NHS Dentistry: Recovery and Reform

Rachael Maskell Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

We have focused this plan on introducing the new patient premium—a bonus for new patients. Having discussed this carefully with professionals, we think that is one way that we can incentivise people into NHS practice. Dentists can already work up to 104% of the contract. Many do that, but some sadly do not, so we are trying to encourage those dentists who already have NHS contracts to go the extra mile and use the full slot available to them.

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

The Health and Social Care Committee took months gathering evidence and putting together a recovery plan, which the Government should have adopted. Dentists wanted that plan put in place. Central to it was reform of the NHS dental contract. However, the Secretary of State has completely failed to even mention reform of that contract. As a result, dentistry in my constituency in York, where constituents are waiting seven years to see a dentist, will not have the recovery that she talks about. Why did she not adopt our plan?

[Victoria Atkins]

I hope the hon. Lady will, as usual, be the help that I expect her to be to her constituents in publicising this plan. We are getting graphics and information out to all Members of Parliament, so that they can help their constituents understand what will be available in their area, because each and every one of us wants the very best for our constituents. She will be interested in the new patient premium, which is encouraging dentists back into NHS practice, or into NHS practice for the first time, and in the increased price for units of dental activity. Reform of the dental contract is part of our agenda, but we realised that we needed to give immediate help to communities such as hers.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Giles Watling (Clacton) (Con)]

7. What recent steps she has taken to increase capacity in NHS dental care.

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

18. What progress she has made on introducing a dentistry recovery plan.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I am determined to ensure that everybody who needs NHS dental care can receive it. We have already implemented a package of reforms to improve access and provide fairer remuneration for dentists. That has had an effect, with 1.7 million more adults being seen, 800,000 more children being seen and a 23% increase in NHS activity in the past year. We know we need to do much more, and our dentistry recovery plan will be published shortly, setting out a big package of change.

--- Later in debate ---

[Dame Andrea Leadsom]

As my hon. Friend will know, this is a local matter, and it is for his ICB to determine whether it wishes to support the excellent pilot proposal for overseas dental students in Clacton. At the same time, it needs to ensure that its actions are compliant with current legislation and within the delegation agreement with NHS England. I have just written to my hon. Friend about that, and my letter should address his concerns, but of course I would be happy to see him again if he has any further questions.

[Rachael Maskell]

We were promised “before the summer”, we were promised “after the summer”, we were promised “before Christmas”, we were promised “soon” and now we have been promised “shortly”. The reality is that Labour has a plan and the Government have not. In York, we cannot get an NHS dentist either. Blossom Family Dental Care is just handing back its contract. My constituents have nowhere to go. What is the Minister going to do to ensure that my constituents can access NHS dentistry?

[Dame Andrea Leadsom]

As I said to the hon. Member for Oxford West and Abingdon (Layla Moran), I absolutely understand the challenge for some people. The situation has improved over the last year. Since the covid pandemic, where almost every dentist had to stop working altogether, we have not seen the recovery we want. We are putting in plans—not a paper ambition like the one Labour has put forward, but significant reforms that will enable many more people to be seen by NHS dentists. I say gently to the hon. Member for York Central (Rachael Maskell) that a recent Health Service Journal article states that Humber and North Yorkshire ICB

“have indicated in board papers that dentistry funding will be squeezed to help them balance their books.”

I encourage her to talk to her ICB about that too.

Draft Anaesthesia Associates and Physician Associates Order 2024

Rachael Maskell Excerpts

Wednesday 17th January 2024 General Committees

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

It is a pleasure to serve on the Committee, Dame Caroline. Before I begin, I declare that I was a registered professional with the Health and Care Professions Council, and worked in the NHS for 20 years before coming to this place. I was also the head of health at Unite, so I have a strong background in understanding the regulatory frameworks in the NHS.

I understand the issues that the Government are trying to resolve, given the changing nature of the NHS, the emergence of new professions, and the need to protect patients. I agree that all NHS professionals must be registered, and regulatory reform is long overdue, including for anaesthesia associates and physician associates. When Agenda for Change was piloted in 2003 and fully instituted in 2004, a job evaluation scheme was designed for this very purpose, and was overseen by the formidable Sue Hastings. However, emergent professions cannot just be add-ons to existing regulation. They required their own registers, governance and accountability, not least to ensure professional competence. The order is the first expression of that, 20 years on.

Also, the knowledge and skills framework enabled people to grow in their professional competencies and provide a higher level of care. That could lead to hybrid roles forming. I remember Alan Milburn saying at the time that the NHS career framework should enable someone to move from the role of porter to neurosurgeon—I do not know if that has ever been achieved. It is important that at every stage there is protection for the professional and, most importantly, the patient.

The reality behind the order is that the professional silos of the last 150 years or more are rapidly evolving and morphing in new ways, and the regulatory framework has to capture that and catch up. I agree that we urgently need a system of statutory regulation for anaesthesia associates and physician associates. They are working at a significant level of decision making, and they have a duty to uphold professional standards, their training must be of the highest standard, and there must be a fitness-to-practise process through which they can be called to account. I agree with my hon. Friend the Member for Bristol South that we need to ensure that that is rigorous and upholds standards, but I also welcome the fact that they may be expedited within the new system.

I have been asked whether the GMC is the right regulatory body. I understand the arguments for and against. This is where a lot of the concern comes from, which is why regulation is important. The challenge to this order is the lack of clarity about titles, roles and the competencies associated with each role. It could be argued that, for greater distinction, the HCPC, for example, is a more relevant registrant. I believe that that should have been examined further, not least as AAs and PAs are professionals allied to health and sit within the “Agenda for Change” family.

The public are nearly universally unaware of different roles in the NHS, let alone what they can or cannot do. In a clinical setting, if someone with a stethoscope around their neck calls themselves part of the medical team and they assess, diagnose and treat a patient, it will generally be assumed that they must be a doctor. I remember that when I started practising, if you were a woman, you were a nurse, and if you were a man, you were a doctor, so I certainly know that the distinctions are not always there. However, some use the title “Dr” because they hold a doctorate in another field, and that needs to be looked at. Further, there is a new lexicon of technicians, assistants, associates, advanced practitioners, and no doubt many more. I urge the Minister to find a common language so that there is simplicity and accuracy, and so the public understand the distinctions between these roles and those of the established professions.

In talking to the British Medical Association, I heard how people are now working above their competencies as AAs and PAs—carrying the consultant’s bleep, for example. That is deeply disturbing and just reinforces the public confusion over the distinct identity and purpose of each clinical role. Boundaries must be clear and distinct and, for the sake of safety, defined nationally rather than determined locally.

While the Government are very much focused on vertical integration, which can exacerbate things such as skill mix, I urge the Minister to further consider the power of horizontal integration. We have seen some, for example with advanced practitioners reaching across professional silos, and in developing a focus on primary care it could bring strong benefits. We need to ensure that new regulatory frameworks address that. The blueprint for a future professional regulation framework must account for this opportunity.

As with all professions, medicine must not be exempt from looking at how it can be reshaped. However, when someone who has had two years’ training is paid more —ironically, 35% more; Members might recall that number—and assumes more authority than a doctor of seven years’ training with a higher level of competency, there is clearly a problem in the design of the role and cause for concern. We need to look at how we can move beyond traditional silos and create skills pathways that honour professions and the level of their skills, so that competencies can be gathered, tested and examined along the way. I believe that there needs to be a full job evaluation to understand the challenges between the professions—yes, across the two core NHS pay structures—and then a clear delineation of roles. For example, senior doctors in training in anaesthetics are now in a logjam, unable to progress to a consultant post due to the rise in the redeployment of anaesthetist competencies to AAs.

The same could be said of the Government’s prioritisation of PAs over, for instance, traditional senior house officers. There is serious concern about the diagnostic skills of PAs; there have been examples of failure, as we heard so powerfully about Emily Chesterton, the daughter of the constituent of my hon. Friend the Member for Worsley and Eccles South.

These functions need serious reconsideration and tight regulation. The GMC must ensure that their scope is clearly defined and that, before further role reforms occur, there are assurances that there will be no further scope creep. Clarity of role is really important in prescribing too. Some AAs and PAs may have transitioned from professions where they were already prescribers. We need to hear from the Minister how that situation will be managed, with clear delineation.

I want to touch on the issue of liability—where responsibility lies. With registration, AAs and PAs will be autonomous practitioners, liable for their own conduct and practice. How will the regulator ensure that liability is apportioned in the right way between them and those who provide supervision? Will they receive one-to-one supervision, and how far will liability carry on to, say, the consultant or senior registrar? That is a really important issue to consider in the immediate future, not only for AAs and PAs, but for doctors and doctors in training, who must receive supervision too. We need to ensure that a new generation of doctors in training are able to receive the support that they need, and that it is not all dedicated to AAs and PAs.

Furthermore, with the envisaged rapid expansion in the number of AAs and PAs, the GMC needs to determine that supervision is safe and appropriate, and at the level required to enable people to mature into highly skilled professionals. It must also ensure that there is not a spike in fitness-to-practise cases due to lack of investment. The call from the medical profession is for us to slow down and properly evaluate and understand the consequences, seen and unforeseen.

On part 3 of the order, which concerns the register, can the Minister clarify that the associates will be on a separate register to doctors at the GMC, and that they will have their own register, as identified in article 5(2)(a)? I note that AAs and PAs will be on one register, but in separate parts. Will he explain to the Committee exactly how that will operate? Holding information separately would enable greater access for the public to the information they seek with respect to the new associate roles. The register must be robust and easy to navigate and, like the register for doctors, provide the public with all the information that they require. I know that the GMC has agreed to put a simple prefix ahead of registration numbers, but the professions are calling for more distinction so that there can be no confusion.

I am mindful of the higher proportion of cases generated from AAs and PAs. Will the Minister ensure that the registration fees reflect that? It is vital that the Government and the GMC, in formally setting up the statutory register over the coming three years, work closely with the professionals to ensure that they are engaged in the process and that their concerns are picked up and addressed along the way. I am asking the Minister to commit to that today, as I know my hon. Friend the Member for Bristol South will when she has the opportunity later in the year.

Patients, the wider public and fellow clinicians need to understand these fine lines and distinctions for their safety and safe practice across the NHS. The culture of “get it right first time” must be central to this debate and all that flows from it. If regulation lands in the wrong place, the Minister and the GMC need to be candid and ensure that it is changed so that it is fit for purpose. I trust that Parliament will have further opportunity to scrutinise these developments.

NHS Winter Update

Rachael Maskell Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I welcome my right hon. Friend back. I have said throughout this that I was extremely disappointed that the committee chose to walk away from discussions. I also think that there is a lot more to discuss apart from pay—I have made it clear that I would like to look at other aspects of their working conditions—but, unfortunately, the junior doctors committee walked out. The strike action has had a real-terms impact on patients. We need to find a fair and reasonable solution, but I will not do that while the junior doctors committee maintains strikes. It will have to come to the table with reasonable expectations and change their minds on the validity of strike action.

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

We have had 14 Tory winters. One would have thought that they would learn by now that the real crisis in our NHS is that social care is not up to scratch. A quarter of patients in my local hospital are waiting for social care. As a result of jamming the back door, the front door becomes inaccessible to so many patients. After all these years, when will the Secretary of State publish a proper plan for social care, or will she leave it to my right hon. Friend to take over?

[Victoria Atkins]

I am so sorry, I do not know who the hon. Lady is referring to. On the Conservatives’ plans, at the 2022 autumn statement we announced up to £7.5 billion of additional funding—an historic increase—and we did not stop there. This summer, we announced an additional £600 million, which brings it up to £8.1 billion of additional funding over two years. That will support our care workforce, and the majority of the funding will end up in the pockets of the amazing people who provide care and support to the patients we are all concerned about.

World Stroke Day

Rachael Maskell Excerpts

Thursday 23rd November 2023 Westminster Hall

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

Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that.

As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack. For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.

I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke. We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that.

I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.

The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer.

I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call. I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment.

I turn to diagnosis. In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know—[Interruption.] It looks like the Minister is in some pain; perhaps he needs my physio skills.

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

Sorry; it is my shoulder.

[Rachael Maskell]

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

[Mr Philip Hollobone (in the Chair)]

No Westminster Hall debate would be complete without a contribution from Jim Shannon.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. Like others, I begin by thanking my hon. Friend—I will call him that, because we are friends—the Member for Bromley and Chislehurst (Sir Robert Neill) for securing this important debate to mark World Stroke Day. I thank him for not just his continued advocacy and the work he does here in Parliament, but sharing his personal experiences. On behalf of the whole House, we send our love to his wife and to him for the work he does to look after her.

We have had a small but perfectly formed debate. I want to thank my hon. Friend the Member for York Central (Rachael Maskell) in particular for her powerful contribution. She speaks with experience that I could only ever dream of; it is so important that her expertise, knowledge and past experiences should shape and inform the debate. I thank her for that. Likewise, I thank the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows), who leads on health issues for the SNP, for their contributions. We have had a good, thorough debate, covering a lot of issues. Hopefully we have marked World Stroke Day well in this place today.

It is stating the obvious to say that stroke can have a life-changing impact. As we have already heard, the statistics show that in the time we are here this afternoon, 14 people across the United Kingdom will have had a stroke—that is one stroke every five minutes. Although often a sudden event, the lasting impact of stroke for patients can be devastating. It is one of the leading causes of adult disability across the United Kingdom. Two thirds of stroke patients—let that sink in—will leave hospital with a permanent disability, often needing lifelong care. Sadly, stroke is often fatal, causing around 35,000 fatalities across the UK every year, making it the fourth leading cause of adult death.

What those statistics demonstrate to me is that however far we have come on the journey with stroke, we need more concerted action going forwards—not just from a patient care perspective, but given the significant impact that not acting on stroke has on the economy. There is an economic argument, not just a patient care argument.

I pay tribute to the work of the Stroke Association, which does incredible advocacy, campaigning and research in this area, as well as other organisations across the UK. Stroke Association research shows that by 2035, stroke is expected to cost the British economy £75 billion a year. That is up from £26 billion as recently as 2015—a rise of 190% in just two decades. Given the strain already on stroke pathways across our health and care system, that is simply unsustainable. The need is clear, and the need is now.

One of the issues holding us back in our fight against stroke is the workforce, as is so often the case and as we have heard today in other contributions. A well-skilled, well-resourced workforce is vital to saving lives and improving the outcomes for patients. However, for too many across the United Kingdom, the workforce is simply not there for them or not there for them in adequate numbers. Half of all stroke units across the country have at least one vacant consultancy post, with the average vacancy being left open for 18 months.

When it comes to thrombectomy—a life-changing treatment that can have a fundamental impact on patient outcomes, as the hon. Member for Bromley and Chislehurst set out—the postcode lottery for care only gets worse. A third of clinicians in this country who can perform thrombectomy are based in London. That is good for Londoners but not for other parts of the country. Given that speed of treatment is critical when it comes to long-term outcomes for strokes, this lottery facing so many people cannot be allowed to continue.

Further along the stroke treatment pathway, other issues persist. Only a quarter of community rehab teams and early supported discharge services are offering support seven days a week. That is not good enough. With patients waiting too long for treatment when they need it and too long for support in the community following treatment, it is clear that the system is broken. That is why I am proud of Labour’s firm commitments on giving our NHS the workforce it needs to get patients seen on time, by delivering an extra 7,500 medical school places, training an extra 700 district nurses each year and ensuring that at every stage of the treatment pathway stroke patients will have access to the care they need when they need it.

But there is so much more work we can do to break down the barriers that too many stroke patients face on their care journey. Breaking down those barriers will take innovation and all parts of the system to be pulling in the same direction. For stroke patients, that is exactly what is needed. Given the crucial role played by primary, acute and social care services in delivering positive, long-term outcomes for stroke patients, co-ordination is the key. However, in too many cases, that co-ordination is simply not happening, and patients are suffering as a result.

We have a primary care system with vast variety in detection of key stroke indicators, such as heart conditions, atrial fibrillation and so on. We have people not getting to the right place in hospital, with only 40% of stroke patients admitted to a stroke unit within four hours of arrival. We have a community care system without the resources it needs to deliver for patients, with the Stroke Association’s report about life after stroke highlighting that only 37% of stroke patients receive a six-month post-stroke review of their needs. It smacks of a system that is not working for anyone.

[Rachael Maskell]

My hon. Friend is making an excellent speech. When it comes to social care, people are often untrained and as a result could cause more harm than good if they do not know how to care for a patient who has had a stroke. Will he ensure that Labour discusses how it will train our care workforce to have the right skills to deliver ongoing care?

[Andrew Gwynne]

My hon. Friend makes an important point. Some of the discussions that I have had, including this week, with professionals in the care sector have been about how we upskill care professionals working in our social care system so that they are able to genuinely—in an integrated fashion, with the NHS—work in accordance with the interests of the person they are caring for and take that person’s needs as a whole. It is also important for these workers to have the professional development, and parity of esteem, terms and conditions and so on with the NHS, to be able to take on those extra responsibilities. My hon. Friend is absolutely right, and that issue is certainly on the radar of the shadow health and social care team as we develop our plans—not just Labour’s workforce plan for coming into government, but our plans on the road map to a national care service.

Whether it is by training more GPs to ease the immense pressure on our primary care system, by putting an end to dangerous hospital waits or through a 10-year plan for fundamental social care reform delivered in partnership with users and their families, Labour is determined to get the system working again. We are determined to build a national health service that is fit for the future, with a long-term vision for a national care service firmly integrated within it. Only by doing all that, getting it right and taking people with us on that journey can we deliver on our long-term mission of cutting stroke deaths by a quarter within the next decade. That is a mission. It is something we are determined to do, because at the heart of this are people’s lives and we want to ensure that we have in place the stroke services that patients deserve.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 17th October 2023 Commons Chamber

[Will Quince]

We will always work with my hon. Friend and the trust on capital improvements where needed, but I am pleased to note that the trust has been allocated significant investment from national programmes in recent years, which my hon. Friend fought hard for, including £32.2 million from our community diagnostic centres programme, which will provide vital testing to local residents close to home, and £3 million from our A&E upgrade programme. We will of course continue to work closely with colleagues in the NHS and the local trust to continue delivering for the people of Stockton.

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

Ten years on from the Francis report, the National Guardian’s Office—for freedom to speak up—reports that last year there were 937 cases where whistleblowers were not listened to and experienced detriment. If we add that to 170,000 complaints, with 30,000 reaching the Parliamentary and Health Service Ombudsman, we can see that the complaints system across the NHS is defensive and dangerous. Will the Secretary of State review the NHS complaints system, and embed a listening and learning culture and early intervention?

[Steve Barclay]

I discussed this with Henrietta Hughes, the patient safety champion, just yesterday as part of the sprint that we have commissioned in the Department in response to Martha’s rule. We are doing considerable work with NHSE colleagues on how we better respond to the concerns of patients, whether it is through the work on Martha’s rule or the complaints process, and a significant amount of work is ongoing as part of that.

LGBT+ People and Spouses: Social Care

Rachael Maskell Excerpts

Tuesday 12th September 2023 Westminster Hall

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

It is a pleasure to serve under you in the Chair, Sir Robert. I pay tribute to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for her powerful advocacy for both Ted and Noel. It was shocking and very difficult listening, and she was eloquent and forceful in making the case to support LGBT people in social care.

I am grateful for the work of York LGBT Forum. It has tirelessly campaigned for the rights of LGBTQ people across the community. It engages with stakeholders to advance the rights of LGBT people across the city and the region. As part of its “Free to be Me” work in social care, the forum is hosting a seminar this coming Friday entitled “Don’t Leave Me in Silence” reflecting on the experiences of people in social care. I spoke to one member last weekend and she talked through the work she had engaged with, and it echoed the inquiry the all-party parliamentary group for ageing and older people, of which I am chair, undertook a few years ago, which recognised the importance of identifying the social care needs of LGBT+ people and their partners.

In the session, which was held in Parliament, we heard how partners were often ignored in social care settings, not least when determining the wishes of their loved ones in care. We heard how, on so many occasions, they were unable to communicate the needs of their relationships before they entered care—instead becoming a distant friend. People in care often felt that they could not even put a picture of their partner up in their room, almost eradicating the memory of their relationship. We heard the distress, the loss of identity and how they felt shame, not to mention their facing some pretty intrusive questioning, too.

With good social care, this should not be an issue. On entering a care setting, a relationship should be established that takes all the needs of individuals into account. It does not take much to ask what someone’s requirements are and who their family is, and to ensure that their family is honoured. It is a central part of care. It is what care is: recognising the human, not just the physical, needs that someone has. It does not take much to ask, and it does not cost much to train staff.

LGBT+ awareness training would significantly enhance the experience of LGBT people in care. The CQC should monitor the training that staff have, and the Skills for Care workforce, which has set out a learning framework, should review that framework, not least in the light of today’s debate, and ensure that it is rolled out to all care settings. It should be a marker that the CQC looks for when examining care settings.

Recently, I talked to a constituent who was still at home and seriously ill. She knew that in the not-too-distant future her time would come for more intense care. She asked that she would be in a setting that recognised her gender identity; she feared being placed in one that would recognise only her birth identity. Such dying wishes must be honoured. That is about respect for the individual and understanding their care needs. It is about ensuring that they are cared for holistically and that they and their families are given the time, care and support that they need. It is about listening; it is about acting. I heard one story about someone who started to be dressed in the clothing that represented their birth gender identity, because no one had taken the time to listen. That cannot be a matter for a care facility to determine; it is a matter for the individual and their family.

This debate has focused on the family, but it is worth remembering that many LGBT+ people may not have family. The chair of York’s Ageing Well Without Children, or AWOC, Sue Lister, has explored what it means for individuals who might not have family at all, or whose partner has passed. She wrote a poem, which I would like to close with today. It is called “Lesbian Loneliness”. It is written about a care setting:

“Magnolia walls house the non-absorbent thrones.

Dry voices whisper round the walls like leaves that fall unnoticed.

Uniformed bursts of energy swirl according to the clock

Bringing this, taking that.

Weathered skin, brittle bones, ghosts of the past

Gather on these barren shores.

My life, my love, has passed away, leaving me hung upon the thorns of grief in a waste of loneliness.

Unspoken. Living too long in the shadow of social shame

I dare not rock the boat and she is buried forever.

‘My love’ I cry in the dark hours and hold her in my heart

By day I pass as an ordinary old woman.”

Countess of Chester Hospital Inquiry

Rachael Maskell Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

First, I join my right hon. and learned Friend in paying tribute to the trial judge and the jury; it must have been a very harrowing case for them to sit on and deal with. He makes, as ever, an important point about open justice. I just have one caveat; I hope he will forgive me. It is that it is also important we get the balance right in respecting the privacy of families where that is their wish, particularly given that quite often these families will have other young children who may or may not know about aspects of this case. So it is important that we have open justice, but at the heart of our approach is ensuring that we are following the wishes of the family, and that includes respecting privacy where that is appropriate.

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

It is all too tragic, and my prayers are also with the families who have suffered so much over this time. It is 10 years since Sir Robert Francis’s report was published, and of course he put forward the duty of candour, yet the duty of candour of seven consultants was ignored and overridden. As a result of that, will the Secretary of State ensure there is an independent external route through which concern can be raised? Further to that, will he look at the accountability, scrutiny and supervision of clinicians throughout the health service, because the pressures on the service at the moment mean that those vital double checks are often missed?

[Steve Barclay]

Again, I agree. It is extremely important that we have the right levels of escalation and the right routes available to those raising concerns. I have already signalled to the House a number of safeguards that have already been put in place following various reviews, including the Francis review. Indeed, I spoke to Sir Robert about the lessons from his report, as I have with a number of other chairs in recent weeks. It is important and a number of safeguards are already in place, but of course the inquiry will look at how those fit together and whether any further steps are required.

Under-age Vaping

Rachael Maskell Excerpts

Wednesday 12th July 2023 Commons Chamber

[Neil O’Brien]

On driving up support for people to Swap to Stop, we are following the recommendations. On the things that we have been discussing in this debate, a whole set of other questions have been raised, on which our call for evidence explicitly invited evidence, because we want to have an evidence-based policy.

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

I am grateful to the Minister for giving way, because I want to turn to the evidence. We know that, when we had plain packaging and removed advertising around cigarette sales, we saw a significant decrease in the use of those products, particularly among young people. We also have other evidence: Israel introduced plain packaging in 2020 and Finland in 2022. There is plenty of evidence out there on the implications of plain packaging, so why will the Minister not use that evidence and implement things?

[Neil O’Brien]

We are garnering evidence on every different aspect of this policy question. In my remarks today, I have tried to illustrate some of the questions that we are thinking about at the moment, which I am sure we will hear more of during the debate. I was simply trying to make the point that we need definitions of things and we need evidence before we take action.

In conclusion, we are committed to doing all we can to stop children from vaping—that is a personal priority of mine. We are also committed to stopping youth smoking. In order to meet our smoke-free 2030 ambition, we are committed to doing all we can to stop people from starting to smoke in the first place, and to give people the support that they need to quit and save their lives.

--- Later in debate ---

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

Twenty-nine years ago I handed in my dissertation for my degree. It was focused on tobacco advertising, and the very arguments being made today by the industry were being made back then as to why it was so important that advertising should not be prohibited further. That is why today’s debate should be as much about the business model, driven by the industry, as about the harm from these products to children and young people. I congratulate my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) on bringing this motion before the House, because the timing is so important. Some 30% of children and young people across Yorkshire have already tried vaping and we know, as we move into that summer period, that more and more children will be socialising outside of school time, and those risks will go up, as will the number of adults we see vaping.

I was honoured to sit on the Health and Social Care Committee as we took evidence from the industry, health professionals and an articulate headteacher talking about their experiences. What I have to say back is that over the past 29 years, we have seen an industry that has become far cannier in how it advertises and markets its products than it was in yesteryear. The situation calls on the Government to step up and be far cannier in being able to expediently put in place the full range of measures that we know will have an impact on the number of young people taking up vaping.

We welcome the reduction in the number of children smoking cigarettes, and we have seen that important shift over the decades. We know the measures that have levered that in—increasing the cost has certainly had an effect, and making smoking less accessible and less attractive has had an impact—but what also needs to be learned is that the very mechanisms put in place around cigarettes need to be applied immediately to vaping, too.

If we look at some of the measures introduced over the past 20 years, we have seen the billboards taken down along with newspaper and magazine advertising, the removal of tobacco from promotions, its removal from sport, its access taken away in shops, the shutters put down, vending machines taken away and these products being put out of use. There were also important public health measures to move away from indoor smoking and, as my hon. Friend the Member for Stockton North (Alex Cunningham) has just said, smoking in cars where there are children. We also had that important intervention on plain packaging, which we know Israel and Finland have already introduced for e-cigarettes. There is therefore no reason for a delay here.

The industry is using every reason it can consider as to why it needs to continue using advertising. I cross-examined the industry at the Select Committee. To summarise some of the exchange, we were discussing why Blackburn Rovers had those products on the shirts of the heroes of that town. The industry was saying, “It’s really important that we distract people from tobacco products on to our products, because that is our public health measure.” I challenged back and said, “Why don’t you have public health messaging on those shirts instead?” Of course, they argued that that would not work, because they wanted to draw in the next generation of people to use their products. That is what the industry has always been about: it is about generating profit for its shareholders. When it did that with tobacco-based products, ultimately its customers died. That was not the best business model it could induce. With vaping, the industry wants to make sure it has a continuous stream of addicts, and we need to understand that business model to introduce the public health measures needed around harm reduction.

If we look at the figures, we see that a YouGov survey showed that of the 3.6 million adults who are vaping, 2 million are ex-smokers who have now returned to using a nicotine-based product, 1.4 million are current smokers and 200,000 have never smoked and are vaping. Another survey showed that of the people who were vaping, only 47% were also smokers, and 53% were not. We can deduce from that that the reach of these measures and the availability of vaping products means they are being used far beyond the purposes that Public Health England intended and that Javed Khan put in his report to reduce people’s use of tobacco-based products. As a result, we are seeing more people drawn into an addictive habit, addicted to nicotine and able to use it more regularly and with far more availability. They are therefore taking on higher quantities of this drug, and we are seeing the consequences of that.

The call for taking all the same measures currently in place for cigarettes is therefore vital. ASH and others recommend putting an excise tax of £5 on the product, and we will need to adjust the cost of cigarettes in line with that to ensure that they remain less attractive. We need to ensure that we have investment in the trading standards workforce to address the illicit trade we see in counterfeit products, with the dangers they cause. On branding, it is very clear that plain packaging is required. We must remove the cartoons, the sweet names, the colours and the flavours that are currently being propagated. We must also ensure that promotion is not possible in any sphere. Ultimately, we need to ensure that these products are used only for harm reduction and take that really important whole approach to public health as opposed to looking at one product or another.

We have got to question why young people are taking up the use of nicotine. Yes, there is peer pressure—of course, we understand that, and that is really important. We heard about how children discuss the different flavours and try them out, using the product more and more as a result. Yes, there is the power of advertising—why else would companies advertise but to attract custom? But why is it that young people need a dependency on a drug? We need to get to the heart of that question through a wider public health approach. I am very disappointed that the Government have pulled away from some of their public health strategies, including the health disparities White Paper and bringing forward a more holistic approach to public health. Ultimately, we have got to protect young people from becoming the addicts of the future. That is the role of this Parliament

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

--- Later in debate ---

[Maria Caulfield]

As I just said and as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said earlier in the debate, the consultation closed only recently. Officials are going through the evidence and will come forward with the results in the autumn and take them forward.

[Rachael Maskell]

I raised the issue of addiction; although the Minister has said that vaping products are safer, does she agree that if they are drawing more children into addiction, they are clearly not safe in that field?

[Maria Caulfield]

We have to consider the evidence and that is not necessarily what the evidence says. NHS England is reviewing the number of admissions and incidents that it feels are caused by vaping, so we are gathering the evidence on that. We need to take an evidence-based approach and currently there is not the evidence that there is necessarily an addiction problem. But we do need to keep building the evidence base.

As we have set out today, we are committed to taking strong and assertive action to tackle youth vaping, and we are willing to go further as part of our evidence-based approach. We have to work with all parties and across Government. This is not just a health issue: it is an issue for the Department for Education, for the Department for Culture, Media and Sport in terms of advertising, and for DEFRA in respect of how single-use vapes are disposed of.

We are committed to effectively tackling the issue and driving down youth vaping rates, while making sure that vapes are available to smokers as an effective aid to quitting smoking. We are committed to doing all we can to prevent children from starting vaping and we are actively working on ways that we can go further. We will go further in not only protecting children but driving down smoking rates, so that we make a future where people are not damaged by smoking. To meet our smokefree 2030 ambition, we will do all we can to prevent people from starting smoking in the first place and to give people the support that they need to quit.

Question put and agreed to.

Resolved,

That this House is concerned that children are being inappropriately exposed to e-cigarette promotions and that under-age vaping has increased by 50% in just the last three years; condemns the Government for its failure to act to protect children by voting against the addition of measures to prohibit branding which is appealing to children on e-cigarette packaging during the passage of the Health and Care Act 2022 and for failing to bring forward the tobacco control plan that it promised by the end of 2021; and therefore calls on the Government to ban vapes from being branded and advertised to appeal to children and to work with local councils and the NHS to help ensure that e-cigarettes are being used as an aid to stop smoking, rather than as a new form of smoking.

Draft Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Rachael Maskell Excerpts

Tuesday 11th July 2023 General Committees

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

It is a pleasure to serve under your chairmanship, Ms Harris. I, too, welcome the draft regulations and wish to highlight the inequality that has arisen between Northern Ireland and England. I have to say that the sluggish response from the Government, knowing the harm that tobacco causes, is quite astounding. I very much hope that we will shortly see regulation on heated tobacco products here in England.

I want to home in on the harm that is being done by putting flavourings into tobacco products. The Health and Social Care Committee recently took evidence not only from health experts, but from the industry. It became incredibly evident to us that this is yet another marketing ploy by the tobacco industry to sell its harmful and life-threatening products. We heard evidence from the head of a school, who said that the topic of conversation for young people in the playground was about the different flavours that they were trying. That is clearly where legislation like this will protect young people. For instance, we were told about different flavours of vape, such as gummy bear, slushy, unicorn milk and unicorn frappé. The introduction of those flavours is clearly not aimed at an adult audience. We are talking about vanilla and other flavours in heated tobacco products, but it will not be long before we see them being extended to products that are attractive to children, to get them to take up smoking.

What through in our inquiry, which applies to the draft regulations, is that the industry is driven to recruit a new generation of addicts, whether they are addicted to tobacco products or to nicotine products, to drive up their profits from another generation, having killed off the last. It is therefore absolutely essential that we get the draft regulations on the statute book not just in Northern Ireland but across England and the rest of the UK. It is evident what the industry is about, and I urge the Minister to go far further and far more quickly, so that we stop producing another generation of addicts to these products and ensure that we safeguard people from the real public health concerns that we all have.