Physician Associates

Debate between Rachael Maskell and Andrew Stephenson

Wednesday 7th February 2024 Commons Chamber

[Andrew Stephenson]

My hon. Friend makes a valid point, and that is one reason why regulation is so important. The GMC has assured me that although draft regulations are out there, it will be consulting further on them later this year, so my hon. Friend, the BMA and various others can make strong representations about how the training framework should be provided. With that introductory regulation, the GMC will be responsible for setting, owning and maintaining a shared outcomes framework for physician associates, which will set a combination of professional and clinical outcomes. The outcomes framework will help to establish and maintain consistency, embed flexibility, and establish principles and expectations to support career development and lifelong learning. While at the moment there is significant variability in the system, I hope that the regulations we passed in this House on 17 January will help to provide that clarity and give the GMC the powers it needs to ensure that the training provided to physician associates is of the appropriate quality for the roles we are expecting them to undertake in our NHS.

Physician associates can work autonomously with appropriate support, but always under the supervision of a fully trained and experienced doctor. As with any regulated profession, an individual’s scope of practice is determined by their experience and training, and will normally expand as they spend longer in the role. That must be coupled with appropriate local governance arrangements to ensure that healthcare professionals only carry out tasks that they have received the necessary training to perform. Statutory regulation is an important part of ensuring patient safety, but that is also achieved through robust clinical governance processes within healthcare organisations, which are required to have systems of oversight and supervision for their staff.

NHS England is working with the relevant professional colleges and regulators, to ensure that the use of associate roles is expanded safely and effectively. That includes working with the GMC, royal colleges and other stakeholders to develop appropriate curriculums, core capabilities and career frameworks, standards for continual professional development, assessment and appraisal, and supervision guidance for anaesthetist and physician associates. NHS England will also work with colleges, doctors’ representative organisations, AAs and PAs to identify areas of concern. Specifically, the NHS has committed to working with the Academy of Medical Royal Colleges and individual professional bodies to develop and implement recommendations as a result.

Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing it to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation and, by making it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors, help to embed such roles in the workforce. Indeed, regulation addresses many of the concerns that we have heard in the debate last month and today. The GMC will set standards of practice, education and training and operate the fitness to practice procedures, ensuring that PAs meet the right standards and can be held to account if serious concerns are raised. GMC guidance sets out the principles and standards expected of all its registrants, and that will apply to PAs once regulation commences. Those standards will give assurance that PA students have demonstrated the core knowledge, skills and professional and ethical behaviours necessary to work safely and competently in their areas of practice and in a care context as newly qualified practitioners.

[Rachael Maskell]

On that point, can the Minister clarify where the liability will sit if error does occur? Will it sit with the clinician or the consultant who is supervising them? I am not clear on that particular issue.

[Andrew Stephenson]

In many ways, it will be the same as with many medical professionals. Once we have the situation clarified in regulation, it will not be any different from the personal liability of a doctor or others working in an organisation. Those are the kind of things that the GMC will be consulting on and discussing with stakeholders in the coming months, and is important that all these points are clarified. The hon. Lady was in the debate we had in January, where the tragic case of Emily Chesterton was raised. In that case, unfortunately we saw a PA move from one practice to work in another, and we need to ensure that there is a proper, robust fitness-to-practice regime so that any medical professional can be held to account in such cases for what has happened and, if necessary, struck off the register and no longer able to practice.

World Stroke Day

Debate between Rachael Maskell and Andrew Stephenson

Thursday 23rd November 2023 Westminster Hall

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

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

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

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

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

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

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

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

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

Sorry; it is my shoulder.

[Rachael Maskell]

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

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

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

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

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

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

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

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

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

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

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

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

Oral Answers to Questions

Debate between Rachael Maskell and Andrew Stephenson

Thursday 30th June 2022 Commons Chamber

[Andrew Stephenson]

We will never compromise on the safety of our railways and the UK railway network will remain one of the safest in Europe. It is important to emphasise, however, that ARS is not a safety system and would never be able to override one. Interlocking is a key safety part of the signalling system and would never permit ARS to set a train into a collision. The Department has invested in early design and testing work to enhance traffic management systems, and we will continue to invest record amounts to ensure that our railways remain some of the safest in Europe.

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

13. What steps he is taking to encourage a shift from the use of cars to active travel.

Transport

Debate between Rachael Maskell and Andrew Stephenson

Thursday 19th May 2022 Commons Chamber

[Andrew Stephenson]

The Government continue to work on that issue with the local authority. Obviously, we have committed funding towards supporting the repairs of the bridge, and I am pleased that the work is under way. I would suggest that the timescale for those works is a matter for the local authority, and I cannot answer that today, but the Government continue to support swiftly bringing that bridge back into use. We have been critical of some of the delays in getting the work under way, but I am pleased to say that it is now happening.

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

York’s rail supercluster is taking rail into the future. I would like to know whether the transport Bill will see investment in research and development to ensure that we can really build on the success of what has been created in York and go further, faster.

[Andrew Stephenson]

I am pleased to say that it will. We are keen to support innovation in our railways across the UK—not just in York I should say, before I get criticised. We have great clusters of small and medium-sized enterprises working in the rail sector to drive forward innovation. I thank the hon. Lady for not making a pitch for York to be the headquarters of GBR; I thought that her question was inevitably going there. I am sure that will follow later in the debate.

I want to leave plenty of time for the debate, so I will close by urging hon. Members to recognise that, far from holding back, the Government are fully backing our transport industry to help us build back better, decarbonise our economy, level up this country and give everyone, wherever they live, the tools to realise their talent.

Oral Answers to Questions

Debate between Rachael Maskell and Andrew Stephenson

Thursday 16th December 2021 Commons Chamber

[Andrew Stephenson]

I congratulate my hon. Friend on standing up for his constituents. One of the benefits of the integrated rail plan, of course, is that it will benefit many smaller places across the midlands and north, rather than just the big cities. On the issue of safeguarding, though, I must ask him for patience. We have committed £100 million to working on the best way to get HS2 trains to Leeds, and we must wait for the outcome of that work before lifting any safeguarding.

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

York has not had a local plan for 67 years and has not had an upgrade of its local transport plan for over 10 years. I hear that the Liberal Democrat-Green council is now kicking proposals into the long grass. York Civic Trust is now grasping the nettle, but wants to know when the new instructions on local plans will be coming out, and what focus there will be on decarbonisation.

Rail Investment and Integrated Rail Plan

Debate between Rachael Maskell and Andrew Stephenson

Wednesday 8th December 2021 Commons Chamber

[Andrew Stephenson]

My hon. Friend tempts me. As he knows, HS2 has already awarded work to 2,200 businesses across the United Kingdom, 97% of which are British-registered firms. There are many people already supplying British steel but I am keen for us to do even more and support even more businesses in Redcar.

My hon. Friends the Members for Harrogate and Knaresborough (Andrew Jones) and for Blackpool North and Cleveleys (Paul Maynard), both distinguished former rail Ministers, welcomed the plans and set out how they build on the £29 billion already invested in transport across the north since 2010. My hon. Friend the Member for Harrogate and Knaresborough reminded us of the £360 million to introduce contactless tap in, tap out ticketing to hundreds more stations outside London and the south-east, which will bring huge benefits to travellers across the north.

The right hon. Member for Knowsley (Sir George Howarth) talked about the impact on Liverpool city region and asked if I would meet the Mayor, Steve Rotheram. I am happy to commit to continuing to work with the Mayor and local stakeholders, but I remind the right hon. Gentleman that under these plans, the journey time from Manchester to Liverpool will fall from 50 minutes to 35 minutes and we will see the number of trains doubled.

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

The Minister will know that York is a formidable rail city, bursting with expert planners and engineers. They were astounded by the rail plan, not least because it is about economic development in Yorkshire and the north-east, as well as the rest of the north. Will he therefore go back and rethink that plan so that the north-east and Yorkshire can see the benefits that elsewhere in the country gets? Ultimately, the expertise needs to be put back on the rail lines, which our city can offer.

[Andrew Stephenson]

I thank the hon. Lady for her point. We have met in her constituency to discuss various proposals, and she knows that the east coast main line upgrade will benefit York. The core Northern Powerhouse network being built from York all the way to Liverpool will benefit her constituents, so I believe that this plan has significant benefits for her constituents.

My hon. Friend the Member for Dewsbury (Mark Eastwood) highlighted the significant benefits to Dewsbury, Mirfield and Huddersfield, which are well beyond anything proposed under the previous plans, including electrification and major station improvements. I look forward to visiting his constituency soon.

Transport for the North

Debate between Rachael Maskell and Andrew Stephenson

Wednesday 24th November 2021 Commons Chamber

[Andrew Stephenson]

My hon. Friend is completely right in what he says about the Leader of the Opposition, who has opposed HS2 consistently over the years and said that its impact on the country would be “devastating”; even in 2019, he was still calling for the project to be cancelled. I am happy to confirm that, as part of the trans-Pennine route upgrade, every single station in my hon. Friend’s constituency will see massive investment, including to make them all fully accessible to disabled passengers.

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

The reason why Transport for the North has rail and political leadership on it is to join up the local economies of the north with the transport system. That is what the Northern Powerhouse Rail project was all about. Cutting the project means that we are going to lose connectivity and capacity and see major disruption on the route. The board of Transport for the North met this morning to try to find a way forward with the integrated rail plan and its proposals. Will the Minister ensure that he meets the board and finds a way forward?

[Andrew Stephenson]

I spoke to Martin Tugwell, the chief executive of Transport for the North, the day before the integrated rail plan came out. I continue to have regular conversations with Transport for the North, and we are determined to work closely with it as its role moves from co-client of the Northern Powerhouse Rail project to co-sponsor.

Oral Answers to Questions

Debate between Rachael Maskell and Andrew Stephenson

Thursday 24th June 2021 Commons Chamber

[Andrew Stephenson]

Of course, the hon. Gentleman tempts me to prejudge the integrated rail plan, which I will not do, because no decisions have been taken yet. However, I am happy to confirm that we are getting on with investing in Transport for the North; we are not waiting for the integrated rail plan to be delivered. On top of the billions of pounds that we have already invested in transport across the north, just on 26 May we announced two new stations outside Leeds—White Rose and Thorpe Park—and we announced an additional £317 million for the TransPennine route upgrade. Of course, over 60% of the region is now covered with metro Mayors, with historic devolution settlements. We are getting on with investing in the north of England.

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

What steps he is taking to ensure that all active travel pilots are fully accessible to disabled people.