her, as I do and as my right hon. Friend the Secretary of State does at every opportunity, just how valued and supported our NHS is. We have put in place just over 1,000 additional critical care bed capacity at this time—the right thing to do. In addition, in respect of supporting staff, we are investing about £15 million—just one example—for mental health hubs and mental health support for staff. I saw, from the hospital that she works in, or has worked in, in her constituency, a number of staff—it was on the BBC recently—setting out just how flat out they are. The best way we can thank them, alongside what we are doing—I make no apologies for reiterating it, Mr Speaker—is by all following the rules to stay at home to help to ease the pressure on those phenomenally hard-working and valued staff in our NHS hospitals.

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

If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Yesterday, we launched our UK vaccines delivery plan, which sets out how we will vaccinate hundreds of thousands of people every day, starting with the most vulnerable and staff in the NHS and social care. I am delighted that across the UK 2.3 million people have already been vaccinated. We are on track to deliver our commitment to offer a first dose to everyone in the most vulnerable groups by 15 February. At the same time, I add my voice to all those who are passing on their very best wishes to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire), who is undergoing further treatment on the NHS. I personally thank all those in the NHS who are looking after him and all the other patients in their care.

[Rachael Maskell [V]]

The NHS is overwhelmed, and critical clinical choices are having to be made due to the limitations of estate and staffing. So I ask the Secretary of State if he will do two things: first, bring all independent hospitals under the NHS to provide a response to the national crisis and, in particular, provide cancer care capacity; and secondly, call all former health professionals to return to practice and re-register even if they are beyond the three years out of practice limit, so they can work with an element of supervision and no one is denied the clinical need they have.

[Matt Hancock]

Of course, all these things are being looked at. The pressures on the NHS are very significant. I also want to say to people who have a healthcare condition that is not covid-related that they should come forward to the NHS. The promise of the NHS, of always treating people according to their clinical need and not ability to pay, is crucial. It is just as crucial in these pressured times as it is at any other time. If you find a lump or a bump, if you have a problem with your heart, or if there is a condition for which you need to come forward for urgent treatment, then the NHS is open and you must help us to help you. So, yes, we absolutely will do everything we possibly can to address the pressures, including looking at the measures the hon. Lady set out, but also let the message go out that, if you need the NHS for other conditions, please do come forward.