Lateral Flow Tests in Healthcare Settings

Rachael Maskell Excerpts

Monday 28th March 2022 Commons Chamber

[Mr Sharma]

I thank the hon. Member for that important intervention. I am sure that the Minister took note of his concerns.

We all know that we are experiencing and facing an increasing cost of living crisis, and earlier this month the Foreign Secretary agreed that the escalating crisis in Ukraine will only drive inflation higher, so in the midst of the most serious cost of living crisis for a generation, with a national insurance tax rise and with covid remaining a global threat, it would be wrong to add a further burden on to families wanting to stay safe from covid and visit friends and families in care settings. The introduction of charges for lateral flow tests risks introducing a serious cost on many for visiting their closest family when those visits mean so much to visitor and host.

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

I am grateful to my hon. Friend for bringing forward the debate. In York, the case rate is now 977.7 per 100,000, 261 patients are in hospital poorly, five more deaths have just been announced and four people are in intensive care, so the virus is far from leaving us. In Labour-run Wales, an extension to the lateral flow test programme has been announced so that we can know where the virus is, manage it and protect our NHS. Should we not be doing that in England?

[Mr Sharma]

I thank my hon. Friend for that intervention. Again, the Minister has taken note. I am certain she will make that comparison and try to assist and to follow the best practices in other parts of the country.

Low-income and frontline workers will be hit the hardest by the introduction of charges, but regular testing is vital to minimise the spread of covid-19. The money saving expert Martin Lewis said last week that he was out of ideas. There is nothing left for families to do. Inflation is just too high. In my constituency, I have spoken to staff and volunteers at Ealing food bank who do amazing work to help those most in need. They are deeply concerned about the move to charge for lateral flow tests. Their service users will have to make the choice between paying to test and heating and eating.

In January, I raised this issue with the then Minister for the Cabinet Office, the right hon. Member for North East Cambridgeshire (Steve Barclay), who agreed that testing

“has played a key role in our response”.—[Official Report, 13 January 2022; Vol. 706, c. 629.]

But now we are cutting off that limb of the response. The Government are choosing to weaken their arsenal in the fight and to lessen the effect of two years of hard work and sacrifice.

Even before the newest wave of inflation struck, families in my constituency were struggling to feed themselves. Now it will get only worse, with a cost of £12 for just one pack of tests. At the end of February I asked the Secretary of State for Health and Social Care how much the packs cost his Department, but he could not give me the figures for commercial reasons.

But please, Madam Deputy Speaker, do not think it is just the cost that is the problem: no, it is the fairness too. Throughout the country, nearly 1.5 million people are eligible for treatments such as antivirals if they get covid-19, because the UK Government have identified them as being at the highest risk of severe illness. We know that those people are more at risk, less safe, and less protected by natural or acquired immunity. Around 500,000 of these people are immunocompromised, meaning it is less likely that they receive the same level of protection from covid-19 vaccines. The vaccines have been incredible and have reopened the world for many, but not for everyone. Infection is still a terrifying and uncertain prospect for many of the 500,000 immunocompromised.

There is more. The national health service has worked tirelessly to keep us safe and to save lives. I again pay tribute to the incredible staff of Hillingdon Hospital who did so much for me when I had my own covid infection. They saved my life, and I am eternally grateful to them. What payment to them for two years of danger and worry is it that they will have no certainty that their patients are covid free?

I recall the fuss from Members on the Government Benches when they were asked to wear masks to help to prevent the spread of covid-19. There were ludicrous comments from some. One compared wearing a mask to abuse, agreeing with the statement that masks were

“germ or bacteria ridden cloths”.

Well, those in the NHS still have to wear masks for their own safety. Perhaps more testing, and allowing people to take responsibility without having to pay for tests, would allow a few more people in hospitals and GP surgeries to take their masks off.

[Rachael Maskell]

My hon. Friend is making an excellent speech, I must say, but could I mention care homes as well? People have made huge sacrifices over the last two years in not seeing their loved ones in care homes, and not being able to afford a test will put another barrier in their way. Does my hon. Friend agree that in the care home setting it is vital that relatives have access to tests?

[Mr Sharma]

I thank my hon. Friend very much, and I was going to talk next about care homes, but her intervention has certainly confirmed my argument and point of view that this is the most important area the Government need to look at very seriously if we want to control the effects of covid-19 on our society.

We could also speak about dentists, whose industry is struggling with the pandemic, while they are driven by targets in NHS contracts that they cannot meet. There is no help from the Government to meet the massive costs of making their practices safer, but now patients are being robbed of the opportunity to test before going to the dentist’s. We cannot erase risk, but we can try to minimise it for everyone working in healthcare and in healthcare settings.

We have all gone through so much to combat covid-19, suffered so much and sacrificed so much. I do not argue for lockdowns and closing the economy or closing the country off from the world, but now is the wrong time to cut this specific key lifeline for millions. It is the wrong time to take away peace of mind, and the ability to do the right thing in checking whether we have covid-19 and acting responsibly. I urge the Minister to work with the Chancellor of the Exchequer to find a way to pay for lateral flow tests, and to protect this tool in the fight to ensure that the worst-off in society are not cut off from their loved ones and that the most vulnerable feel more secure leaving their homes.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

First, I thank the hon. Member for Ealing, Southall (Mr Sharma) for bringing forward this debate about lateral flow tests in healthcare settings. He speaks so passionately about health issues more broadly, and I am grateful for his speech on this important topic today. He has spoken previously about access to covid-19 testing, particularly in specific settings, and I want to put on record my thanks for his contributions on these matters.

As the hon. Member highlighted, the pandemic has provided this country with a monumental challenge. When coronavirus first emerged, we knew very little about it, other than reports that people were becoming seriously ill and, very sadly, passing away. The Government moved quickly with unprecedented measures that affected every single person on these isles, building and scaling up our testing capability to levels not seen before, sponsoring the development of groundbreaking vaccine technology and being the first country in the world to approve a vaccine.

Our huge thanks go to all those who supported the vaccine roll-out and mass testing. From our NHS staff on the frontline, primary care workers and individuals in the community to the military providing expertise in logistics and planning, colleagues from the private sector and civil servants deployed from their normal roles, we recognise the immense effort and long, exhausting hours they have put in working to keep the nation safe.

I am proud of how the Government responded at pace to the challenges that health and social care staff faced. Since April 2021, we have dispatched over 5.8 million rapid lateral flow tests to NHS workers in England—directly to NHS trusts, care settings and the homes of individual staff members—with over 60,000 of those going directly to the hon. Member’s local NHS trust in Ealing.

Testing has been a crucial countermeasure throughout the pandemic. The world-beating scaling up of our PCR testing capability proved invaluable, enabling us to diagnose symptomatic individuals when facing a growing but relatively unknown threat from a new virus.

We introduced lateral flow devices in November 2020 as a tool in addition to the highly sensitive PCR tests. LFTs were a significant step change in our battle against covid-19, enabling us to open up greater levels of asymptomatic testing and tackling asymptomatic transmission when the vaccine roll-out was in its infancy yet still ahead of the rest of the world.

Since April 2021, 13,500 positive but asymptomatic NHS-linked individuals have been identified by LFTs. Through their tireless dedication to regular testing, staff in the NHS and in care drove that most pressing fight to protect those most at risk—their colleagues at work, their friends, their families and, most importantly, their patients. All were protected because we were able to break the chains of infection using LFTs. I want to put on the record my immense thanks to each and every NHS and care worker for their valiant and unwavering efforts.

Since the early months, we have learned a lot more about covid-19, including what makes someone more at risk of contracting the virus and how best to mitigate the risk of transmission. That applies in all settings, although especially in healthcare and social care ones, where the close nature of the care provided creates greater opportunity for transmission. In these places, LFT testing has helped to ensure that staff can continue to safely carry out essential care for those most at risk.

By relying on the expert advice of our medical and scientific advisers, many of whom have become household names because of their immense contributions, we have been able to take steps to mitigate the rate of transmission of covid-19. We are now in a much better position, where the link between infection and severity of disease is substantially weaker than in earlier phases of the pandemic. We have severely weakened the link between infection and severe disease. As the hon. Member for York Central (Rachael Maskell) said, cases are rising again. However, we are on the front foot thanks to vaccines and community covid-19 treatments.

The UK’s investment in groundbreaking vaccine technology and our world-beating vaccination programme has put us one step ahead of the virus. Vaccination is now the UK’s first line of defence. Thanks to the actions taken by the people of the United Kingdom, as of 24 March 2022 more than 85% of those over 12 have had two doses. Now we are also inviting those aged 75 and over, residents in care homes for older adults, and individuals of 12 years and over who have a weakened immune system to take up the offer of a spring booster jab.

Importantly, we now have widespread availability of targeted community covid-19 treatments. For people who are eligible, those can significantly minimise the chance of developing severe disease. I hope that the spring booster and the community covid-19 treatment programme reassure the hon. Member for Ealing, Southall that we take very seriously the situation of the immuno-suppressed.

[Rachael Maskell]

My concern is that in York, where about 90% of people are vaccinated, the rate of people getting very poorly with covid is going up. The antiviral treatments are not effective, because there is an increase in mortality as well. Putting the additional line of defence—testing to prevent transmission—in the system is one way to save lives. I cannot understand why the Government will not move the issue on for three months; we could then review the situation again.

[Maggie Throup]

I thank the hon. Lady for that intervention; I know she is passionate about this issue, which she has spoken about many times. It is important that we should recognise that we have moved on. We have broken the chain of transmission with the vaccination programme, which is our first line of defence along with antivirals and therapeutics within NHS settings.

Core to continuing to stay ahead of the virus and learning to live with covid is a move to everyone embodying safer behaviours in their day-to-day lives. The Government recommend continued vaccination, which ensures that everyone is as protected as possible and reduces the chance of their becoming infected and transmitting it to others and of developing severe disease. We have the spring booster programme, and there is an evergreen offer to those who have not yet come forward for their first dose—there are a few of them every day—or who have delayed their second dose or booster. They are welcome to book their vaccines at any time.

We recommend ventilation to ensure that harmful particles are blown away, and the wearing of face coverings in crowded and enclosed spaces to minimise transmission, particularly where prevalence is higher. People should stay at home if they are unwell, to ensure that they do not spread the virus to their friends and family, as well as washing hands regularly and following NHS advice to “catch it, bin it, kill it.” In addition to that advice, NHS England for NHS staff, and the Department of Health and Social Care and the UK Health Security Agency for social care staff, provide expert infection prevention and control guidelines to ensure that healthcare staff, their families and their patients are kept as safe as possible.

Over the past two years we have worked relentlessly to ensure that the people of the United Kingdom have been protected from the virus, reacting to learnings and putting them into practice, as well as using them to implement pragmatic long-term plans. The approach to managing covid-19 in NHS and social care services has evolved over time, giving us the opportunity to learn what works best to keep people safe. We have the opportunity to put that learning into practice, while continuing to focus on providing care for those who need it and supporting those at risk from covid-19.

As we know, the pandemic is by no means over. The UK Health Security Agency continues to monitor the virus and has recommended a package of contingency capabilities that form a reasonable insurance scenario to enable us to respond to resurgences or new variants of concern. I reassure the House that in line with recommendations, the Government have secured a supply of lateral flow devices to use if necessary. Limited ongoing free testing will be available for a small number of high-risk groups within the settings we have discussed, plans of which will soon be set out in further detail by the Government. Once again I thank the hon. Member for Ealing, Southall for securing this debate on such an important issue and expressing his remarks so well.

Question put and agreed to.

Covid-19: Deteriorating Long-Term Health Conditions

Rachael Maskell Excerpts

Thursday 10th March 2022 Westminster Hall

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

It is always a pleasure to serve with you in the Chair, Mrs Cummins. I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for opening the debate and for putting a lot of material as well as a lot of data before us to consider, which is incredibly useful. I am also indebted to the Backbench Business Committee for allowing today’s debate to go ahead.

Even pre-pandemic, there were many challenges for people with long-term health conditions and their management. There was a really good focus on the acute phase, but as people moved into the more chronic phase of their illness, the amount of rehabilitation and support individuals received waned. It was dependent on geography, where someone lived, and on how many in-person interventions they had. Through that time people’s baselines lowered as their function decreased, but it did not need to decrease. That is why it is so important to look at the issue today.

I echo the remarks of the hon. Member for Bromley and Chislehurst on prevention. Of course, prevention is always better than cure, and having a strong public health strategy is crucial. In the acute and early intervention phases, many people missed out during the pandemic. We think about delays in diagnosis, the scale of treatment that people had because clinicians were placed elsewhere, and the value of input. We have talked about strokes today, and people having fewer rehabilitation sessions and less intervention from some of the leading clinicians, which meant they did not leave hospital at the same level that perhaps they did pre-pandemic. We need to pick that up now.

Early discharge has put more pressure on achieving a good baseline for somebody to move into the more chronic phase, the longer phase, of their rehabilitation. We know that once somebody goes home they do not have the physio nagging them every day and telling them to do certain things, so their function deteriorates unless there is good community intervention, which is what I want to focus my remarks on today.

We are talking about a broad range of conditions—neurodegenerative and other neurological conditions. The hon. Member for Bromley and Chislehurst set out some of those, but we can think about motor neurone disease, where time is simply not on your side, or Parkinson’s, where intervention is really important to ensure people maintain function.

We have learnt a lot about respiratory conditions over the last two years with covid, and suddenly lungs have come into central view. Cystic fibrosis has been mentioned. Chronic obstructive pulmonary disease is a condition that really does need good management in the community. There are cardiovascular, psychological and other conditions. We must remember that comorbidity is an issue that impacts on and intersects with many conditions. Somebody who has a combination of COPD and Alzheimer’s will often not remember or be able to steer the management of their condition. As a result, they are perhaps more susceptible to getting an infection and then finding it difficult to clear their lungs or to follow whatever treatment is prescribed, so they are more at risk and early morbidity is a serious risk factor. Therefore, we need to consider these issues in that context.

As I said, intervention at the acute phase of a disease can be intense, but it is about what happens next. We know that often there are not enough rehabilitation beds available to continue someone’s treatment. I have always argued that the convalescent stage is also really important for people to build their confidence, which is often what is needed after the acute stage. That is where the biggest challenge lies.

As the hon. Member for Bromley and Chislehurst outlined, some services have been able to be delivered through new mechanisms, such as Zoom, that simply were not there before. However, as a physiotherapist myself who spent 20 years working in this area, I must say that I would find stroke rehabilitation very difficult on Zoom, and anything involving respiratory medicine as well, because it is all about diagnosing and treating people through the physiotherapist’s hands. Body-to-body contact is absolutely crucial in the development of interventions. Clearly, the lack of it has impeded people’s rehabilitation and had an impact on it. It is not just physiotherapy or occupational therapy that are affected; other services, from dietetics right through to psychological therapies, are also affected. For somebody who is already impaired, face-to-face contact is vital, particularly if they are neurologically impaired and have just had a new diagnosis. Therefore, the risks of a patient regressing and not reaching their baseline, and then regressing further from that, are even greater.

The NHS is in some ways now coming under greater pressure than it did during the covid period. My concern is that the focus, politically and clinically, will be on the elective list and those numbers—we will drive up those numbers for sure and the Government will look at them—and will move on to dealing with acute care as it appears and to dealing with the elective backlog. GPs will of course make the same call, saying, “Look at our waiting lists, look at what is happening here.” Consequently, people with long-term conditions will be squeezed out of the system. That is why I am really grateful to the hon. Member for securing this debate. People absolutely need intervention. Without it, their progress and even their functions will decrease, and that will put even more pressure on both social care and the health system. The debate today is therefore really timely, allowing us to consider the new pathways that need to be created in order to support people with long-term conditions. They have been the poor relation for some time and we cannot let that situation continue.

In the last decade or so, Labour in particular has been looking at pathways that could be developed, such as the expert patient, which enabled people to have control and management of their own disease. Enabling the patient to lead wherever possible is really important. New technology has come on board. Under this Government there has been a particular focus on how new technology can help to provide support, measure things and move medicine forward. All those interventions are absolutely welcome, but they should not detract from the importance of the physical interventions that are necessary. We must ensure we maintain that baseline, so that if somebody does regress, we can give them an injection of rehabilitation to get them back up again to their normal functioning. It is really important to do that in a timely way.

I very much look at this issue from a physical perspective because of my professional background, but I recognise that people with other clinical expertise and competencies will look at their particular field and the need that particular types of intervention. As the hon. Member said, it is right that people have the correct balance between physical and psychological health, and they have to be brought into one space. Sadly, if someone has a physical diagnosis, the psychological aspect is often left behind, because doctors are looking at the primary root of someone’s condition. We must look at people far more holistically than we do currently.

I therefore want to set out a four-stage rehabilitation service to support the physical and psychological needs of people living with chronic ill health. Taking that approach forward will need funding and a workforce plan, which the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), has been incredibly powerful in calling for. I see a concept in which the first phase looks at assessment and measurement, the second at self-management, the third at therapeutic interventions, and the fourth at the psychosocial support, which is also needed.

First, interventions clearly need to be individualised. Everybody is unique in their presentation. We need to recognise that there is an opportunity to develop the service not only in domiciliary settings, but in rehab settings and, for some, in group settings. We have lost some of the collective healthcare that is important for not only the socialisation of health, but the encouragement from one patient to another. We have to capture that again. Often, a patient will be encouraged by seeing somebody else doing what they want to do and that will spur them on to go that little bit further.

Secondly, we have to look at patient management and how people enter services. It should be a given that patients will continue with their interventions once they leave formal healthcare settings. We need to make sure there is a continuum of regular assessment and monitoring. For some individuals, some of that assessment and monitoring can be done at home, but some of it will need external intervention.

Thirdly, regular support may not always require an intensive burst of intervention—sometimes it will—but if it can enhance function, it does need to be examined. I looked at some statistics provided by the Chartered Society of Physiotherapy. Only 15% of people with lung disease deemed eligible for pulmonary rehab are able to access it, which is quite shocking and we really need to address that. Some 50% of people eligible for cardiac rehab cannot access it. From running cardiac rehab classes, I know how people gain confidence from rehab to do things they never thought they would be able to do. They no longer live in fear, but live a confident life.

One in five people receive post-hip fracture rehab on discharge. I know of many cases where all the money is spent on repairing somebody’s hip or getting them a new hip, then getting them up, standing and walking in hospital, only for them to go home and just sit in a chair. Those patients then become fearful, which means social care has to come in, costing the NHS and the care system. It also means that somebody loses their independence, which is the biggest cost of all. This issue needs to be addressed.

Some 44% of people with a neurological condition do not access the services they need. We have a big amount of catching up to do. The biggest thing is that if somebody loses their confidence there is a rapid decline. We must remember that many of these people are elderly and live on their own. They do not have the interventions and the injection of hope that they need. We are talking about life-changing events—people’s whole world is reoriented. We need to make sure that patients maintain social connection, where possible, and are able to access that support.

Waiting lists for elective treatment have become so long. I cannot remember if we are at 6.2 million people or more, but with those kinds of figures many people will need additional support—for example with their diet, or they may be less mobile—so as not to trigger other thresholds that further delay their surgery. It is important that people do not become sedentary and that they have the support they need. If people have a lung disease, it is important that they do not increase the damage to their lungs, lose function or become psychologically impaired, because it is then harder to regain function. We do not want to see people spiralling, which can happen very quickly. Once people get into that place—which is not a great place to be—it is much harder to get people back, so let us really focus on that area.

Fourthly, I want to talk about people living with chronic conditions. Often, people get locked into a space where their life has changed so much that they become more isolated. They lose those social connections, and they also lose their ability to move forward. That might be because, for instance, they have lost their speech, or they might not have the same ability to communicate with people in all sorts of ways. We need to look at how we bring social prescribing into this agenda, as well as the voluntary sector and community support, which is necessary. I want the Minister to look at different pathways to bring that whole family of measures together. Often, we have isolated that into the various parts of someone’s body or mind, as opposed to looking at the person holistically.

Of course, if someone is more isolated, they may experience more loneliness and that impacts on anxiety, depression, motivation and function. People’s skills and confidence then decline even further. We need to ensure the programme has the resources it needs. People are whole beings, and we need to recognise that in our health systems. For too long, we have talked about arms and legs or lungs and brains, but we do not talk about people, and it is people who need that support. If we can look at such a model, we need to think carefully about how we socialise our health system.

I have been looking, in a completely different context, at fostering. There is a programme called the Mockingbird programme. I do not know if the Minister has heard of it, but groups and different people come and support the family. It may be an individual, a partner and their carer, or a family unit. They get that more community- based support. In the context of fostering, it is different families, so there is that concept of a community raising a child. Why do we not look at that for later in life for people with chronic conditions and for how we can provide support? Carers are often with their partners for weeks at a time with hardly any social interaction, and that can be quite telling if someone has an acute psychological condition as well.

Much more can be done for carers, as well as patients, as we move forward. We need a strategy, a workforce plan and funding. In this new world of integrated care partnerships, we have an opportunity to deliver that. July is day one. That is the moment to break out of the past which has let down people with long-term health conditions and move into a new era. I very much hope the Minister will be able to bring that forward.

[Judith Cummins (in the Chair)]

I aim to start the Front- Bench speeches no later than 2.28 pm.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 1st March 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for all her hard work on campaigning for more dental appointments for her constituents. I believe that she met the Secretary of State last night to push him further on this. Her local area has an allocation of £4.7 million from the £50 million fund, and I encourage her to speak to her local commissioners to make use of that allocation. We are also looking at improving dental training so that we can get more dentists into her area.

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

Since dentistry was debated just a few weeks ago, another 10,000 of my constituents have received letters to tell them that they will have to go private. They are already waiting for five years to get an appointment. When will they actually get to see a dentist, or are they expected to have poor teeth?

[Maria Caulfield]

I am not sure where those constituents’ letters have come from, but if a contract has been handed back and that is the reason for the letter, the local commissioners should be looking for new providers, so I am very happy to meet the hon. Lady and her commissioners to see what is going on to make that happen.

Public Health

Rachael Maskell Excerpts

Tuesday 1st March 2022 Commons Chamber

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

In the light of these really important regulations and the protections they have provided for so long, I believe it is important to scrutinise the Minister on how we will maintain public safety as we move forward, in particular for vulnerable groups who have had protections during the pandemic. For instance, there is currently no guidance in place for visitors to care homes or staff working in care homes. It would be helpful to hear from the Minister how she is going to handle that, as well as any outbreak of covid, and what forms of test and trace will be in place to address those issues.

Access to NHS Dentistry

Rachael Maskell Excerpts

Thursday 10th February 2022 Westminster Hall

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

Thank you, Mr Efford, for allowing me to speak in this debate to highlight how the dental crisis is impacting on my city of York.

Healthwatch York has been at the forefront of campaigning on dental services, and I pay tribute to York dentists and the wider dental community, who have been generous in sharing the challenges that they face on a daily basis. I have also been inundated with correspondence from constituents, asking me for help. I hasten to add that they do not want me to get out my Black & Decker. They want me to stand in the gap between my city and the Minister in order to find the solutions. It is getting harder, because dentists are disappearing, waiting lists are growing and oral health is deteriorating rapidly.

Healthwatch York carried out a study in 2018. It found that it taken over two years for 45% of York residents to find a dentist, so none of this is new. Back then, 84% of respondents had an NHS dentist; last year, that figure fell to just 59%. Of those who did not have an NHS dentist, 71% could not find an alternative. The number of people who have not seen a dentist in the last two to three years has risen sixfold. According to the national data, the number of children who have seen a dentist has fallen by 44%. In York, it can take five years before people can see a dentist, and no practices are seeing new patients. Out of 39 practices, only one is accepting NHS patients on to a waiting list, but it already has 2,000 people on it.

In the midst of this crisis, many are receiving letters to say that their NHS dentist is going private, and they are therefore left without. One constituent said that they had spent their burial savings on tooth treatment, and another extracted his own tooth. This is a time of real crisis.

Some of my constituents have found a dentist 40 miles or more away, and some say it is cheaper to travel abroad. Many have no dentist at all. The cost of living crisis is bearing down on York because of housing costs, meaning that people simply cannot afford to go private. And nor do they want to. The principle of the NHS is so important to them, so they seek solace at A&E or with their GP in order to address the pain that they are experiencing, at a time when, as we all know, oral health inequality is growing sharply.

A third of people now see a dentist privately, but 71% of them say that it is not by their choice. Accessing NHS healthcare is really important for them. People just cannot afford it any more. There is also a two-year waiting list for an appointment at the only orthodontic practice for children in York.

We need to address the real challenges. First, we need a workforce plan. Things are getting much worse. Last month a BDA survey showed that over 40% of dentists plan to change career or seek early retirement in the next year, so this is urgent. We need dentists, hygienists, technicians, nurses and receptionists. A practice in my constituency has already lost three receptionists because of the abuse they get from very frustrated members of the public. And, of course, they are only on the minimum wage. We need to fill those vacancies. One practice in York has only one and a half full-time-equivalent dentists, rather than the required six, to see 10,000 patients. This is detached from reality.

We also need to make sure that the failed dental contract goes. Since covid, things have got much worse. The need will not be addressed simply by setting compliance at 85% or, as might happen in the coming days, at 100%. Putting more pressure on dentists will make them more stressed and more sick, while also heaping more stress on their colleagues as they take up the slack. Things will just spiral downwards. That approach will not work. It provides the wrong incentives and no solutions.

In York, we have been working through opportunities and plans, because at this point it is really important to look to the future. First, we need to create a national dental service; the system is so broken that we need to build it from scratch. The service must be free at the point of need and should never be dependent on people’s ability to pay.

Secondly, the school service must be reinstated. The Government are struggling to institute the supervised toothbrushing programme that they promised in the general election. Let us get that in place, because prevention is better than cure. And while we are at it, let us make sure that older people also access those services, because poor dental health leads to malnutrition and is actually one of the leading causes of premature death in older people.

We also need to look at the new structures emerging in our health system. I appreciate that this is still going through Parliament, but the integrated care system footprint should have responsibility for those services and we need to take advantage of the opportunities. The York Health and Care Alliance will cover the footprint of our city and integrate mental health, physical health and social care—and I would add dental care to that list. Supporting the alliance will enable us to deliver an integrated healthcare service. That is, of course, important, because our mouths are not divorced from the rest of our bodies. In York we are looking at how to pull all the services together, as we have done with diagnostic and treatment hubs and vaccines. There is a community of expertise that knows about integration, and we need to make sure that it pulls things together for dental services, too.

Finally, our city has called for a new dental school. Our city’s medical school is a unique model. We believe that we should not just look around the world but grow our own talent in order to provide dental services. That is why York—along with Hull, given the shape of our medical school—should have a dental school.

Our dental service has decayed. Oral health is regressing, and now we need a national dental service.

Elective Treatment

Rachael Maskell Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

My right hon. Friend is absolutely right about the importance of making sure that every penny spent in the NHS, or social care for that matter, is spent wisely and in the very best interests of taxpayers. I absolutely agree with him on that, and that also has to translate into the ambition. My right hon. Friend, like other hon. Members, will not have had time yet to look at the plan. I am happy to discuss it with him afterwards if he wishes. I hope he agrees that it is full of ambition. Indeed, if the NHS can go much further than the targets I set out earlier, that is what we all want. As I said in my statement, it does depend on how many people come back to the NHS, and that is very hard to estimate, but I want as many people as possible to come back.

My right hon. Friend is right to raise the importance of social care and the need for much better integration between healthcare and social care. We will set out more detailed plans on just that very shortly.

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

As a clinician, I am astounded by what the Secretary of State has brought forward today. First, he talks about health inequality, then puts forward a solution that will exclude people who experience the greatest health inequality because they also experience digital inequality. Not only that, but people on waiting lists are in a lot of pain. They are put on waiting lists because of the advancement of their condition. They do not need a website; they need clinicians surrounding them to give them the physical and psychological support they need over the two or more years they will have to wait. What plans has the Secretary of State got to ensure that they get the physical and psychological support that they need over that time?

[Sajid Javid]

The hon. Lady is of course right to talk about the importance of health inequalities. I hope that when she has had time to look at the plan she will see just how seriously the NHS and the Government take that. More broadly, I will have a lot more to say about tackling health inequalities shortly. Of course, the hon. Lady is right that there need to be alternatives to digital access for those who cannot easily access digital, be it through a web platform or the NHS app. There are alternatives in place, but I hope she agrees that for those who can use digital tools, we should make them part of the offering. The new “my planned care” service will be hugely important in providing more transparency than ever before, but also in helping people prepare for their surgical procedures. She may have heard me say earlier than one third of on-the-day cancellations of surgical procedures happen because people were not prepared.

Elective Care Recovery in England

Rachael Maskell Excerpts

Monday 7th February 2022 Commons Chamber

[Edward Argar]

I can give my hon. Friend that reassurance. The clinical decision making will rightly inform the approach we adopt to the diagnosis and treatment of cancers, as my hon. Friend would expect, but he is absolutely right that we cannot neglect blood cancer in that context, and nor will we.

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

The elective recovery fund had perverse thresholds written into it, so those hospitals that really struggled and battled with the pandemic were the very ones that did not get any money. Will the Minister ensure a fair distribution of funding in his plan, so that hospitals such as my local one in York that are still battling with very high levels of covid get the resources they need?

[Edward Argar]

I am happy to reassure the hon. Lady that our approach, and that of NHS England and Improvement, is designed to ensure that all hospital trusts can make progress—hopefully rapid progress—in tackling their waiting lists and get the resources they need to do that.

Vaccination: Condition of Deployment

Rachael Maskell Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

I am happy to clarify the point raised by my right hon. Friend. The Government have made a decision on this matter, which I hope I was very clear about in my statement, but for statutory reasons there needs to be a consultation. There will be a two-week consultation and then a statutory instrument will be presented to the House and will be subject to the will of the House.

The Government have made their decision on this, and the Department will write today to all NHS trusts and contact care home providers and wider social care settings, such as domiciliary care, to make it clear that the deadline my right hon. Friend referred to is no longer applicable. I am very happy to make that clear. She has raised an important point. While the decision is subject to this House, there will be no further enforcement of the regulations, for the reasons I have set out today.

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

The Health Secretary has not only bullied and threatened NHS staff at a time when they are so fragile, but ignored the royal colleges and all the trade unions when they said that the initial statutory instruments should not have been made. In fact, he has not made it clear today that both will be withdrawn, so I ask him to make that clear. I also ask him to say whether or not all those staff who have lost their employment to date will be reinstated with continuity of employment, including their pensions and other conditions?

[Sajid Javid]

I am happy to answer those questions. First, the Government’s decision is to revoke both statutory instruments; I am happy to confirm that. On those who, following the statutory instrument on care home settings, chose not to get vaccinated and preferred to leave their job than do the professional thing and get vaccinated, that was their choice, and that does not change. That policy was right at the time—I have set out the reasons why—because the dominant variant was delta. Should those people choose to apply for a job in a care home once the restrictions have been lifted, that is a decision for them. However, I continue to encourage them to make the right positive decision and get vaccinated.

Skin Conditions and Mental Health

Rachael Maskell Excerpts

Tuesday 25th January 2022 Westminster Hall

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

Thank you for calling me in this debate, Mr Gray. I also thank the right hon. Member for Gainsborough (Sir Edward Leigh) for bringing this issue to the Floor of the House.

I want to raise the case of one of my constituents who experienced topical steroid withdrawal and the side effects of that as a result of the treatment she received for her eczema. I very much concur with the conclusions of the right hon. Member for Gainsborough on the steps that now need to be taken, not least in instituting mental health support in the care pathway.

Having been prescribed topical corticosteroid medicines over a long time, my constituent experienced a very severe reaction upon withdrawal that caused far worse symptoms than those her eczema preparations were intended to treat. The nerve pain was unbearable and inescapable; the skin split and bled; it was sore and painful. The oedema impacted on her care and was debilitating in itself. Those symptoms, exacerbated by the insomnia she experienced and by not going out—being housebound—therefore had a massive toll on her mental health.

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines have reviewed the impact of withdrawal and the over-prescribing of those preparations, which they often are because people need to treat their skin condition continually. As a result of an investigation under the yellow card system, they identified how poorly managed the condition is and how little known.

It comes back to the need for education around dermatology. At each GP practice, there should be a doctor who not only specialises in dermatology but has a good understanding of topical steroid withdrawal, who can therefore manage the pathway of patients. Patients should regularly see their GP for a review of the application of their medicine. It is even harder to trace what happens because there is no coding for this condition. We need to see coding to help to trace exactly what is happening. However, without proper research and investment in research into dermatological conditions, alternative preparations for the treatment of skin conditions are not being advanced at the pace that they should.

The debilitating process that my constituent suffered over not just days and weeks but months and years had a massive impact on her mental health. Depression is one of the side effects listed for these preparations. However, there is no point listing such conditions in the small print; we need to ensure that those side effects do not happen in the first place. We therefore need to ensure a proper review process within the education given to patients and the availability of other services.

That is why I support IAPT—improving access to psychological therapies—services being made available to people undergoing this treatment so that they can get the support they need. It is also worth noting that 81% of the people who experience topical steroid withdrawal are women; I notice that imbalance across healthcare and I will raise it every time. We continually fail on women’s health, and that needs to be looked at specifically.

Finally, I would like to say that there is good support from charitable organisations. Globally, the International Topical Steroid Awareness Network is looking at this issue, as well as Scratch That—I know it is quite a name for a charity—which does fantastic work supporting people and building a network, particularly to help people with their mental health issues. It suggests that it can advance support by building a community, but also by giving people hope. People with a debilitating illness often particularly need hope. I trust that a proper pathway for people with TSW—but, more importantly, prevention—will be developed.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

Although evidence shows that the omicron variant causes less severe disease than previous variants, yesterday in England we still had over 16,000 covid patients in hospital and over 84,000 reported cases. Plan B measures are currently in place in England, and will be reviewed before the regulations expire on 26 January. The best thing everyone can do to help to keep the virus under control is to keep coming forward for booster jabs to help to stop the spread of infection and manage the immediate pressures on the NHS.

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

I am seriously concerned about the rapidly depleting efficacy of the vaccine—at 10 weeks, between 40% and 50% protection—and therefore my question to the Minister is: what happens next? Already we are talking about a mandatory programme of vaccine for NHS staff which will see depletion after 10 weeks, but also public health measures may be removed: what next after the booster?

[Maggie Throup]

I would like to reassure the hon. Lady that the Joint Committee on Vaccination and Immunisation is monitoring this all the time, and we take advice from the JCVI.