National No Smoking Day

Rachael Maskell Excerpts

Thursday 9th March 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing today’s debate. I was really sorry to learn about the circumstances that have brought him here; they really do account for why he is such a passionate advocate for non-smoking.

For decades, tobacco companies have used every manipulative means possible to recruit the next generation of smokers. For them, it is about big profits—£900 million at last count. With around 75,000 victims of their exploits dying every year, those companies have to market their products to new generations to replace those who die. I am angry because they are deliberately causing harm and taking advantage of marketeering, peer pressure and a pack of lies around a pack of cigarettes to make their victims feel good about succumbing to the powers of their addictive means. Once people are hooked, companies draw their prey into a lifetime of handing over precious savings to deposit in their bank accounts.

Those companies are using their resources wisely. British American Tobacco has bankrolled the Institute of Economic Affairs, a Tory think-tank that wants to privatise the NHS. One of its trustees has reported funding a former Health Secretary with £32,000 between 2010 and 2018—the less said about him, the better. With 30 Tory MPs benefiting in all, what could their motivation be? What could BAT’s motivation be? We will never forget Margaret Thatcher taking $1 million from Philip Morris as a consultant.

It is children that these despicable companies are targeting. I have been following the vaping debate, and child vaping is the latest fad. British American Tobacco and others are at it again, addicting children to their products, using different products at different times, with different flavours and colours and cheap devices. They are once again addicting a generation. Among young people, vaping is now seen as cool, as smoking once was, but the harms of these stimulants are unknown, and a lifetime of expense lies ahead, costing users physically, mentally and financially. These wolves in sheep’s clothing need calling out, and today’s debate is a good place to start.

Tobacco is still the biggest killer, luring people into horrible diseases such as cancers—including lung cancer—stroke and heart disease, as well as dementia, which, as we have heard, is the focus of national No Smoking Day. Given that that costs the NHS £2.2 billion a year and social care £1.3 billion, I have to ask why the Government are content not to set out an ambitious plan that is ruthless with the tobacco giants yet compassionate with their victims, taking every step to draw people out of their addictions and recover their health. Why are Government paralysed when the evidence is screaming at them?

This is the difference between the Tory party and the Labour party: Labour knows that health inequality is unjust. We want to take people to a safer, healthier place. That will be our priority. Thirty years ago, I did my dissertation on this very issue for my degree, and my conclusions were simple: money buys silence. Labour must never touch dirty money, and nor will it. That money kills, whether directly or indirectly. Instead, we must invest in health.

According to Action on Smoking and Health, 9.2% of the community in my city of York smoke. While that is lower than the national average of 13%, it costs our city £46.9 million. In my ICB area of Humber and North Yorkshire, 2,500 people, sadly, die each year. The healthcare costs are £8.2 million, adding to economic costs of £19.9 million due to lost earnings and £10.9 million due to smoking-related unemployment. What a lot of money. Let us reflect: 6.6 million people smoke across the UK. There are 150 new cancer cases a day, and 54,300 a year. Every minute, another victim is admitted to hospital, with 506,100 hospital admissions attributed to smoking. Last year, the cost to the public finances was £2.6 billion.

These wretched companies are fleecing their victims of their hard-earned living, with an average smoker spending £2,500 a year. Some 70% of smokers want to quit, so we need to ensure they have the means to achieve that. Let us remember that these multimillion-pound companies prey on the poorest, with 31% of households with somebody who smokes falling below the poverty line—if ever there was exploitation, this is it. Many new communities of people coming into the UK from challenging places across the world also have a high prevalence of smoking, presenting a new challenge for public health teams, and it is important to get on top of that too.

The UK Government aim to reduce the level of smoking to just 5% by 2030, but there is no tobacco control plan. In York, the local authority’s public health grant has been cut by 40% over the term of this Government, yet we do not know what is to come in 22 days’ time, when the public health grant runs out. On top of that, we have not seen the health disparities White Paper. We understand that it has been scrapped, so what on earth is going on? Tobacco companies make an annual profit of £900 million, yet only £2.2 million is spent on prevention. We need funding, we need professionals, we need education and we urgently need to move people to a space where their lungs and bodies can start to recover.

Despite Javed Khan’s independent review of tobacco control, published nearly a year ago, the Minister has been silent. Mr Khan recommends spending £125 million each year to enable the UK to hit its target, which will be missed without the investment that we absolutely need to see; increasing the age at which people can buy tobacco products; and ensuring that every public health intervention is made. I take the point made by my hon. Friend the Member for Blaydon (Liz Twist) about the illicit trade in tobacco, which we also need to crack down on. There are 15 strong recommendations in Mr Khan’s review, and I want to see the Government taking action, responding to that report and publishing their plan.

Unlike the Minister, Humber and North Yorkshire ICB is not sitting back. Its outstanding public health team are engaging in driving down smoking levels, with a new centre of excellence to co-ordinate population-level interventions, and investing in programmes of activity targeted at those who most need them. With stop smoking support and lung health check screening, work is under way to screen and divert. Like many colleagues across the House, I am asking the Government to publish the tobacco control plan; to publish a strategy to tackle the rise in vaping, particularly among our young people; to give local authorities the means and tools to safeguard a generation; and to introduce an annual public health windfall tax on these companies in the Budget next week. It is all about profit for them, and that profit should be used for public health.

[Mr Sharma]

Does my hon. Friend agree that the Government’s strategy and plan should include special provision for black, Asian and minority ethnic communities, so that they can be targeted and helped to give up this dirty habit?

[Rachael Maskell]

I thank my hon. Friend for making that really important intervention. We must help communities that are finding it hard to quit, including new communities. We really welcome the large number of asylum seekers who have come to York, but we know that there is a higher prevalence of smoking in that community. We must ensure that proper interventions are targeted at BAME communities too.

The figures speak for themselves, and the Minister cannot afford to sit back any longer. Labour will not. We want to save lives, and we want to save the health of our NHS too.

Future of the NHS

Rachael Maskell Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne]

I agree that if things do not change, that is exactly the route we are going down.

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

I congratulate my hon. Friend on securing the debate. Does she acknowledge that this has already happened in dentistry, with families taking out dental plans because they cannot access an NHS dentist?

[Kate Osborne]

We are seeing this across the whole NHS, including dentistry, as my hon. Friend rightly says.

As with any crisis, we see companies step in to exploit the situation and make money. US group Cleveland Clinic plans to open its third UK facility in London later this year, adding to the 184-bed hospital and six-floor clinic that it opened in 2021 and 2022 respectively. HCA Healthcare, another American group, which has over 30 facilities in London and Manchester, will be opening a £100 million private hospital in Birmingham later this year. Some 40% of private mental health companies need safety improvement, and we are handing over billions to companies that are failing our constituents.

Too much of what is happening is hidden from Parliament and from the public. Where is the accountability for these private companies? Labour’s plan for the NHS includes working with partners to ensure patient safety and to bring down waiting lists. What it does not include is the rampant corrupt profiteering, with contracts for cronies and profit put above patients, that this Government are presiding over.

In England, we have a 20-year gap in life expectancy between the most and least affluent areas of the country. Less than a year ago, the Government promised to tackle the causes and symptoms of these underlying health inequalities and publish a White Paper on health inequalities. Last month, the Department of Health and Social Care confirmed that no White Paper would be published. I am pleased that today, Labour announced that we will build an NHS fit for the future and cut health inequalities.

The cost of living crisis has pushed over two thirds of UK households into fuel poverty, which will exacerbate health inequalities that were already widened during the pandemic. In September 2022, one in four households with children experienced food insecurity, and in my constituency of Jarrow, 39% of children are living in food poverty. Malnutrition costs the NHS an estimated £19.6 billion each year. Investment in greater support, particularly targeted at the most vulnerable, would lead to returns in reduced NHS demand. As well as a strategy for the NHS, this Government need to start prioritising much more support to get the most vulnerable through the cost of living crisis. I hope Ministers will listen closely to the contributions in the debate and take on board what is needed for a workforce strategy and funding to secure the future of our NHS.

--- Later in debate ---

[Rachael Maskell]

I am listening carefully to the point that the hon. Gentleman is making. The knowledge and skills framework was introduced in 2004 as part of the “Agenda for Change” package, but the Government have not invested in the opportunity that the framework provides to do the very thing that he suggests—to enable people to climb the skills escalator and move through their profession into higher roles. Does he agree that we need to make that investment so that we are using the skills that are already in the NHS?

[Sir Christopher Chope]

The hon. Lady makes a very good point, and I am glad that I gave way to her to enable her to make it. We must do everything possible to increase the size and quality of the workforce and enable people who are already in it to improve their qualifications and progress through their chosen profession.

Constituents also tell me that there is a problem with retention. When nurses retire, they are expected to continue with continuous professional development; if they do not do that and fill in a lot of bureaucratic forms, they become ineligible to return to nursing later on. One of my constituents contrasted the situation in our country with that in the United States, where there are not so many bureaucratic barriers to someone’s carrying on nursing after they have retired, perhaps temporarily. I raised that point with the Government, thinking that it was a really good idea and that they should be getting to grips with it, but their answers to my questions suggested that it was not really on their radar and they were not interested in investigating it. Their response was, “We have a graduate-based profession, we have a retention scheme that we are not interested in changing, and the register will stay as it is.” I thought that that was a remarkably complacent response to what I considered to be quite a constructive suggestion from a qualified nurse.

Many people have made the point that we are training nurses and doctors at great public expense, and they then leave the profession and the national health service before they have paid back their dues. Again, there is a big contrast between what happens here and what happens in the United States. I am not saying that help with people’s development as they go through university should be conditional on their being forced to work for a particular employer or for the NHS when they graduate, but I do think there should be a system similar to the one in the United States, whereby those who are not going to work for the NHS are expected to pay back some of the costs of their training. There is a great deal of talk in this country about increasing the number of doctors and nurses, and the newspapers today refer to the need to increase the number of graduates, but that is not much use if so many of those graduates do not provide their services to the NHS.

--- Later in debate ---

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

I thank my hon. Friend the Member for Jarrow (Kate Osborne) for securing this really good, much-needed and timely debate. It is a pleasure to follow my hon. Friend the Member for Wirral West (Margaret Greenwood), who set out the ideology that sits behind the Government party.

Driven by the injustices of inequality, 75 years ago we saw the advent of the NHS under Nye Bevan. Health has moved forward ever since, until just recently when we have seen a drop in life expectancy. It is the injustices exposed today that have motivated many of us to speak in this debate. Just yesterday, as a member of the Health and Social Care Committee, I had the privilege of visiting Great Ormond Street Hospital. I have been steeped in health all my working life—for the record, I declare that I am a member of Unite and the GMB. I was head of health at Unite and prior to that I worked for 20 years as a senior clinician in the NHS.

I recognised the most caring of staff and the most visionary of leaders at Great Ormond Street. They are carrying out medical advances that we could only have dreamed about just a few years ago: cures for rare cancers that no child could previously have survived; state-of-the-art technology keeping the most delicate of hearts and lungs working; and research and science breaking new frontiers. However, like in my own patch in York, when they intersected with social care, the whole system ground to a halt. They cannot get the staff.

Let us not be shocked: social care cannot get the staff because the Government have not provided the means by which to pay them. Many are doing highly skilled, professional roles, but are paid a pittance. If they were employed on “Agenda for Change” pay scales, which are job-evaluated, we would not be carrying the 165,000 vacancies we see today. We would not have the delayed discharges and flows in hospital would return to some semblance of normality. Patients would get into emergency departments, freeing up ambulances to reach the sick in time. Stress levels of staff would fall and absenteeism would drop. But the wealthiest sitting in Cabinet do not understand that that is fiscal responsibility.

Let me set out the challenge. In York, the local authority does not have social care capacity because staff are too low paid. Wages are very low and the cost of living is very high. The local authority is having to buy beds in residential homes, at around £1,400 per patient, per week. That is not out of the ordinary. To provide a timely social care package would have cost just £500 for the maximum package. The Government are paying £900 more per patient, per week. Imagine if that £900 went on social care staff pay—just hold that thought.

No patient who goes into hospital independent, who then has a delayed discharge and ends up placed in residential accommodation because there is no care package available for them to go home, goes home from residential care—that is the case even though they were independent before they went in. Instead, they become deconditioned and dependent, with both the taxpayer and the patient paying a heavy price. The cost of that is £1,400 and rising throughout the patient’s life—not £500 and falling as the patient becomes more independent. If that money were spent on recruiting, training and paying care staff the wages they deserve, we would see no delayed discharges. Patients would be at home and independent, and thousands of pounds from the Health and Social Care and DWP budgets would be saved.

To make sense of the crisis, this is not just about the amount of money; it is about where the money is placed and how it flows. We could say the same about paying exorbitant amounts to the social care providers that are making billions in profit between them, as opposed to having a state-run social care service—what I would call a national care service—that is publicly accountable and controlled. The Government need to look at the waste in the system, and not just talk about the amount of money they are putting in. If we addressed those issues, we would make savings, pay the staff what they deserve and have a system that works for everyone.

In 2004, Labour created “Agenda for Change”, which put NHS staff on decent terms and conditions and pay. All the Minister has to do is to put people doing exactly the same tasks in social care as they do in the NHS on that job-evaluated scheme. That would put the staff on those wages and terms, and give them the career opportunities that were created under the Labour Government through the knowledge and skills framework. It would save money and ensure that people get the pay they deserve. That is not a massive ask; it is common sense.

That would also mean that we would start getting integration. As I said at the Health and Social Care Committee, the problem is that we still do not have a system that can integrate. Integrated care systems are collaborating at best, not integrating. They have separate funding, separate staffing and separate policies—we kid ourselves if we think that is integration. However, we need integration because we need to bring the whole system together.

We also need to look at the workforce across the board. The Chancellor, when he was Chair of the Health and Social Care Committee, set out his determination to stop workforce depletion after 12 years of this Government. He recognised how it was impeding the NHS. But now there is no workforce plan to behold. As Labour did in 1997, we will recruit the workforce the NHS needs. We understand that staff need a pay rise. When the NHS cannot retain staff, it pays more to agencies. Last year, the NHS paid £3 billion for agency staff. If that money had gone into the pockets of NHS staff, the NHS would have retained them. Staff are now leaving at the highest rate ever: 42,411 staff left in the second quarter of last year. We understand that we cannot keep taking out of the NHS; when the staff are not there, we cannot train the next generation. Of course, we then pay more and more for agency staff.

Turning to health visitors, I commend the Government for putting forward the health visitor implementation plan. In 2010, there were 8,092 health visitors, which was 4,200 short of the number required for safe working levels. The Government made it their objective to recruit those staff—it was a No. 10 priority—and did so over five years, scraping by in achieving it. However, the Government did not invest in those individuals, so come August 2022 there were just 7,013 health visitors, 1,000 fewer than in 2010. That means that we just do not have the health visitors—key public health professionals —to keep patients safe. Health visitors are working under considerable stress and strain, as well as not making the interventions that are desperately needed. This can and must be addressed. While we have promised to do so, the Government have been silent on health visitors.

We have heard much about dentistry challenges in this debate. The data shows that 26 million appointments have been lost since 2018-19. In York, 126,130 appointments—62% of them—have been lost. Many people are seeing their dentists every other year, and virtually none of my constituents has seen an NHS dentist. I know that to be true, because nobody is able to see an NHS dentist unless they are a long-term patient. People are often waiting five or six years to see a dentist. The oral health of my constituents has been failed because the Government have not put the right measures in place. We are losing the workforce and dentistry is being privatised before our eyes. Intervention is needed now, and it will make a difference.

Of course, we are talking about not just dentists and health visitors but the NHS as a whole, and we know that the story is the same in maternity services, emergency departments, urology departments and all specialties. Nurses, physios, doctors, pharmacists and so many others should not be in the position of having to beg for a pay rise. They should be valued—and, of course, if we value something, we pay for it. Decent pay retains and attracts staff, which results in productivity soaring. When Labour came to power, the NHS had a pay rise after the Tories had decimated it. I worked in the NHS, so I know that people were on their knees, working double shifts and often working into the night when they should have gone home hours earlier. The same is true today, but if we invest in staff, productivity will rise and the outcomes will be so much better. People are burned out and breaking because they are unable to be the professionals that they trained to be. They cannot practice what is written into their DNA because the pressures are so great. But I say to them, hold on, a Labour Government are on their way.

This talk of using the private sector must stop. If we are serious about rebuilding capacity in the NHS, clearing backlogs and addressing the challenges—the Government, of course, are being very sluggish because they are not fixing the challenges as they come—we need to move staff back into the NHS as well as keep staff in it. The NHS has more than 133,000 vacancies right now. We need to get people back into the system and to pay them and respect them. If they are being paid more in the private sector, of course they are going to stay there, but we need to stop reinforcing the system of privatisation by moving work to that sector. We need to get those staff back into the NHS, working in a service of which they can be proud. That would also help improve patient flows across the NHS.

I visited the amazing NHS staff in the emergency department in York just a few weeks ago. They want to do the job that they were trained to do, but they are having to manage a decline in staff as people go to agencies for better pay. They have to work alongside agency staff who are paid more than them, as are the CIPHER staff who come in and sit with patients—a move enforced by the NHS. That hardly boosts morale. And then we have Vocare—the least said about it, the better, as it sucks money out and fails to provide the necessary service. We cannot have patchwork privatisation. It does not work and it increases risks. We need to see the end of this fragmentation. Instead of paying more for private, we should pay the NHS staff and get them back on to the wards, holding their heads up high again, confident that they are working for a service in which they are valued.

One more thing on where the funding goes: if discharge funding goes to the acute sector, it can build more institutions, which is what the Government have decided to do. What it cannot do is push people out of the system, but if we gave that funding to social care, it could bring people out of the system. Therefore, joining up these new transitional units with hospitals has been a waste of funding. We should have invested in social care, so that those people can get home, get the care they need there, and get mobile and moving again, which would improve their quality of life. The Government have got it wrong again because they do not understand the system. They just listen to who is shouting loudest and throw out money, as opposed to hearing what can make a real difference.

I want to talk briefly about primary care, because Nimbuscare in York have achieved so much. It set up a paediatric assessment unit to take the pressure off admissions to the emergency department. The system is run by GPs and has saved 1,300 children from going into acute A&E. In fact, only 3% of referrals from the unit had to go on to A&E, and only one child was admitted. This is simply about understanding patient flows, who has the expertise, who can make the diagnosis, and who can provide the solutions and treatments, and about putting money in the smart place: in the NHS.

There is so much more that Nimbuscare could do if only it had the money—taking all that expenditure out of the NHS and ensuring provision in the community and primary care, as opposed to secondary care. It works, it is more effective and it is better for patients—and of course there are other specialties, such as elderly care or women’s health, and respiratory clinics and others who need support. We can then start to see prevention and interventions being made, such as health checks, to ensure that people get the support they need. We can introduce social prescribing, to ensure that people have healthier and happier lives. There is so much that can be done, if only the Government had the kind of vision that Nye Bevan had when he set up the NHS. It is not about managing the system; it is about feeling the injustice and the inequality, and putting in the solutions that are needed.

In closing, I want to touch on health inequalities. The health disparities White Paper has been scrapped, the 10-year cancer plan has been scrapped, the 10-year mental health strategy has been scrapped, and the Khan tobacco control plan has been scrapped. There is no plan for management around alcohol, and we have not seen a strategy on gambling. Public health has become the poor relative of the NHS, when prevention should be driving the NHS. Of course, the NHS public health workforce have been decimated under this Government, so how are we meant to shift the dial for the future? Michael Marmot has set out exactly what needs to be done, and he has looked not only at healthcare but at the broader issues of poverty and what really drives the inequality across our society, as has been said.

We need to put the investments in the right place, which is what this Government are failing at. It is what the next Government will do when Labour comes to power. If only the Health Secretary, and indeed the Minister, could look at the evidence, understand the system, and put their feet in the shoes of people who work in the NHS, we would make such a difference. If nothing else, let us in York pilot some of these ideas. We are really keen to do so, because we know it will make a difference.

NHS Strikes

Rachael Maskell Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

That certainly is an option. My right hon. Friend talks about NHS managers. Understandably, the Opposition focus on nurses and paramedics, but let us not forget exactly who we are talking about: the entire Agenda for Change workforce, which is 1.245 million people. That is exactly why every 1% equates to £700 million. My right hon. Friend is right that pay is a factor, but it is not the only factor, which is why we also focus on working conditions and environment.

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

Taxpayers want NHS staff to be there when they need them, but as more and more staff leave the service, flipping over to work for agencies because they simply cannot afford to work for the service on their salaries, their money is being spent in the wrong way. On Friday, when I met NHS staff who came in on their day off, they said that the thing that is breaking them is the Government’s contempt for them. They simply want the Government to negotiate—so why will they not?

[Will Quince]

I thank the hon. Lady for her question, but she could not be more wrong. I was in Darent Valley hospital today and I was in Watford hospital last week, and I have the utmost respect for all those who work in our NHS. Everybody in this Chamber wants those who work in our NHS—in fact, all public sector workers—to be paid more, but the independent pay review process is a tried and tested process that has been used for more than 40 years, and it is important that the unions engage with it so that we get this right from April.

Urgent and Emergency Care Recovery Plan

Rachael Maskell Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

The funding to put that in place has been earmarked from the £2.8 billion next year. The key thing is less to do with the funding than the accuracy of the data, which will help us to see where there are gaps in coverage and how we get the right levels of community response. The integrated care boards have been set up to take an integrated approach on that. One of the best enablers will be the control centres that the ICBs will set up, which will allow us to get much greater visibility on where that has been delivered and how we escalate it when it has not.

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

The 300,000 vacancies in health and social care mean that, whatever the Secretary of State puts on the table, his plans will never be delivered. What is he doing to retain the burned-out, traumatised staff who currently work in the NHS, to resolve their pay dispute and to put enough money on the table to pay social care staff enough to come and work in the service?

[Steve Barclay]

We recognise the huge pressure on social care; that is why, at the autumn statement, the Chancellor set out the biggest-ever increase in funding into social care of any Government, £7.5 billion over two years. We are putting more funding in. On the workforce more generally, the Prime Minister and Chancellor have committed themselves to bringing forward the workforce plan, which will set out the longer-term ambition on workforce and will be independently verified. In addition, we are recruiting more staff, as I updated the House, whether that is the 3% more doctors this year than last year, the 3% increase in nurses, or the 40% more paramedics and 50% more consultants compared with 2010. We are recruiting more staff, but the grown-up position is to recognise that there is also more demand.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

I am happy to join my hon. Friend in paying tribute to the work of call handlers at the South Western Ambulance Service, and to the staff there as a whole. He is right to draw attention to the improved performance that we have seen in recent weeks, and also right to point out that all parts of the United Kingdom have faced considerable challenges, particularly over the Christmas period when we saw a significant spike in flu levels.

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

We have just heard in the Health and Social Care Committee that on strike days there was a drop in service demand, but also value added by the increased clinical support, resulting in better and more cost-effective decisions. Why does that happen on strike days rather than on every single day of the year?

[Steve Barclay]

We are taking a number of steps to improve performance, and not just on strike days—but I thought the hon. Lady was going to refer to the comment that she made about those on her own Front Bench, when she said:

“I think what our health team need to do is really spend more time in that environment with clinicians to really understand what drives them.”

We on this side of the House are spending a significant amount of time with clinicians, and it is important that those on the hon. Lady’s Front Bench do so as well.

NHS: Long-term Strategy

Rachael Maskell Excerpts

Wednesday 11th January 2023 Commons Chamber

[Wes Streeting]

My hon. Friend has campaigned so determinedly on the issue, and she is absolutely right. When I spoke about self-referral in an interview with The Times, it was partly with ophthalmology in mind. In the vast majority of cases and for the vast majority of conditions, self-referral will not be appropriate and it is right that people see a GP before being referred to specialist services. But when people go and see someone who is trained and qualified to investigate their eyes, and that person makes a clinical judgment that they need to see a specialist, how can it be that, rather than being referred straight to the specialist, they are sent off to a GP first? That is absolutely crazy. It is wasting valuable doctors’ appointments and is lengthening waiting times for patients.

Labour is willing to look with an open mind at how we improve the patient journey. It is that fresh thinking that the NHS needs and is so badly missing from this Government. That touches on what I have been saying about the need to fix the front door to the NHS in primary care, with more care in the community. Our plan to recruit more doctors will deliver better access to GPs and ease pressure on accident and emergency departments.

We have to take a look at the GP partnership model, which under this Government is withering on the vine. By 2026, a majority of GPs will be salaried. There are three routes: let it wither on the vine, as the Conservatives are doing; accept that it is in decline and have something better to follow as it phases out over time, which is how we would approach it; or accept that GP partnership is valuable, in which case we should rebuild it. I am open-minded about whether we phase out GP partnerships or whether we rebuild general practice, but what we cannot do is what the Conservatives are doing, which is allowing general practice to wither on the vine. That is exactly what they have done.

Do you know what I found most remarkable today, Mr Deputy Speaker? In advance of this debate, I received a letter from the Minister, no less—the hon. Member for Harborough (Neil O’Brien), who is unfortunately not in his place—telling me that the current system of general practice is working. Bad news for you guys sat opposite, who are facing the patients and the voters at the next general election: your Ministers think that general practice is working. Your Ministers are therefore not looking at plans to fix it. Your Ministers are leaving you hanging out to dry at the next general election, because patients can see that only Labour is thinking about how to fix the front door to the NHS and rebuild general practice.

Our plan to recruit 8,500 mental health workers and provide community mental health clubs in every community—a plan championed by my hon. Friend the Member for Tooting (Dr Allin-Khan)—will deliver faster treatment, supporting schools and easing pressure on hospitals, as well as general practice.

Then there is the exit door of the hospitals to social care. Labour’s commitment to deliver better pay and better terms and conditions for care workers will reduce the 400,000 delayed discharges every month and provide a better quality of care for not just older people but working-age disabled people. There are so many people in hospital who would not need to be there if we could provide quality care in their homes, which is why our commitment to double the number of district nurses qualifying every year is central to our policy. We will also give every child a healthy start to life, with 5,000 more health visitors. [Interruption.]

The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) has just said, from a sedentary position, “We need more GPs.” I know we need more GPs. Patients know we need more GPs. So why have the Government cut more than 5,000 GPs in the last decade?

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

We have seen 13 years of failure in social care, with promises made and nothing ever delivered. There are now 165,000 social care vacancies, which is why the NHS is logjammed. Does my hon. Friend agree that it is time to pay our social workers a fair wage? Agenda for Change is a framework already built; let us give social workers a decent wage for the excellent work that they do.

[Wes Streeting]

My hon. Friend has consistently made the powerful case that pay and terms and conditions are directly linked to retention. No wonder we are losing so many people, not just from the NHS but from social care, to other employers in sectors such as retail. Earlier today, in this Chamber, I heard the Prime Minister say that as the minimum wage increased care workers would benefit, which tells us that care professionals are on the minimum wage while doing a really difficult job. No wonder they are going off to other jobs that cause less stress and anxiety and are better paid. This is not the way to run a social care system. We understand that, but the Government do not.

NHS Winter Pressures

Rachael Maskell Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend is right. That is why, in the run-up to Christmas, one of the ministerial priorities was to have a whole series of ministerial meetings with the chairs and chief executives of the integrated care boards, because, as the Government have recognised, it is through the integration of those 42 ICBs that we will bring health and social care together. The ICBs have been operationally in place since July and are ramping up at pace. One thing that is making a real difference to them is having control centres that allow patient flow to be tracked through the system—Maidstone is a good example—with the data allowing blockages, as a whole-of-system problem, to be gripped at a much earlier stage.

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

Staff retention in both the health sector and the social care sector is at the heart of this crisis, but staff cannot be retained if they are not paid and, if they are not paid this year, the issues will not be addressed. Will the Secretary of State recognise that when he set the remit for the pay review body, inflation was not where it is and we did not have a war in Ukraine, so factors have changed and the remit for pay must therefore change this year so that we can retain the staff to deliver what he proposes?

[Steve Barclay]

On delayed discharge, the key is having domiciliary care support. That is not about the NHS Agenda for Change contract; it is about funding for those in the social care sector. Around a quarter of delayed discharges are due to delays in what is known as pathway 1, the domiciliary care side. That is what the £500 million in particular recognised. We are putting in more money, but that is about the social care sector so we can get flow through delayed discharge.

NHS Industrial Action: Government Preparations

Rachael Maskell Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

Representing the garrison city of Colchester, I have nothing but the utmost respect for our armed forces. It has not escaped my notice that many of them are on lower pay than NHS staff and will be giving up their time over Christmas to cover strike action. My right hon. Friend is right that to mitigate the impact of planned industrial action in the ambulance sector, NHS England has explored a range of measures, which include engaging with the Ministry of Defence on military support. As a contingency, a MACA request—a request for military aid to civil authorities—for a limited number of personnel has been submitted to the MOD. It was submitted at the end of last week, and the plan is that MOD personnel will be trained to drive ambulances, but only deployed where they are needed across the country.

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

The Government need to stop hiding behind the pay review body. The pay review body sorts out the distribution of the funding, while it is the Government who determine the size of the envelope, and it is the envelope that is in dispute. Why will the Minister not get a Treasury Minister alongside him and make sure they negotiate on the size of the envelope? If they can afford the right hon. Member for South West Norfolk (Elizabeth Truss), they can afford a nurse.

[Will Quince]

The average pay settlements in the private sector range between 4% and 6%, and we want to have a fair deal for both NHS staff and the taxpayer. The hon. Lady makes reference to the pay review bodies, but it is important to stress that they are made up of independent experts. They recommended the uplifts for NHS staff, and in formulating their recommendations, the review bodies carefully considered evidence from a wide range of stakeholders, including NHS system partners and trade unions. The independent pay review body is a respected mechanism, and we should accept its recommendations, which we have.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 6th December 2022 Commons Chamber

[Neil O’Brien]

Of course, I would be keen to meet to try to address those issues and to build on the work that we are doing nationally.

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

York has had a dental desert for years. It is six years now to see an NHS dentist and the Government have made no change to improve that situation, or to bring more NHS centres into my area. In March, dentistry will be moving into integrated care systems and integrated care boards. How are they going to solve the problem?

[Neil O’Brien]

One problem has been that having large, remote regional commissioning for dentistry has meant that it is more unlikely that specific local problems will be picked up. That is why we are taking the step that the hon. Member has described. She is now complaining about it, even though it is a measure to get more local accountability over the way that services are commissioned.

NHS Staffing Levels

Rachael Maskell Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Margaret Greenwood]

The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.

The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.

As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.

The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.

If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.

Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.

Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.

The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.

In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?

I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?

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

The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?

[Margaret Greenwood]

As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.

To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.

The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.

--- Later in debate ---

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to speak under your stewardship, Mr Hollobone. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for initiating the debate.

Where do I begin on this subject? It is difficult to know because Members have brought forward a plethora of information, but I will start with the House of Commons Library briefing, which is always a good source of information, and its research is based on independent sources. It says that the Health and Social Care Committee has said:

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.”

The NHS, which is the best part of 80 years old, is facing the worst crisis in its history, with a vacancy rate of 9.7%, which is 132,139 members of staff.

There is significant shortfall in staff across the piece. The hon. Member for Westmorland and Lonsdale (Tim Farron) talked about vacancies in pharmacy, dentistry, radiology, podiatry, ambulance staff, back-office staff—as those people who are at the heart of the service and keep it going are disparagingly called—cleaners and porters. Everybody says the whole NHS is under huge stress.

[Rachael Maskell]

I want to highlight the neuroradiology profession and the reality that staff shortages have an impact on clinical outcomes. Hardly any of our NHS trusts have neuroradiologists, but they could save 9,000 lives lost to strokes by being able to advance new techniques. Does my hon. Friend agree that it is important to look at the clinical outcomes that health professionals could bring?

[Peter Dowd]

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens”

that are affecting staffing, to

“help pharmacies to expand their role in primary care”

and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.